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Delirium with UTIs in Older Adults


A patient consulting with her doctor

Have you noticed a change in the behavior of an older adult you care for? Perhaps this change has taken place over the span of several days, and includes symptoms such as confusion, restlessness, hallucinations or social withdrawal?

Before we jump to the conclusion that a loved one has the beginnings of dementia, we should have a physical exam performed by a physician. They instead might be suffering from delirium brought on by a urinary tract infection (UTI). In older adults, UTIs can become quite serious, so it is important that we have an assessment or checkup done as soon as possible.

UTIs happen when bacteria enter the urinary tract through the urethra, traveling to the bladder, then to the ureters and, finally, resting in the kidneys. The kidneys work to filter waste out of the blood and pass it through the urinary tract in urine. However, once bacteria infect the kidneys, they can infect the bloodstream and carry the infection all the way to the brain.

The science is still evolving, but what is known is that blood vessels in the brain become weaker as people get older, making the brain more susceptible to infection. Older adults are also more susceptible to UTIs and can sometimes experience more severe symptoms because of other conditions they may have, such as diabetes, incontinence, enlarged prostate, kidney stones, urinary retention—the inability to fully empty the bladder—and immobility. On the other hand, many older adults experience little to none of the common symptoms of UTIs, and instead experience seemingly unrelated symptoms like confusion or disorientation. This can make it difficult to identify a UTI as the source of their discomfort.

Besides delirium, other UTI symptoms to watch for in our loved ones are:

  • Urine that appears cloudy or bloody or has a strong odor
  • A frequent need to urinate
  • Pain or burning with urination
  • Fever

Treatment is handled through a course of antibiotics. If the delirium is present and continues, a short-term course of antipsychotics may be needed.

Prevention is also key. We should have a loved one drink plenty of water to keep them hydrated and to keep fluid moving through their system. Proper hygiene is also important, and our loved ones should wipe “front to back” to keep bacteria from entering the urethra, as well as wear clean cotton underwear.

Resources: Aging, American Medical Association

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