Urinary Tract Infections and People with Alzheimer's Disease or Dementia
- Publish Date: 2012/06/04 - (Rev. 2015/04/28)
- Author: Wendy Taormina-Weiss
- Contact : Disabled World
Outline: Urinary tract infections can cause confusion in older people and those who experience dementia or Alzheimers disease.
A urinary tract infection is something that can cause confusion in people who are older or who experience dementia or Alzheimer's disease.
A UTI is an infection in the urinary tract. Infections are caused by microbes - organisms too small to be seen without a microscope - including fungi, viruses, and bacteria. Bacteria are the most common cause of UTIs. Normally, bacteria that enter the urinary tract are rapidly removed by the body before they cause symptoms. However, sometimes bacteria overcome the body's natural defenses and cause infection. Bladder - an infection in the bladder is also called cystitis or a bladder infection. Kidneys - an infection of one or both kidneys is called pyelonephritis or a kidney infection. Ureters - the tubes that take urine from each kidney to the bladder are only rarely the site of infection. Urethra - an infection of the tube that empties urine from the bladder to the outside is called urethritis.
If a person with dementia or Alzheimer's suddenly and without reason displays a change in their behavior such as agitation, confusion, or withdrawal it might be caused by a urinary tract infection (UTI). The person might not have the ability to tell you how they are feeling so it is important that you be familiar with the symptoms of a UTI, as well as to get them the medical attention they need and appropriate treatment.
A UTI can speed up the progression of the dementia the person has. Every urinary tract infection needs to be identified as quickly as possible and treated. UTI's are commonly experienced by:
- People who require total nursing care
- People with compromised immune systems
- People who use continence aids or catheters
While some people who have a UTI do not experience any symptoms, most people do experience a certain amount of discomfort. Caregivers need to be aware of the signs and symptoms of a urinary tract infection (UTI) because their loved one or the person they are caring for may not be able to tell them about any discomfort they are experiencing. A UTI infection in Seniors or people who experience Alzheimer's or dementia has the potential to profoundly affect not only their health, but dramatically affect their behavior through increases in aggression or confusion. The signs and symptoms of a urinary tract infection include:
- Urine that smells offensive
- Urine that looks milky or cloudy
- Back pain; the person may rub or grab their back
- Changes in behavior such as distress or increased confusion
- Fever, which may indicate the infection has moved into the person's kidney
- Painful, burning urination; the person may cry or be distressed when they urinate
- If the person already has a kidney infection, they may experience nausea or vomiting
Causes of Urinary Tract Infections
Believe it or not, urine is normally sterile, meaning that it does not contain any bacteria. Women and men who are older commonly have a form of bacteria in their urine known as, 'bacteriuria,' and it is very common for older people who live in care homes, or who use a catheter, to have bacteria in their urine. The presence of this bacteria does not usually mean it needs to be treated unless the person begins experiencing symptoms of a UTI.
Women more commonly experience a UTI because their urethral opening is close to the vagina and anus, making it easier for bacteria to enter the urethral opening to their bladder. Improper hygiene and wiping, 'back to front,' instead of, 'front to back,' after going to the bathroom can enable bacteria from a woman's bowel and vagina to enter their urethra. Sexual intercourse can also cause a UTI in some women.
A, 'prolapse,' where a woman's uterus, bladder, or bowel descend from the usual position because of weakness in the supporting structure may cause issues with emptying their bladder and contribute to a UTI as well. In men, an enlarged prostate may contribute to a UTI. For both women and men, catheter use is a common cause of UTI. People who have weak immune systems, people with diabetes, or people who are being treated for cancer with chemotherapy are all more susceptible to urinary tract infections (UTI's).
Testing for a Urinary Tract Infection
A sample of the person's urine and a routine, 'dip test,' can be sent to a laboratory for testing; something that should preferably be done in the morning. Getting a sample of urine from a person who experiences dementia or Alzheimer's may be difficult, and a caregiver is the best person to help with getting the sample. If the person is incontinent and wears pads, a urine collection pack can be used to obtain a sample of the person's urine.
It is important to tell the person's doctor of any signs they are experiencing related to a UTI. The person's doctor will send a sample of their urine to test for the type of bacteria that may be present, and the lab will test to find out which antibiotic is best to use to destroy the bacteria. Infections that cause symptoms which are similar such as Mycoplasma or Chlamydia need to be sampled separately with a particular bacterial culture. Additional tests such as ultrasound, intravenous pyelogram (IVP), or cystoscopy might be needed in order to detect the cause of the person's urinary infection, especially if they are recurring and do not respond to the medication the doctor prescribes for them.
Types of UTI's and Treatment
Lower Urinary Tract Infection: A lower urinary tract infection involves only a person's urethra and/or their bladder and is also referred to as, 'cystitis.' A dip test can help to diagnose it. Women who experience a lower urinary tract infection might find this referred to as a, 'simple,' or, 'uncomplicated,' UTI. The symptoms of a lower urinary tract infection include:
- Mild fever
- Lower abdominal pain
- Acute confusion or delirium
- Feeling unable to urinate completely
- Cloudy, bloody, or foul-smelling urine
- Pain or burning when urinating (dysuria)
Treatment of a lower UTI commonly involves a three-day course of antibiotics, and maybe some over-the-counter pain medication to relieve discomfort. If the person's infection does not respond to treatment, another urine sample might be collected and sent to a laboratory to find out which bacteria are present.
