If a 30-year-old woman experiences painful burning when she urinates, it’s almost certain she has a urinary tract infection. But an elderly urinary tract infection rarely causes such clear symptoms and might not involve pain or discomfort at all. “As you get older your immune response changes; it’s part of normal aging,” says Anna Treinkman, a nurse practitioner at the Rush Alzheimer’s Disease Center in Chicago and president of the National Conference of Gerontological Nurse Practitioners. In fact, a sudden change in behavior is one of the best indicators of a urinary tract infection in older adults. Some common warning signs might include the onset of elderly urinary incontinence, confusion, or not being able to do tasks the patient could easily do a day or two before. “Anytime there’s a change in an older adult… if one day they’re able to dress themselves or feed themselves and then there’s a sudden change, a red flag should go up in a caregiver’s mind,” Treinkman says.
Half of all women will develop a urinary tract infection (UTI) in their lifetimes. Ranking as the body’s second-most common infection type, UTIs in women—and less often in men—account for about 8.3 million doctor visits each year, according to the National Center for Health Statistics. Typically, UTIs, also known as bladder infections, are easy to cure. But if left untreated, the infection can spread and develop into far more serious conditions. UTIs, for instance, are a leading cause of sepsis, a potentially life-threatening infection of the bloodstream.
“A bladder infection places stress on the body,” says Dr. Mary Ann Forciea, an associate clinical professor for the University of Pennsylvania Health System. That stress can result in confusion and abrupt changes in behavior in older adults with an elderly urinary tract infection. And for people suffering from Parkinson’s disease, Alzheimer’s disease, or other dementia, “any kind of stress, physical or emotional, will often make dementia temporarily worse,” Forciea says.
Causes and Symptoms
The kidneys, ureters, bladder, and urethra work together to rid the body of urine: the kidneys remove extra liquid and waste from the blood in the form of urine, the ureters carry the urine from the kidneys to the bladder, and the bladder stores the urine until it is emptied through the urethra.
An infection can occur when bacteria cling to the opening of the urethra and begin to multiply. UTIs are thought to be much more common in women because the urethra is shorter in women than in men, giving bacteria—which live in the rectal area and also on a person’s skin—an easier route into the body.
The most common diagnosis is cystitis, the infection and inflammation of the bladder, which causes frequent and painful urination. However, other parts of the lower and upper urinary tract system can become infected. As a general rule of thumb: the higher up the infection in the urinary tract system, the worse it is.
Burning urination is often the result of urethritis, the infection of the urethra. In men, urethritis can also cause penile discharge. Pyelonephritis occurs when a bladder infection spreads to the kidneys. It can cause upper back and flank pain, shaking, chills, nausea and vomiting. UTIs in men can lead to prostatitis, or enlargement of the prostate gland, the male organ that produces semen, which is located just below the bladder.
Forciea says it’s helpful to think of the prostate as shaped like a doughnut. Urine comes out of the prostate’s center. As the prostate swells, the opening for urine shrinks, making it more difficult to urinate. Some swelling of the bladder wall can block the exit path of urine, resulting in a bladder outlet obstruction. A key indicator that the outlet is beginning to close, Forciea says, is if the patient starts to urinate more frequently. If his usual tendency is to void every two hours and now he’s urinating every thirty minutes, that’s a sign that the outlet is beginning to close and only small amounts of urine are passing through.
Other symptoms of a UTI include: general discomfort, a feeling of being over-tired, blood in the urine, and pain even when not urinating. Men might feel fullness in the rectum. Back and side pain can indicate the infection has reached the kidneys. An elderly person will rarely get a fever, but if an older patient has one it is considered an emergency. “It shouldn’t be taken lightly,” Treinkman says. “If they do have a fever, it’s a serious infection.”