From the Guidelines
Urinary tract infections (UTIs) in elderly patients with dementia often present with atypical symptoms, including increased confusion, agitation, behavioral changes, and falls, rather than the classic symptoms of burning during urination, frequent urination, or lower abdominal pain. These atypical symptoms can be challenging to recognize and may include lethargy, decreased appetite, new or increased incontinence, low-grade fever, and sometimes foul-smelling urine 1. Changes in mental status are particularly significant, as a UTI can cause delirium that appears as a rapid decline in cognitive function. Physical symptoms may include lower abdominal tenderness, though this can be difficult to assess in patients with communication difficulties.
Key Symptoms to Recognize
- Increased confusion or sudden worsening of dementia symptoms
- Agitation
- Behavioral changes
- Falls
- Lethargy
- Decreased appetite
- New or increased incontinence
- Low-grade fever
- Foul-smelling urine
Caregivers should be vigilant for any sudden behavioral or functional changes, as these could indicate an underlying UTI requiring prompt medical attention. Early detection is crucial because untreated UTIs in elderly patients can quickly progress to serious complications like kidney infection or sepsis, especially given their often compromised immune systems 1. The management of UTIs in this population should consider the potential for atypical symptoms and the need for a holistic assessment to avoid overdiagnosis or underdiagnosis 1.
Importance of Early Detection
Early detection of UTIs in elderly patients with dementia is critical to prevent progression to more severe complications. Given the high prevalence of comorbidities and polypharmacy in this population, treatment selection should take into account potential drug interactions and contraindications, such as impaired kidney function, making certain antibiotics inappropriate for this population 1.
From the Research
Common Symptoms of UTI in Elderly Patients with Dementia
- The common symptoms of UTI in elderly patients with dementia may differ from those in younger adults, and can be challenging to diagnose 2
- People with dementia may exhibit signs of sudden altered mental status, such as:
- Increased confusion
- Agitation
- Withdrawal
- These symptoms can make diagnosis challenging, as they may not be typical of a UTI in younger adults 2
- Other symptoms of UTI in elderly patients with dementia may include:
- Change in frequency
- Dysuria
- Urgency
- Presence or absence of vaginal discharge 3
- It's essential to consider the patient's pretest probability based on symptoms and characteristics when interpreting test results, such as dipstick urinalysis 3
Diagnosis and Treatment of UTI in Elderly Patients with Dementia
- Urine culture is the gold standard for detection of UTI, but asymptomatic bacteriuria is common in older adults and should not be treated with antibiotics 3
- First-line treatments for UTI include nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole (when resistance levels are <20%) 3
- Non-antimicrobial options, such as cranberry products, OM-89 Escherichia coli bacterial lysate vaccine, and estrogen therapy in postmenopausal women, may be considered, although evidence for their efficacy is weak 4
- A medical device (Utipro Plus®) containing xyloglucan, gelatin, propolis, and extracts of Hibiscus sabdariffa may be effective in controlling and preventing UTIs in elderly patients 4