Urinary tract infections (UTIs) can be a problem as people age, so it’s important for caregivers to know that symptoms can manifest differently in someone with a memory loss condition, says Nathaniel A. Chin, M.D., associate professor at the University of Wisconsin Department of Medicine, Geriatric Division. Chin is a member of AFA’s Medical, Scientific and Memory Screening Advisory Board.
“People without memory loss usually experience traditional urinary complaints of fever, chills, dysuria (pain or discomfort while urinating), urgency, frequency and may notice changes in their urine,” he said. “In dementia, you may not experience the fever or chills, or even the urinary complaints. Instead, you could experience abdominal or pelvic discomfort, loss of appetite, fatigue, malaise, confusion and restlessness. Sometimes people with dementia have a hard time explaining what they’re feeling or sensing.”
Women traditionally have more UTIs than men because they have shorter urethras than men, Chin says. This makes it easier for bacteria to travel to the bladder. UTIs are also more common for women after sex.
According to Chin, caregivers should be aware of the following UTI symptoms in individuals living with a memory loss.
- Their temperature and heart rate can become elevated while their blood pressure may decrease due to wholebody inflammation.
- You may observe changes in behavior, fluid intake and food consumption. Eating and drinking less, confusion, restlessness and agitation are also common.
- An increase in urination frequency may occur. There is no exact number that indicates a UTI, but when a person urinates more often than their baseline, that could be a sign.
- A person may appear uncomfortable when urinating. Sometimes people with dementia deny painful urination but grimace when it happens. Try to talk about it using simple terms.
- Urine may be dark, cloudy and have a foul odor.
Here are some ways that UTIs can be
prevented, according to Chin.
- Try to ensure that your person urinates completely.
- Keep them well hydrated.
- Help them to maintain proper hygiene by wiping from front to back and avoiding irritating cleaning or feminine products. UTIs are most often caused when bacteria from the anus infect the bladder.
- If they are wearing incontinence pads, make sure they are changed frequently.
- When a UTI is diagnosed, use an antibiotic, prescribed by a doctor, to treat the bacteria.
Chin said opinions on the effectiveness of drinking cranberry juice are mixed. “It’s not going to hurt. If infections are recurring, it’s worth a try. Later in life, some people are on chronic antibiotics, but that’s a serious conversation to have with a doctor. Being on chronic antibiotics can lead to resistant organisms that become hard to treat. Additionally, a person could develop kidney injury, side effects and even a dangerous colon infection caused by a separate organism called C. Diff.”
Chin doesn’t recommend routine screening for UTIs because bacteria are usually present in the bladder and do not necessarily indicate infection.
When Delirium Occurs
UTIs do not cause or worsen dementia. They cause delirium, which people with memory loss conditions are at greater risk of developing. Delirium is acute confusion, disorientation and fluctuation in attention due to another medical issue. It resolves with time or when its cause is treated effectively.
“It may look as if the dementia is worsening, but when you treat the cause of delirium, people get better — although some don’t recover to their prior baseline. That’s why it’s important to treat it right away. UTIs are one of the most common causes of delirium in people with memory loss. You can see delirium in a cognitively healthy person, but they’re less vulnerable.” “People with dementia cannot go to sleep at 10 p.m. and wake at 8 a.m.,” Mehrdad Ayati M.D., says. “It’s a ridiculous expectation that we have for them. This is our problem that we want them to sleep.” Ayati shares the following advice for managing sleep disruptions: