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Urinary tract infections and delirium in older adults

Older people, especially women, and especially those living in long-term care facilities, are at increased risk for urinary tract or bladder infections. Women appear to be more susceptible for a number of reasons, including the prolapsing of anatomy with age, and loss of estrogen. They become more prone to infection, with fewer numbers of protective bacteria to suppress the bad infectious bacteria. Not drinking enough liquids also contributes.

Urinary tract infections (UTIs) may sound like a simple, local problem down under, but they can lead to dire consequences, including kidney infection, blood poisoning (bacteria in the blood), and death. UTIs are responsible for one-third of hospitalizations of nursing home patients.

Moreover, UTIs can be hard to diagnose in older people, who often don’t have the usual symptoms of infection: no pain, no fever, no feeling of having to run to the bathroom. Often the only symptom is a change in mood or confusion, and this can be subtle. Family members are often the ones to notice the change. It’s important they learn to notice the subtle and individual signs for their loved one, of when to alert a health care provider that it’s time to check a urine sample for infection.

Whenever my mother starts to talk about being transported to somewhere we know she hasn’t been, my sisters and I know it’s time to check her urine. She’ll say she has spent the night out of town in the home of one of her grandchildren and that the furniture was identical to that in her own room. Other times she’ll say she has been taken “to a shack in the boonies” and describe fierce wind and rain and the swish of swamp grass. She’ll deny it as a dream and really believe this happened. She’s quietly delirious, so she isn’t bothering the staff with agitated behavior.

Patients I have go the other way and become very irritable and paranoid towards others, thinking people are stealing things from them. They even become threatening. For these people, health providers know to check their urine.

I’ve noted the danger of delirium when moving from one care facility to another and from lack of water and malnutrition. Every time an older person becomes delirious, their brain function slips a bit and may not recover to the point that it was. This is especially concerning in those who are already impaired, such as those with dementia.

Keep in mind that once people get a UTI, they often get another. Although it used to be thought that cranberry juice or cranberry juice capsules might prevent infections, a study last year found this not to be true. For more information on UTIs, visit the Mayo Clinic web site.

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