Urinary tract infections (UTIs) commonly occur in people with dementia. Older adults with or without dementia may experience atypical UTI symptoms, such as delirium, changes in behavior, and hallucinations.
A UTI is a bacterial or fungal infection in the urinary system. This includes the urethra, bladder, kidneys, and ureters.
Dementia refers to symptoms of cognitive decline. Various brain disorders, such as Alzheimer’s disease, are types of dementia.
This article looks at symptoms, causes, treatment, and diagnosis of UTIs in people with dementia. It also looks at how to prevent UTIs.
![A carer looking after an older adult with dementia and a UTI.](https://media.post.rvohealth.io/wp-content/uploads/sites/3/2024/06/caring-for-senior-man-1296x728-header-1024x575.jpg)
Typical UTI symptoms include pain or discomfort during urination and feeling a more frequent and urgent need to urinate.
However, a
- delirium
- hallucinations
- paranoia
- behavioral changes, such as aggression
- anxiety
- depression
- confusion
- dizziness
- changes in sleeping patterns
- falls
- a decreased appetite
- drowsiness
- hypotension, low blood pressure
- tachycardia, a fast resting heart rate
- urinary incontinence
Although UTIs do not always cause clear physical symptoms, some older adults with UTIs may also experience:
- fever
- back or abdominal pain
- dark colored urine
- a change in urine smell
- difficulty urinating
Delirium
Delirium is one of the
Delirium involves a sudden change in someone’s ability to think (cognitive function). This can include difficulty paying attention, slurring or incoherent speech, and uncharacteristic moods and behaviors.
Medical professionals do not know precisely how infection may lead to delirium. It may occur due to increased inflammation and stress on the brain, which may be more pronounced in older adults.
Although dementia and delirium have some symptoms in common, differences between the two include the following:
- Dementia develops slowly, while delirium causes sudden symptoms.
- Symptoms of dementia do not usually improve, while symptoms of delirium can worsen or improve.
- Dementia does not cause hallucinations, while delirium may.
- Dementia usually starts with memory loss, while delirium mainly involves difficulty paying attention.
Dementia is
Risk factors may
- Catheterization: A doctor may insert a thin tube, called a urinary catheter, to help drain urine from the bladder. People with dementia
can develop incontinence, which a health professional may address with catheterization. This may allow bacteria to enter the body, which can lead to UTIs. - Comorbidities:
Many older adults and those with dementia have additional health conditions. Some common comorbidities in people with dementia, such as diabetes, mayincrease their risk of developing a UTI. - Functional impairments: People with dementia may have personal care and hygiene issues due to cognitive decline. This can
increase the risk of developing a UTI. - Age-related changes in immune function: As people age, their immune systems may become less effective at fighting infections. Health professionals refer to this as immunosenescence.
- Exposure to nosocomial infections: People with dementia may have a higher risk of developing nosocomial infections. These are infections that a person may acquire while receiving medical care and include UTIs.
Treatment for UTIs in people with dementia may differ according to the type and location of the infection.
Lower UTI
A lower UTI affects the bladder, the urethra, or both.
A doctor may treat a lower UTI with over-the-counter (OTC) pain-relieving medication, such as acetaminophen, and a short, 3-day course of antibiotics.
Upper UTI
An upper UTI affects the kidneys and ureters and often also involves the bladder, urethra, or both. The infection is typically more serious than a lower UTI. It may lead to complications such as bacteremia, a potentially severe condition that involves bacteria in the blood.
A doctor may treat an upper UTI with a 7- to 14-day course of antibiotics. In severe cases, a person may require hospitalization and intravenous antibiotics.
Catheter-related UTIs
Catheters, especially indwelling catheters that remain in the bladder, can increase a person’s risk of UTIs.
If a doctor suspects a person has developed a UTI as a result of catheterization, they may prescribe antibiotics.
Recurrent UTI
Doctors may describe a person as having recurrent UTIs if they develop more than two UTIs within 3 months.
A doctor may treat recurrent UTIs with low dose, long-term antibiotics. A doctor may refer a person with recurrent UTIs to a urologist for further testing and treatment.
A carer may have to assist a person with dementia in providing a doctor with information about their symptoms.
A doctor
They may also send a urine sample to a laboratory to identify the types of bacteria it contains.
A doctor may refer a person to a urologist, who may perform further tests. These may include:
- blood tests
- cystoscopy, in which a urologist uses a small camera to view the inside of the urinary tract
- a rectal examination to assess the prostate gland
- an ultrasound to view the bladder and kidneys
Obtaining a urine sample
It may be difficult to obtain a urine sample in the usual way from a person with dementia.
If the person has incontinence, a healthcare professional may be able to draw a urine sample from an incontinence pad with a syringe.
People with dementia may require care to help maintain their personal hygiene.
Carers can help prevent UTIs in people with dementia by:
- ensuring they are well-hydrated
- helping them use the toilet regularly
- wiping from front to back after using the toilet
- helping them maintain hygiene by assisting with cleaning and promptly changing incontinence pads, underwear, and bedding, when wet
- avoiding the use of catheters when possible
- following good infection prevention measures if a person requires a catheter
Why do UTIs cause confusion in those with dementia?
Health professionals do not know the exact causes of atypical UTI symptoms, such as confusion, in those with dementia.
The infection may cause more inflammation and stress than usual in the brains of older adults and those with dementia, which may contribute to confusion.
Is there a connection between UTI and dementia?
People with dementia may have a higher risk of developing UTIs for various reasons. These include changes in the function of the immune system, catheterization, and comorbidities.
How does a UTI affect the brain?
A UTI
Can UTI-related delirium be permanent?
Doctors
UTIs commonly occur in people with dementia. This is due to various risk factors, such as catheterization, a high rate of comorbidities, and difficulties maintaining hygiene.
People with dementia and older adults may experience atypical UTI symptoms. These include delirium, hallucinations, and changes in moods and behaviors.
Doctors typically use urine samples to diagnose UTIs. They usually treat UTIs with antibiotics.
Carers may help prevent UTIs in people with dementia by helping them maintain good hygiene and hydration.