UTIs in Older Adults: What You Need to Know

“A doctor diagnoses a urinary tract infection by identifying overgrowth of bacteria in the urine (based on a urine culture), as well as having symptoms that indicate the overgrowth is causing some kind of inflammatory process in the lower urinary tract,” says Candace Parker-Autry, MD, assistant professor of urology at Wake Forest University School of Medicine and urologist at Atrium Health Wake Forest Baptist, both in Winston-Salem, North Carolina. “These symptoms might include painful urination, blood in the urine, increased urinary frequency or urgency, urinary incontinence, or nighttime voiding.”

Learn why UTIs become more common with age, how to spot the symptoms of a UTI in yourself or an older person you care for, and what to do if you suspect that you or someone else has a UTI.

Is The Diagnosis Of A UTI Different For Older Adults?

It’s a common misperception that older adults have different symptoms or that they may have a UTI without symptoms, says Parker-Autry. “To be correctly diagnosed with a UTI, a person needs to have overgrowth of bacteria in the urine and symptoms that are consistent with a urinary tract infection,” Dr. Parker-Autry says.

“Often, there can be an assumption that when an older adult comes in with confusion, this is associated with urinary tract infection because they have an overgrowth of bacteria in the urine,” says Parker-Autry.

But one thing that does change with age is that this overgrowth of bacteria, called asymptomatic bacteriuria (ASB), is more common than in younger adults, says Parker-Autry. “Asymptomatic bacteriuria is the presence of bacteria in the urine of a person who has no signs or symptoms of a UTI, and it’s not the same as having a urinary tract infection, or UTI,” she says.

Home UTI Tests

“Taking an at-home UTI test is a convenient option,” says Ronan Factora, MD, a physician at the Center for Geriatric Medicine at Cleveland Clinic in Ohio. “You just have to be careful that you do that test in the context of the presence of other symptoms, because if you test positive, the next question is, ‘What are you going to do about it?’” he says.

The person undergoing testing should have UTI symptoms that make you think there's something going on, says Dr. Factora. “If they have the symptoms of a urinary tract infection, do the test, and that way, if it’s positive, they can receive treatment as if it's a true infection. But if there are no symptoms, and you do it, and it's positive, that needs a different approach as it doesn’t necessarily indicate a UTI,” he says.

A urine culture offers an advantage, especially if a person has had recurrent urinary tract infections or they’ve been on a lot of antibiotics, says Factora.

“That’s because the results of that culture can show which bacteria are causing the infection, and therefore which antibiotics will or will not work to treat the infection in that person. That's not something that the home test will tell you,” he says.

Challenges With Identifying UTI Symptoms in Older Adults

Some older adults may not be able to verbalize symptoms, or (due to aging or certain medications) their baseline, or normal, behavior may resemble certain symptoms of a UTI, such as frequent urination, says Factora.

“That makes it harder to know if they are experiencing symptoms, but what you’re looking for is change — anything different from the baseline. So if the person is already going to the bathroom very frequently, you’ll just be looking for a change from that,” he says.

Factora recommends noting the following:

• Is the urination even more frequent?
• Is it associated with pain?
• Is it now more frequent both night and day?

“And they don’t have to have a fever, but a UTI can come with a low-grade fever, which, for older people, can be 99 degrees F or higher, or two degrees above their baseline temperature. Keep in mind that core body temperature in older adults can be lower than that of the general population,” says Factora.

Older adults can also experience a change in mental status when they have a UTI, but that can also result from many other conditions or infections, he says.

“It can be very difficult to say that’s related to the bladder. It could be underlying dementia, poor sleep, or other types of infections. That’s why a person needs to have bladder symptoms for a diagnosis of a UTI,” he says.

UTI Symptoms to Look For in Older People

Signs to look for include a change in the frequency or urgency of urination, making more trips to the bathroom, and a low-grade fever. “Be sure to check the temperature with an accurate thermometer,” says Factora.

“My threshold for treating the infection is pretty low, but a patient needs to have one of those symptoms in order for me to be convinced that it is truly a urinary tract infection,” he says. In rare cases, the only sign of a UTI is a change in mental status, says Factora.

Why Does a UTI Sometimes Affect an Older Person’s Mental Status?

Delirium, a mental state in which a person experiences confusion and disorientation, can accompany any infection, including a UTI, especially if a person has underlying dementia, says Factora.

