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UTI And Confusion In The Elderly: Can A Urinary Tract Infection Cause Dementia-like Symptoms?

by — Last updated: 2020-08-10 in Urinary Tract Issues

If your elderly parent, friend, or neighbor suddenly seems very confused and disoriented, you may suspect dementia. Sometimes, the cause is much simpler: a urinary tract infection.

When it comes to the elderly, it’s important to respect them, their privacy, and their autonomy, even when it comes to life and death situations involving their health. However, there are several instances that could be concerning and must be addressed quickly in order to avoid complications, and in many cases, the senior may not be aware of the underlying issue or may not notice the symptoms.

This can be the case with a urinary tract infection, or UTI. For most younger people, UTIs are a minor irritation. In the elderly, urinary tract infections are a potential killer. Even more concerning, the symptoms of a UTI in senior citizens may not be readily apparent to caretakers without proper education.

Could dementia and similar behaviors be signs of a UTI in the elderly?

What is a urinary tract infection (UTI)?

A urinary tract infection is caused by bacteria or a fungus that enters a part of the urinary system, which includes the urethra, bladder, ureters, and kidneys. When a younger or middle-aged individual contracts a UTI, there are common symptoms to look for, such as:

  • Greater urinary urgency and frequency
  • Increased amounts of urine
  • Burning, pain, and discomfort when urinating
  • Sensations of pressure in the lower abdomen, as well as in the pelvic region
  • Cloudy or smelly urine
  • Never quite feeling as though the bladder is empty, even after returning from the restroom
  • Pain in the back, flank, or lower abdomen
  • Blood in the urine
  • Fever
  • Fatigue
  • Nausea
  • Vomiting
However, when it comes to seniors who are experiencing a UTI, these tell-tale symptom may or may not manifest. Other, more serious symptoms that are atypical in younger individuals could signal the presence of an infection in the elderly population.

UTI symptoms in seniors: What to watch out for

For seniors, many of the symptoms of a urinary tract infection are linked to changes in behavior, and they may include:

  • Confusion
  • Agitation
  • Restlessness
  • Social withdrawal
  • Hallucinations

Many of these atypical UTI symptoms mimic the signs of dementia, and the initial reaction to a senior acting in this way may be fear of developing or worsening dementia or Alzheimer’s. The first thing to do is to find out if the elderly individual has a UTI, since a UTI can exacerbate symptoms of dementia or cause these symptoms in an elderly individual who has not developed dementia.

Why are symptoms of a urinary tract infection different in the elderly?

Scientists and the medical community aren’t completely certain of the exact reason for the change in physiology. However, the fact is that the immune system changes as people age, which could lead to a different reaction to the bacterial infection. In addition, some theorize that the blood vessels weaken with age, making the blood more susceptible to carrying the urinary tract infection through to the nervous system and thereby affecting the brain functionality in seniors.

Risk factors for UTIs in the elderly

The elderly are sometimes already at greater risk for UTIs because they are often not as active as younger individuals. Extended immobility can lead to a UTI because the person isn’t able to expel urine as frequently, allowing for the bacteria to cultivate in the urine inside the bladder. Other risk factors may be similar to those in younger people, though significantly amplified, such as:

  • Diabetes
  • A weakened immune system
  • Being female (as well as postmenopausal)
  • Exposure to bacteria found in hospitals and care facilities
  • Incontinence
  • Enlarged or shrunken prostate
  • Use of a catheter

Complications of UTIs in seniors

A UTI that goes untreated in anyone can lead to complications. However, elderly individuals have a higher risk of complications from urinary tract infections than any other category of individual.

  • Kidney damage. A typical UTI can become more difficult to treat and tolerate if it moves into the kidneys. In addition, it can cause scarring on the kidneys, which leads to potential for hypertension and kidney failure.
  • Septicemia. Because kidney function can be reduced, some of the waste the kidneys would normally filter out and push from the body with urination may flow back into the bloodstream, leading to illness, which is difficult on the senior’s immune system.
  • Sepsis. In the same process, the infection may enter the bloodstream, leading to blood poisoning that is a life threatening issue.
  • Worsening dementia. While the symptoms of confusion that a UTI causes in the elderly may not directly lead to dementia, if the condition develops in a patient who already has dementia, a urinary tract infection could cause a quicker progression of dementia, leading to worsening overall health for the elderly patient.

Prevention of UTIs in the elderly

It’s important to address the issue in advance in the attempt to prevent UTIs in seniors. Several urinary tract infection prevention methods exist, including:

  • Reminding the individual to drink plenty of water (six to eight glasses a day), as proper hydration keeps the urinary tract in good health
  • Avoiding consumption of alcohol and caffeine as much as possible
  • Encouraging the senior to use the restroom frequently, at least every three hours
  • Promptly caring for soiled materials due to incontinence
  • Wiping from front to back when using the restroom
  • Promoting good hygiene, such as daily showers, and avoiding baths — and special care should be taken if the senior citizen uses a urinary catheter

Urinary tract infection: Diagnosis and treatment in seniors

The diagnosis of a UTI begins with a physical exam and urinalysis. The urine sample is cultured to see what sort of bacteria grow so that the correct treatment is offered. In addition, other testing may include a CT scan, x-rays, and an ultrasound.

Depending on whether the infection is caused by bacteria or a fungus, doctors will prescribe an antibiotic or antifungal medication to clear up the urinary tract infection. It’s important to report all medications the senior is currently taking to the physician, so that the doctor doesn’t prescribe anything that could cause an interaction or be detrimental to the patient’s health. In extreme cases, with infections that have progressed and are severe, intravenous antibiotics may be required.

Because elderly people also often suffer from the mental problems associated with UTIs, the physician may also prescribe a temporary antipsychotic drug to those who have not already developed dementia. Depending on the individual, those who have dementia and are showing behavioral changes may be recommended for an increased dose until the infection clears.

Conclusion

Unless a senior already has dementia, it is unlikely that the sudden symptoms of confusion and behavioral changes they experience during a UTI will be permanent. However, if not treated quickly in those with dementia, the infection could exacerbate symptoms and cause a faster progression of the neurological condition. Making sure the individual is following good practices for prevention of UTIs can help increase overall health and happiness, especially in the golden years.

  • Photo courtesy of SteadyHealth