Elderly Patients and Urinary Tract Infections

“It seems that Mom has a urinary tract infection…Can we get some antibiotics?”

Sound familiar? It does to an emergency physician who frequently treats older patients. Urinary tract infections, or UTIs, are regularly diagnosed in older adults. Here is what you should know about urinary tract infection (UTI) diagnosis and treatment.         

What is a UTI and what are the symptoms of a UTI?

You may not like to hear this, but, you are covered with bacteria. It’s natural and there is nothing you can do about it. There is such a thing as “good bacteria,” it thrives in places like your digestive tract and your bladder. A balance between our bodies and bacteria exists. When the balance is in order, you feel fine. When the balance is upset, you may develop an infection. 

Urinary tract infections or UTIs are regularly diagnosed bacterial infections in older adults. Symptoms of UTIs, including urinary frequency, pain with urination, lower abdominal pain, fevers or chills as well as blood in the urine, are known to doctors, patients and caregivers alike. Some less common, or “non-specific” symptoms, are frequently experienced by older adults grappling with multiple medical problems.

What can cause unexplained or “non-specific” symptoms in older adults?

Non-specific symptoms including confusion, agitation, change in behavior, dizziness and sometimes falls can be caused by many different issues. In older adults especially, medication reactions, dehydration, unrecognized or undertreated pain, are responsible for non-specific symptoms.

In older adults with memory problems such as Alzheimer ’s disease, a new environment or caregiver, a change in routine or simply the underlying memory problem can be responsible for non-specific symptoms.

What will my doctor tell me?

It is helpful to view a diagnosis as a collaborative process. You help provide a physician with information, they apply training and expertise to recommend the most effective treatment. Treating a UTI should require antibiotics. But, it’s important not to assume that non-specific symptoms are a UTI. And, it’s worth reiterating that taking antibiotics for non-specific symptoms is a bad idea.

Is there a downside to taking antibiotics?

Any medication has possible side effects. There are side effects associated with antibiotics including allergic reactions, reactions with other medications a patient may be taking, nausea, vomiting, diarrhea, heart or joint problems and even development of other infections.

Also, the more you take an antibiotic, the less likely it will work in the future.  This is called developing “drug-resistance.” Older adults living in nursing homes are particularly susceptible to “drug-resistant” infections. This is, in part, due to the over use of antibiotics for “non-specific” symptoms and the likely over diagnosis of UTI among elderly patients.

Finally, there are times when connecting the dots between non-specific symptoms and the ultimate diagnosis require more information. Prescribing antibiotics too quickly can sometimes lead to a delay in making the ultimate diagnosis.

What should I ask the doctor?

Simply asking, “Could Mom’s medication be causing her symptoms rather than an infection?” is one way to make sure your doctor has considered other, often, overlooked causes of non-specific symptoms.

Furthermore, understand the risks associated with antibiotics by asking, “Are their side effects or medication reaction concerns with the antibiotic you are prescribing?”

Being inquisitive and proactive can ensure you or your loved one receives the most appropriate care before an emergency occurs.

And, if you do have to go to the emergency department, you can be assured that a trained and qualified emergency physician will be available to treat you anytime.

Phillip Magidson, MD, MPH, an emergency physician and geriatrician with Johns Hopkins University in Baltimore.

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