UTI Complications in Older People - Causes, Symptoms, and Management

Introduction:

The urinary tract consists of kidneys, bladder, ureters, and urethra. Kidneys filter blood, and urine is produced as an output. Urine is collected in the bladder, which is then passed through ureters to the urethra. Urethra is a small hollow tube through which urine leaves the body. When disease-causing bacteria invade the urinary tract through the urethra, urinary tract infection (UTI) occurs. Pregnant women, men with enlarged prostates, older adults, children with poor hygiene, people involved in vigorous sexual intercourse, etc., are at higher risk for developing UTI. Burning sensations, frequent urination, fever, and blood in the urine are the common symptoms of UTI.

What Causes UTI in Older Adults?

Bacteria and fungi can be responsible for UTIs. The bacteria Escherichia coli or E.coli is the most common cause of UTI. Following are the risk factors and causes that result in UTI in older adults:

• History of previous urinary tract infections.

• Age-related changes in the immune system.

• Benign prostatic hyperplasia or enlargement of the prostate in males.

• Urinary retention.

• Increased post-void residual or the amount of urine remaining in the bladder after urinating.

• Conditions such as stroke, Parkinson’s disease, Alzheimer’s disease, etc., can lead to bowel or bladder irregularity that can predispose to UTI in older adults.

• Bladder stone or kidney stones.

• Older adults with urinary catheters.

• In postmenopausal women, the level of estrogen is significantly reduced. Estrogen is said to protect from bacteria, especially E.coli. Hence, the reduction of estrogen levels in postmenopausal women makes them highly prone to UTIs.

What Are the Symptoms of UTI?

The symptoms of UTI can be more severe in older adults than younger adults.

• Blood in urine.

• Cloudy and foul-smelling urine.

• Burning sensation and increased discomfort while urinating.

• Frequent urination.

• Nausea and vomiting.

• Fever and chills.

In addition to the above symptoms, older adults may experience the following symptoms:

• Constipation.

• Agitation.

• Lethargy.

• Decreased mobility.

• Decreased appetite and anorexia.

• Confusion and hallucinations.

• Restlessness.

How Is UTI Diagnosed in Older Adults?

The physician will take a detailed medical history. Urine analysis is conducted to detect the presence of diseases causing bacteria in urine and can confirm the bacteria that caused UTI. In addition, a urinary dipstick test for leukocyte esterase and nitrates will be conducted. These are predictive tests for UTIs. In males, tenderness or swelling of the prostate will be checked.

If older adults experience other symptoms like blood in urine, fever, chills, delirium, confusion, etc. then computed tomography (CT) or ultrasonography will be conducted to detect any other abnormalities.

How Is UTI Treated in Older Adults?

• The antibiotics amoxicillin and nitrofurantoin are the treatment of choice for UTI in older adults.

• Ciprofloxacin and levofloxacin are required in severe cases. The course of antibiotics as prescribed by the physician has to be completed to prevent antibiotic resistance.

• For patients who are suffering from delirium, agitation, confusion, etc. antipsychotic medications are prescribed.

• For healthy older adults, NSAIDs (Non-steroidal anti-inflammatory drugs) like ibuprofen and acetaminophen are given to relieve pain and burning sensation while urinating.

• Heating pads can be used to relieve back pain associated with UTI.

• In addition, physicians will ask patients to drink plenty of water and cranberry juice as it can subside symptoms.

What Are the Complications of UTI in Older Adults?

If UTI is left untreated in older people, it can lead to severe complications.

• Bacteremia: When viable bacteria exist in blood, it is known as bacteremia or blood poisoning. It is considered one of the most common complications of UTI. Low blood pressure, rapid heartbeat, abdominal pain, nausea, vomiting, diarrhea, fever, chills, etc. are the common symptoms of bacteremia. Bacteremia, if not treated, can end up in sepsis.

• Sepsis: It is an inflammatory response to infections that results in multiple organ failures and even death. Sepsis that occurs after urinary tract infections, pyelonephritis, cystitis, renal stones, and kidney infections are referred to as urosepsis. Shortness of breath, disorientation, extreme pain, sweaty skin, etc. are some of the early signs of sepsis. Almost one-fourth of the cases of sepsis arise from the urogenital tract.

• Papillary Necrosis: The death of cells of the renal medulla and papillae in the kidney is known as renal papillary necrosis. Diabetes, UTI, overuse of NSAIDs, pyelonephritis, vasculitis, etc. are the most common causes of papillary necrosis. If left untreated, papillary necrosis can result in kidney failure.

• Kidney Failure: If the bacteria or viruses reach the bladder and kidney, it may result in kidney infections, which in turn cause kidney failure.

How Are the Complications of UTI Treated in Older Adults?

• Bacteremia: Ampicillin and vancomycin are the most preferred antibiotics for bacteremia. IV (intravenous) fluids are also administered to relieve the symptoms.

• Sepsis: Early therapy can limit the mortality rate of sepsis. Initially, antibiotics are given to subside the infection. Piperacillin with a beta-lactamase inhibitor, cephalosporin, and fluoroquinolones are the commonly administered antibiotics for a sepsis patient.

• Papillary Necrosis: The treatment of papillary necrosis is done by treating the underlying cause. However, patients are asked to stop taking NSAIDs and other over-the-counter medications if they are using them.

• Kidney Failure: It can be reversible in acute cases. Diuretics are given to filter out excess wastes from the body. Dialysis is advised when kidneys can no longer filter blood and produce urine. Kidney transplantation is performed in the end stage of kidney failure.

How to Prevent UTIs in Older Adults?

UTI can be prevented to a certain extent by adopting the following methods:

• Drink plenty of water, at least eight ounces glasses of water daily.

• Drink cranberry juice, and eat blueberries and foods rich in probiotics and vitamin C.

• Avoid caffeinated products and alcohol as they can cause irritation to the bladder.

• Do not hold urine for a long time. Empty the bladder and use the bathroom whenever required.

• Urinate after sexual intercourse.

• Maintain good hygiene in the genital region as well as the whole body.

• Older women can use low-dose vaginal estrogen cream to prevent UTIs.

• Older women can consume phytoestrogen-rich foods like garlic, flax seeds, nuts, peaches, soybeans, etc.

• Older people who wear adult diapers should be changed frequently.

• Limit the use of catheters.

Conclusion

Urinary tract infections are very common in adults. If left untreated, it may end up in severe, life-threatening complications. Bacteremia, sepsis, papillary necrosis, and kidney failure are common complications of UTI in older people. Older males with an enlarged prostate are at higher risk for UTI. Older women can reduce the risk of contracting UTI by consuming estrogen-rich foods. Older men and women can prevent UTIs by drinking plenty of water and cranberry juice and consuming probiotics and foods rich in vitamin C. It is important to consult a physician when the warning signs of UTI appear to prevent further complications.