In men, a lower UTI might need to be investigated by a urologist and include an ultrasound of their bladder and kidneys, a rectal exam to assess their prostate gland, cystoscopy of their lower urinary tract, or blood tests. In some instances the underlying cause might be due to prostate disease, or another urological condition like a bladder stone or a tumor.
Upper Urinary Tract Infection: An upper urinary tract infection occurs when a person's ureters and kidneys become infected in addition to their bladder and/or urethra and is a more serious condition than a lower UTI. An upper UTI can result in damage to a person's kidney's if it remains untreated. An upper UTI can be accompanied by bacteria in the person's blood, something that is referred to as, 'bacteraemia,' and has the potential to be life-threatening if it is not treated. The symptoms of an upper UTI can include the ones of a lower UTI as well as the following:
- Loin pain
- A high fever
- Shaking or chills
- Nausea or vomiting
- Tenderness on the side of the body between the ribs and hip
Treatment for an upper UTI usually involves a course of antibiotic medication. A urine test might be pursued to decide if a further course of antibiotics is needed. Men are commonly referred to a urologist if they are experiencing the symptoms of an upper urinary tract infection.
Recurrent Urinary Tract Infection: A person is described as experiencing, 'recurrent urinary tract infections,' if they have two or more UTI's in a three month period of time. Treatment of recurrent UTI's involves referral to a urologist, who may place a person on a low-dose, long-term antibiotic.
Catheter-related Urinary Tract Infections
Catheters that remain in a person's bladder referred to as, 'indwelling,' catheters are a major cause of urinary tract infections. Despite the most careful attention to personal hygiene, people with indwelling catheters will most likely develop bacteria in their urine at some point. Intermittent catheterization presents less of a risk of infection, although repeated catheterization is difficult for people with dementia or Alzheimer's many times and can be distressing.
Unfortunately, it might be necessary for a person to use a urinary catheter after a surgery for example. The catheter should be removed as soon as possible so they can regain their usual bladder function and minimize their risk of infection. The longer a person uses an indwelling catheter, the greater their risk of developing a UTI.
Delirium and Urinary Tract Infections
A urinary tract infection (UTI) can cause significant and often times distressing change in a person's behavior commonly referred to as, 'delirium,' or, 'acute confusional state.' Delirium involves a change in a person's mental state or consciousness and often develops of a period of a day or two. There are different types of delirium. The symptoms can include:
- Difficulty concentrating
- Agitation or restlessness
- Hallucinations or delusions
- Sleepiness or withdrawal from others
Family members, caregivers, and friends need to seek medical help for the person if they witness a sudden change in the person's behavior to make sure the person gets the help they need. If the person's delirium is caused by a UTI, treatment with antibiotics can help to ease the symptoms. In some instances, short-term treatment with an antipsychotic medication might be considered if other types of treatment are unsuccessful.
Ways to Help Prevent Urinary Tract Infections
It is recommended that every adult should drink between six and eight glasses of fluids each day. Where people with dementia or Alzheimer's are concerned, drinking fluids can be encouraged by finding out what the person likes to drink and then making the fluids available to them and visible. Use a brightly-colored glass or cup; it can help. It is important to monitor the amount of fluids the person drinks each day, especially if they are less mobile or at risk of dehydration. If the person is not drinking enough, or if they are having trouble with swallowing, think about asking for an assessment by a speech/language therapist.
No one, especially people with dementia or Alzheimer's, should hold urine in their bladder for too long. People with dementia or Alzheimer's should be prompted to use the toilet regularly. Make sure the location of the toilet is clear. Maybe put a sign on the door with a picture, it might help. Think about changing the color of the toilet seat itself to red or black.
Avoiding constipation can help to prevent a person's bladder from properly emptying, something that can in turn cause a UTI. Eating foods that are high in fiber, drinking plenty of fluids, and exercising can all help to prevent constipation. It is also important to pursue good hygiene, making sure the person's genitals are washed at least once a day with soap that does not have perfume. Do not use talcum powder. Women need to wipe, 'front to back,' after using the toilet; 'wet wipes,' can help to promote good hygiene. A health care professional can help people who use catheters to follow good infection prevention measures.
For family members, friends, and caregivers of people with dementia or Alzheimer's disease, a urinary tract infection (UTI) can cause a lot of havoc. The symptoms of a UTI are strong and might even mimic the end of the person's life. Caregivers of people with dementia or Alzheimer's disease are used to the slow progression of these disabilities, and a UTI can make everyone feel as if it is a life-threatening emergency.
Fortunately, UTI's do not cause permanent damage and respond successfully and quickly to treatment. Even though a UTI does not need immediate treatment, it is important for the comfort of the person with the infection and the family and caregivers. After the infection clears up the person returns to the condition they were in before experiencing the urinary tract infection.
Caring for Alzheimer's