Urinary infections in older adults : Symptoms, Risks and Prevention.

One of the issues that concern relatives, caregivers, and healthcare providers of older adults the most is urinary tract infections, as they are very common and can be caused by various pathogens. The most common ones are:

1. Escherichia coli (E. coli): It is the most common cause of urinary tract infections.
2. Proteus mirabilis: Common in complicated urinary tract infections.
3. Klebsiella pneumoniae: Common in hospital-acquired urinary tract infections.
4. Enterococcus faecalis: Can be a cause in complicated infections.
5. Pseudomonas aeruginosa: Especially occurs in hospital-acquired infections and in patients with urinary catheters.

Urinary tract infections in older adults can present with both classic and atypical symptoms. The most frequent classic symptoms include:

1. Classic Symptoms:
   • Dysuria (pain or burning during urination).
   • Polyuria (increased urinary frequency).
   • Urinary urgency.
   • Cloudy or foul-smelling urine.
   • Hematuria (blood in the urine).
   • Pain or pressure in the lower abdomen or pelvis.
   • Fever or chills (less common in older adults).
2. Atypical Symptoms:
   • Changes in mental status or confusion, which can be the only signs in some cases.
   • Fatigue or general weakness.
   • Urinary incontinence or worsening of existing incontinence.
   • Loss of appetite.
   • Nausea or vomiting.
   • Pain in the lower back or side.

Because older adults may not exhibit the typical symptoms of a urinary tract infection, it is important to be vigilant for any changes in behavior or mental status, as well as less common physical symptoms.

Older adults with urinary incontinence use diapers to relieve this discomfort, and this can influence the incidence of urinary infections due to:

1. Increased moisture:
   • Diapers can retain moisture near the skin and urethra, creating a favorable environment for bacterial growth. Persistent moisture can facilitate bacterial colonization and eventually lead to a UTI.
2. Fecal contamination:
   • Diapers can contribute to fecal contamination of the genital area, especially in people with fecal incontinence. Gastrointestinal tract bacteria, such as Escherichia coli, are a common cause of urinary tract infections.
3. Skin irritation and damage:
   • Prolonged use of diapers can cause skin irritation and small abrasions, which can serve as entry points for bacteria, increasing the risk of infection.
4. Urinary retention:
   • Some older adults may avoid urinating frequently due to the discomfort of changing diapers, which can lead to urinary retention. Stagnant urine in the bladder can become a breeding ground for bacteria.

To mitigate these risks, it is important to take certain preventive measures:

• Frequent diaper changes:
  • Ensure diapers are changed regularly to keep the skin dry and reduce exposure to moisture.
• Proper hygiene:
  • Properly clean the genital and perineal area with suitable, gentle products to avoid bacterial buildup.
• Use of quality absorbent products:
  • Opt for diapers and pads that keep moisture away from the skin and provide an effective barrier against bacteria.
• Monitoring and medical attention:
  • Monitor for signs and symptoms such as strong-smelling urine, mental confusion, and seek medical attention promptly if an infection is suspected.

Tips to Prevent Urinary Tract Infections in Older Adults:

1. Proper hygiene: Maintaining proper genital hygiene is crucial to prevent bacterial colonization.
2. Hydration: Drinking enough water to maintain frequent urination helps expel bacteria from the bladder.
3. Regular bladder emptying: Avoid holding urine for prolonged periods.
4. Avoid irritants: Limit the use of irritating products such as scented soaps, bubble baths, and feminine hygiene products that can disrupt the natural balance of genital flora.
5. Frequent change of underwear: Use cotton underwear and change it daily.
6. Care with catheters: If urinary catheters are necessary, they should be handled with aseptic techniques and regularly checked.
7. Control underlying diseases: Properly manage conditions such as diabetes, which can increase the risk of infections.
8. Prostate care: In men, conditions such as prostate enlargement can increase the risk of urinary tract infections and should be monitored and treated appropriately.

Implementing these measures can significantly help reduce the risk of urinary tract infections in older adults and improve their quality of life.

I hope this post has been helpful to you. In my next post, I will discuss end-of-life expenses, as this is a topic we do not often talk about but need to prepare for.

References

Detweiler, K., Mayers, D., & Fletcher, S. G. (2015). Bacteruria and urinary tract infections in the elderly. Urologic Clinics, 42(4), 561-568.

Lim, V. H., Whitehurst, T., Usoro, E., & Ng, S. M. (2014). Management of urinary tract infections in elderly patients: Strategies for improvement. BMJ Open Quality, 3(1), u203314-w1503.

Nicolle, L. E. (2009). Urinary tract infections in the elderly. Clinics in geriatric medicine, 25(3), 423-436.