UTIs: What Puts Your Senior Loved One At A Higher Risk?

Kathy Quan

A urinary tract infection (UTI) is caused when bacteria enters the urethra. This most often comes from the skin or from the rectum and is usually due to poor toileting hygiene habits. The bladder can become infected by this bacteria. 

A bladder infection is a lower urinary tract infection called cystitis. If the infection spreads up the ureters into the kidneys, this becomes a serious upper urinary tract infection known as pyelonephritis. Each of these needs diagnostics with a urine culture to determine the epidemiology (type of bacteria) and correct treatment with fluids and antibiotics as soon as possible to prevent complications.

The bladder and bowel contain multiple bacteria to promote healthy function, but introducing other bacteria can be dangerous. The most common bacteria causing a UTI is E. coli (Escherichia coli) which is found in the bowel. 

The female anatomy increases women’s susceptibility to UTIs because the urethra is short and is in close proximity to the rectum.

What is toileting hygiene?

Toileting hygiene is a habit that needs to be established at birth and taught during potty training. It must be practiced throughout a lifetime to help prevent UTIs and other infections. 

Toileting hygiene involves wiping away urine and feces after each urination or bowel movement. If there are remnants left, they can get on underwear and the bacteria can spread easily to the urethra. 

For females, wiping needs to be a front-to-back motion, and use fresh toilet paper with each wipe.

A spray bottle or bidet can be helpful after a bowel movement. Using wet wipes can also be handy, but these may not be flushable, or can easily clog pipes. Handwashing after each bathroom visit is also necessary to eliminate bacteria on the hands.

A (UTI) is a common occurrence in young children and older adults. Some are at a higher risk than others for developing chronic UTIs. This is again more often due to poor hygiene. Infrequent or incomplete bathing contributes to the growth of bacteria on the skin. Focusing on hygiene in the genital area is essential to preventing UTIs.

What Can Cause UTIs In Older Adults?

Factors that contribute to the growth of bacteria and increased risk of UTI are part of the aging process and include:

  • Poor hydration habits.

  • Holding urine for long periods of time.

  • Not completely emptying the bladder when voiding.

  • Conditions that restrict the flow of urine such as enlarged prostate, prolapsed uterus, kidney stones, tumors, restrictive clothing, and sexual intercourse.

  • Hormonal changes with the use of birth control, higher levels of estrogen in pregnant women can allow bacteria to spread more easily. Menopause and low estrogen can put older women at risk for UTIs.

  • Chronic diseases such as Diabetes can reduce the immune system’s ability to fight infection.

  • Spinal cord injury and other damage to the nervous system from Parkinson’s, MS, or injury can affect the ability to fully empty the bladder completely and regularly.

  • Bladder and bowel incontinence increase the risk for UTIs. 

  • Sitting in a soiled diaper or underwear, even for a short period of time, allows for the free flow of bacteria.

  • Use of a urinary catheter provides a direct pathway for bacteria to enter the urinary system.

  • Recurrent UTIs increase UTI risk.

  • Dementia, cognitive delays, or forgetfulness.

What Are The Signs & Symptoms of UTI?

Older adults with a UTI can present as asymptomatic at first. In fact, one of the first UTI symptoms can be sudden confusion, rapidly increasing confusion or other altered mental states with or without changes in behavior such as becoming combative.

Look for other signs and symptoms as listed by the National Institute of Diabetes and Digestive and Kidney Diseases such as frequent voiding, a feeling of having a full bladder, or exhibiting a frequent urge to void without any results

Other signs such as abdominal pressure, pain, or cramping, dysuria such as burning or pain during urination, bloody urine, or a foul odor to the urine can be more obvious. Shakiness, fatigue, muscle aches, and weakness are also common symptoms associated with UTI.

Worsening symptoms such as fever, chills, lower back, pain in the side of the back (flank area and nausea or vomiting can indicate a possible kidney infection.

Please notify your primary healthcare professional immediately for further instructions and treatment. Left untreated, a UTI can become a serious health issue and cause kidney damage, sepsis, or kidney failure.

What Are The Treatment Options for UTIs?

The urine culture determines which antibiotics the UTI is most susceptible to for treatment. A UTI needs to be treated as soon as possible and the entire course of antibiotics completed.

Hydration is imperative to help flush out the bacteria and restore normal bacteria balance to the kidneys and bladder.

Drinking cranberry juice can be soothing to the bladder and may help to change the pH of the urine to deter the growth of bacteria. Routine toileting and good toileting hygiene are also important. 

The physician may also recommend using an antimicrobial soap short term for handwashing and genital hygiene short term to help reduce new bacteria.

4 Final Tips To Prevent Your Senior Loved One From Getting a UTI While it may not be possible to completely prevent recurrent urinary tract infections in your loved one, prevention can help to reduce susceptibility and incidence of infections.

1. Hydration is essential  

The body is comprised of 50 to 70% water. Water is essential to normal function from cells to organs. There are multiple ways to flavor water to make it more palatable. Juices such as cranberry juice can be more desirable.

Fruits and vegetables also contain water. Using calibrated devices such as cups and pitchers can assist in measuring the intake which should equal about 15 cups/day for men and 11 cups/day for women unless otherwise restricted due to chronic illness.

2. Avoid holding onto urine for too long

Toileting every two hours while awake will help reduce incontinence and avoid holding urine too long. 

After toileting, remember to drink more fluids.

Empty the bladder first thing in the morning and the last thing before bed. In addition, ensure your loved one avoids douching and completely empties their blatters after any and all sexual activity.

3. Encourage a daily hygiene practice

Daily hygiene care should include a thorough cleansing of the genital area.

If there is a catheter present, bacteriuria risk is increased and thorough cleansing is indicated at least twice a day, morning and night, in addition to after any bowel movement.

Having your loved one maintain good urinary tract health as a part of their healthy lifestyle is essential to them living a long and healthy life.