“We see people get delirious when they have a kidney infection or if they have pneumonia; it's not unusual. The reason behind that is not really clear. It may occur due to inflammatory substances that the body's immune system releases while trying to fight off that infection,” he says.

It could also be that the person is not able to express that they're experiencing painful or bothersome symptoms, which might lead to behaviors like pacing or irritation, says Factora.

Age, Risk Factors, and UTIs

Advanced age can raise the risk of developing a UTI, says Parker-Autry.

“In women, hormone-related changes occur in the lower urinary and reproductive tract after menopause,” she says. Lower circulating levels of estrogen trigger a change in the pH (acidity) of the vagina and thin the skin, which increases the risk of both UTIs and recurrent UTIs, she says.

“Changes in the bladder during aging can also cause incomplete bladder emptying, which can also contribute to recurrence and presence of urinary tract infection,” says Parker-Autry.

For older men, enlargement of the prostate can occur, and they may also gradually lose the ability to empty completely as the bladder wall weakens, and both factors contribute to the likelihood of urinary tract infections, she says.

Outside the use of catheters (thin tubes used to drain urine from the bladder), UTIs aren’t as common in older men as they are in women, she adds.

Does Being Sedentary Raise the Risk of a UTI in Older Adults?

On its own, simply being sedentary doesn’t increase your risk of a UTI, says Factora. “However, if it comes along with decreased cleanliness after using the bathroom or a lack of continence care (if the older person has incontinence), that could make a UTI more likely,” he adds.

Does Having Dementia Increase the Likelihood of a UTI?

People with dementia may not be able to speak up and say they’re experiencing symptoms, so their UTI may go undetected, says Factora.

“The other thing that may be related to dementia is the loss of ability for self-care, which happens in moderate to severe dementia. That lack of ability to perform appropriate hygiene after using the bathroom could be a risk factor for urinary tract infection,” he says.

Chronic Medical Conditions That Increase UTI Risk in Older People

People with type 2 diabetes are at greater risk for having UTIs, both as a result of having the condition and because certain diabetes medications are also associated with a higher risk, says Factora.

Pelvic surgeries, hysterectomies, and treatments for prostate cancer or enlarged prostate can all increase the risk of UTIs and more complex UTIs, he says.

How Older Adults Can Prevent UTIs

Proper hydration can help reduce the risk of a UTI, says Factora. “When you drink plenty of fluids, it allows the bladder to keep flushing out its contents, including bacteria that tend to stick around the bladder wall. So if you maintain adequate hydration and drink plenty of fluids during the daytime, it helps to reduce your risk of UTI,” he advises.

Maintaining proper hygiene around the urethra can also reduce the risk of a UTI, says Factora. “The urethra is the opening of the tube that connects the bladder to the outside. Keeping that area clean can reduce the risk of urinary tract infection, because those bacteria can move up the urethra into the bladder,” he says.

That’s more of an issue in people who have a vagina, because the urethra is shorter and closer to the anus compared with people with a penis, says Factora.

UTI Treatment for Older Adults

“The treatment is very similar in an older adult versus a younger person in terms of duration and the types of antibiotics that a doctor would typically prescribe,” says Factora.

There are a few exceptions to that: For example, if a person has had pelvic surgeries or has a more complicated UTI, they may need to be on antibiotics for longer, he says.

Managing Recurrent UTIs

In an older person with recurrent UTIs, there’s a concern that repeated antibiotic use could lead to bacterial resistance, making future treatment with oral antibiotics more challenging.

“In that case, you may have to use a more powerful antibiotic to kill off the bacteria causing the infection, but it might kill other types of bacteria as well, including the good germs that protect the body against harmful infections, like Clostridium difficile (C. diff) infection,” Factora says.

“That’s why we must be very careful about distinguishing between asymptomatic bacteriuria and true UTIs, and not overtreating. People can develop resistance down the line, and that may increase the risk of developing C. diff,” says Factora.

• Staying hydrated
• Topical estrogen (in women who get recurrent UTIs due to low estrogen)
• Using a catheter, nonantibiotic medications, or other treatments to manage urinary retention as advised by your doctor

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• Supplements, including cranberry, intravaginal probiotics, and D-mannose

If you have asymptomatic bacteriuria or recurrent UTIs, speak with a healthcare professional about the steps you can take to keep them at bay.