From the Guidelines
Urinary tract infections (UTIs) in dementia patients in long-term care facilities (LTCFs) often present with atypical symptoms, and the most recent evidence suggests that common symptoms include increased confusion, agitation, behavioral changes, falls, lethargy, decreased appetite, and new or worsening incontinence, rather than the classic symptoms of dysuria, frequency, and urgency seen in cognitively intact adults 1.
Symptoms of UTIs in Males and Females with Dementia in LTCFs
The symptoms of UTIs in males and females with dementia in LTCFs can be summarized as follows:
- Common symptoms:
- Increased confusion
- Agitation
- Behavioral changes
- Falls
- Lethargy
- Decreased appetite
- New or worsening incontinence
- Atypical symptoms:
- Dysuria
- Frequency
- Urgency
Comparison of Symptoms between Males and Females
| Symptom | Males | Females |
|---|---|---|
| Increased confusion | Yes | Yes |
| Agitation | Yes | Yes |
| Behavioral changes | Yes | Yes |
| Falls | Yes | Yes |
| Lethargy | Yes | Yes |
| Decreased appetite | Yes | Yes |
| New or worsening incontinence | Yes | Yes |
| Dysuria | Rare | Rare |
| Frequency | Rare | Rare |
| Urgency | Rare | Rare |
Treatment Options
For treatment, empiric antibiotic therapy should be initiated after obtaining a urine culture, with first-line options including nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin for uncomplicated cases, and fluoroquinolones or amoxicillin-clavulanate for complicated UTIs 1.
Prevention Strategies
Prevention strategies include adequate hydration, proper hygiene, regular toileting schedules, and prompt changing of incontinence products, as well as staff education on recognizing atypical UTI presentations in dementia patients 1.
From the Research
Symptoms of UTIs in Patients with Dementia in LTCFs
- Increased confusion, agitation, or withdrawal are common symptoms of UTIs in patients with dementia 2
- Voiding issues and impaired personal hygiene due to dementia can increase the risk of developing a UTI 2
- Sudden altered mental status can be a sign of a UTI in patients with dementia 2
Treatment Options for UTIs in Patients with Dementia in LTCFs
- First-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis includes nitrofurantoin, fosfomycin tromethamine, or pivmecillinam 3
- Second-line options include oral cephalosporins, fluoroquinolones, and β-lactams such as amoxicillin-clavulanate 3
- Treatment options for UTIs due to antibiotic-resistant bacteria include carbapenems, ceftazidime-avibactam, and cefiderocol 3
Differences in Symptoms between Males and Females with UTIs who have Dementia in LTCFs
- There is limited research available on the differences in symptoms between males and females with UTIs who have dementia in LTCFs
- However, it is known that UTIs can present differently in older adults with dementia, making diagnosis challenging 2, 4
Table to Review Differences in Symptoms
| Symptom | Males | Females | Notes |
|---|---|---|---|
| Increased confusion | Common symptom in patients with dementia [2] | ||
| Agitation or withdrawal | Common symptom in patients with dementia [2] | ||
| Voiding issues | Increased risk due to dementia [2] | ||
| Impaired personal hygiene | Increased risk due to dementia [2] | ||
| Sudden altered mental status | Sign of UTI in patients with dementia [2] |
Note: The table is not exhaustive, and more research is needed to fully understand the differences in symptoms between males and females with UTIs who have dementia in LTCFs.