UTI in Elderly: A Clinical Evaluation

Introduction

The function of the urinary system is to excrete urine, which, in turn, helps excrete toxic substances from the body. However, common infections like urinary tract infections are responsible for urinary complications. Urinary tract infection commonly affects women. Women of all ages suffer from this type of infection. However, the prevalence of such infections is higher in elderly women and men.

What Is UTI?

Urinary tract infections, or UTI, is a collective term that encompasses infection in different parts of the urinary system. UTI may affect any part of the urinary tract, such as the kidney, ureters, bladder, and urethra. Based on the site involved, the urinary tract infection can either be an upper urinary tract infection or a lower urinary tract infection. In most cases, the lower urinary tract involves the urinary bladder and its associated structures.

Persons suffering from an anatomical and structural urinary tract abnormality are susceptible to such infections. These types of urinary tract infections are known as complicated urinary tract infections. However, such infections are usually uncommon. The most prevalent cases of urinary tract infections are seen in persons without any anatomical complications. These cases are known as uncomplicated urinary tract infections. It is caused by bacteria like Escherichia coli, Proteus, Klebsiella, Pseudomonas, Serratia, and Enterococci. These microorganisms usually ascend the urethra into the bladder and invade the bladder mucosal wall. Bacteria responsible for UTIs typically possess adhesins on their surface, enabling them to adhere to the urothelial mucosal surface. Pathogenic bacteria have evolved strategies to withstand hyperosmolality, with some being able to convert urea into alkaline ammonia to raise urinary pH. Moreover, the shorter female urethra facilitates the invasion of pathogens into the bladder and lower urinary tract. This causes inflammation of the urinary bladder.

What Is UTI in the Elderly?

The urinary tract infection is a common type of infection seen in elderly people. Such infection is more prevalent in older women than in older men. Almost ten women above the age of 65 suffer from such infections. However, with increasing age, the incidence of such infection rises. Almost 30 percent of women above the age of 85 suffer from urinary tract infections. The risk factors for elderly urinary tract infections are;

1. Change in the women's vaginal environment is one of the main causes of urinary tract infections in elderly women. Change in the normal vulva is one of the distinctive features of menopause. A reduced level of estrogen is associated with this. The normal level of estrogen maintains the balance of microorganisms in the vaginal tissues. Alteration in the level of estrogen associated with this condition is characterized by a decrease in lactobacilli count in the vagina. As a result, the vaginal pH balance of tissue becomes acidic and becomes susceptible to infections. Also, vaginal atrophy due to age is associated with increased incidence of infection.

2. In older males, hyperplasia of the prostate gland is responsible for bladder obstruction. These obstructions lead to urinary retention and cause infections. Several factors like obesity, hypertension, and obstructive sleep apnea lead to glandular and stromal hyperplasia of the prostate gland. Apart from this, a decreasing amount of testosterone and an increasing amount of dihydrotestosterone (DHT) and androgen receptors associated with increasing age are associated with benign prostatic hyperplasia.

3. Another important factor associated with the increased incidence of urinary tract infections in elderly people is the use of catheters. Seventy-five percent of hospitalized elderly acquired urinary tract infections due to the use of the catheter. Urinary catheters play a crucial role in draining urine from the bladder, but they also create a pathway for bacteria to travel from the rectum and periurethral area to the bladder, potentially causing infections. By bypassing the urethral sphincters and reducing the natural turbulence of voiding, catheters can increase the risk of UTIs. Also, they can irritate the uroepithelium, making it more vulnerable to bacterial adhesion. The immune response to catheterization can lead to fibrinogen accumulation on the catheter, creating an ideal environment for pathogens to grow.

4. Sexual intercourse is another main factor associated with urinary tract infections. Unprotected sex and transmission of infection during intercourse may lead to UTI.

5. Urinary incontinence or sudden accidental leakage of the urinary may lead to urinary tract infection. Elderly women often suffer from pelvic floor weakness, which is the root cause of this type of urinary incontinence.

The physical condition of elderly people plays a pivotal role in urinary tract infections. Systemic disorders like diabetes, high levels of uric acid in the blood, and kidney disorders increase the chances of such infections.

What Are the Complications of Elderly UTI?

The complications caused by UTI in the elderly are;

1. Pain and burning sensation during urination.

2. Fever due to bacterial infection.

3. Increased frequency of urination.

4. Inability to control the urge to urinate and inability to start urination.

5. Pain in the lower abdominal region. It is caused by the spasm of the bladder muscles.

6. Presence of blood in the urine.

7. Symptoms like lack of appetite, vomiting, nausea, delirium, and increased lethargy are common among elderly people.

Different diagnostic tests can be used to determine urinary tract infection. Urine sample collection and analysis of the urine is the most common test. The pH of the urine in patients suffering from UTI ranges from 8.5 to 9.0. This is due to the presence of urea-splitting organisms in the urine. A nitrate or dipstick test is another useful test to detect the presence of microorganisms in the urine. In the urine, the presence of blood, white blood cells, and pus cells can be identified.

What Are the Treatment Options?

• The non-pharmacological treatment option for preventing urinary tract infections is to maintain health and hygiene.

• An increased fluid intake and consumption of cranberry juice are also useful.

• Antibiotics like Fosfomycin, Pivmecillinam, or Nitrofurantoin are the first line of drugs in such cases.

• Along with this, drugs like combination therapy of Amoxicillin combined with an aminoglycoside or a second-generation cephalosporin combined with an aminoglycoside can be advised.

• In severe cases, intravenous administration of third-generation

• Cephalosporin is recommended.

• Estrogen vaginal cream is useful in preventing vaginal dryness and prevent urinary infections.

Conclusion

Urinary tract infection in elderly people is a common type of infection. Elderly women are mostly affected by this condition. However, elderly men are also affected by this. Different physical changes in the body and the presence of systemic disorders are responsible for such infections. Accurate diagnosis and administration of medication can cure UTI in the elderly.