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Confusion, Possible Agitation Sign of UTI

By Kathy Hubbard

Anyone who works in skilled nursing or assisted living facility will tell you that it’s not just anecdotal that the elderly displaying symptoms of dementia are often actually suffering a urinary tract infection (UTI). If you’ve seen it or experienced it yourself, you are nodding now.

Suddenly the senior seems confused, suffers memory loss, has trouble concentrating, or becomes lethargic. He or she may have hallucinations, become delusional, or extremely restless and agitated. Violent behavior or yelling in anger is not uncommon. In some cases, the person has varying levels of consciousness.

“Keep in mind that it can be difficult to notice UTI mental symptoms in seniors living with Alzheimer’s disease or other forms of dementia and individuals with existing mental health issues,” The Aging Care website explains.

They describe an eighty-one-year-old woman who suffered from chronic depression. When she displayed symptoms, her children assumed it was associated with her mental health condition. It wasn’t. It was a UTI.

If someone who is otherwise cognizant and alert displays one or more of these symptoms, it should raise a red flag for family and caregivers. Typically, dementia occurs gradually. But if you’re caring for someone frail, it’s sometimes hard to connect the dots. And, the puzzling part is that the medical community doesn’t know why it occurs.

They do know, however, what causes UTIs. “A UTI occurs when bacteria in the urethra, bladder, or kidneys multiplies in the urine. If left untreated, a UTI can lead to acute or chronic kidney infections, which could permanently damage these vital organs and even lead to kidney failure. UTIs are also a leading cause of sepsis, an extreme and potentially life-threatening bodily response to an infection,” Aging Care says.

Not all seniors will display mental symptoms. Most often on the list of signs of a UTI are the need to go to the bathroom frequently or urgently; pain or discomfort while urinating; pain in the lower abdominal area; fever or chills; and urine that’s cloudy, dark, or foul-smelling. Caregivers should notice if the patient is touching themselves frequently or if he or she is showing new or worsening signs of incontinence.

So, why are older people more vulnerable to urinary tract infections? The short answer is their overall susceptibility to infections due to a weakened immune system. The National Institutes of Health credits several issues. Diabetes heads the list, followed by urine retention (weakening of the bladder and pelvic floor muscles), urinary catheter use, bowel or urinary incontinence, an enlarged prostate, kidney stones, and often, UTIs are due to immobility.

“People with incontinence are at increased risk for UTIs because of the close contact that adult briefs and other incontinence products have with their skin. While these products can help contain messes and prevent embarrassment associated with accidents, they can also introduce bacteria into the urethra.”

It’s important to note here that although urinary tract infections are the most commonly diagnosed infections in older adults, confusion and delirium may not be caused by a UTI. If there are no other symptoms, it is possible that the mental health aspect of symptoms could be caused by dehydration.

That gives credence to the first recommendation for preventing a UTI. Stay hydrated. The Aging Care website suggests seniors drink from two to four quarts of water each day unless their physician advises them not to.

“Avoid or limit caffeine and alcohol, which irritate the bladder,” they say. “If incontinence is not an issue, wear breathable cotton underwear and change them at least once a day. Change soiled incontinence briefs promptly and frequently, and keep the genital area clean and dry.”

Many caregivers keep home test strips for UTI detection on hand; however, many are not reliable. If you choose these, be aware that a urine culture often needs to be performed to determine what type of bacteria is causing the infection and the best antibiotic to cure it.

So, you know the drill, if you or your loved one suspects a urinary tract infection, seek medical attention right away. If the primary care provider isn’t available, Bonner General Immediate Care is an excellent alternative.

Kathy Hubbard is a member of the Bonner General Health Foundation Advisory Council. She can be reached at kathyleehubbard@yahoo.com.

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