Woman with thermometer/infection
Source: Pond5

As we get older, unfortunately, we become more susceptible to infections. That’s because, with age, the immune system doesn’t work as well as it used to.

It gets even more difficult if you’re also dealing with chronic health conditions such as diabetes, chronic obstructive pulmonary disease (COPD or emphysema), heart problems, or cancer.

Infectious diseases account for one-third of all deaths in people 65 and older. It can be difficult to catch an infection in an older person because there may not be any of the usual signs and symptoms. Sometimes, the only sign is a behavior change that could be mistaken for dementia.

Especially in the ‘old old’ or people 85 and older. The symptoms are often masked and can be ‘dismissed’ as just a sign of getting older or becoming more frail. It is critical to monitor older adults for these symptoms, especially those who are more frail.

Linda Samia, PhD, RN, CNL, Associate Professor at USM’s School of Nursing.

The most common infection in older people

A common infection in older people is a bladder infection. A few years ago, a friend of mine, who was “only” in her 60s had a high fever and no other symptoms. It was before the time of COVID and she figured it was just a virus that would run its course. About three months later, she ran a second high fever. This time, she saw her healthcare provider, who ordered a urinalysis to “cover the bases.” Turns out she had a bladder infection. She was given a prescription for an antibiotic.

A third fever two months later sent her back to the doctor’s office, where another urinalysis showed that she still had the infection. It was resistant to the antibiotic she had been taking, so she was put on a new one. “I hope it works,” she says. “I’ve had five months of feeling like crap.”

She asked me to tell her story because she hopes it will prevent someone else from going through what she did. And she asks this question: “How do we know when to advocate for ourselves and push for certain tests without being labeled hypochondriac?”

First of all, let’s look at some of the facts about urinary tract infections in older people.

Usual symptoms

By usual, I mean symptoms you’re more likely to see in a younger person (let’s say under 65).

  • Difficulty urinating
  • Increased frequency
  • Increased urgency
  • Cloudy urine
  • Blood in the urine
  • Foul or strong odor
  • Fever (sometimes)
  • Abdominal pain (sometimes)
  • Incontinence

My friend had a fever and no other symptoms. Had she realized that urinary tract infections were more common with age, I’m sure she would have asked her doctor about that possibility.

Older people often don’t have clear-cut symptoms. That’s why it’s important to pay attention to other possible signs of an infection.

  • General weakness
  • Fatigue
  • Malaise — just don’t feel well
  • Sudden or worsening incontinence
  • Sudden change in behavior

The last bullet point — sudden change in behavior — is especially important to recognize and understand if the person is unable to communicate well.  For instance, sudden signs of delirium — acting confused and disoriented — could mean he/she has a urinary tract infection (or some other infection).

When someone is already confused and disoriented because of Alzheimer’s disease or another cause of dementia, it might be easy to think the dementia is simply progressing. Instead, an infection might be the cause, so it’s important to have it checked out right away.

Why do older people get urinary tract infections?

Infections are more likely to occur in people who have trouble totally emptying their bladders. That’s because the longer urine sits in the bladder, the more time bacteria have to grow.  For several reasons, it’s usually more difficult for older people (men and women) to completely empty their bladders because of:

  • Side effects of certain medications, e.g., antihistamines, tricyclic antidepressants, and medicines to treat stomach and muscle cramps
  • Prostate problems
  • Bladder prolapse after menopause
  • Incontinence

Here are some other common causes of urinary tract infections:

  • Diabetes
  • Being catheterized
  • Kidney stones
  • Being immobile

How is a urinary tract infection diagnosed?

Most of the time, an infection can be diagnosed with a urinalysis. Sometimes it’s necessary to do what’s called a clean-catch urine culture to identify the bacteria that are causing the infection and help figure out the best antibiotic.

Caught early, a urinary tract infection can usually be easily treated and any symptoms (including delirium) go away. Untreated, it could spread and cause much more serious problems. My friend is lucky her infection didn’t spread to her kidneys.

Be an advocate

As for her question about being an advocate, I also wrote a blog post about what we can do to prevent medical errors. In it, Kathy Day, whose father died of an infection he got while he was in the hospital, urges us all to speak up for ourselves.

I don’t think patient engagement is an option. We need to engage in our own care and advocate for ourselves because nobody else is going to do it for us like we would.

Kathy Day