Spotting and caring for UTIs in the elderly

Spotting UTI signs early to help get the correct care.

UTIs are routinely experienced by older adults for a number of reasons, and it is important for caregivers to spot the signs early in order to get them the appropriate treatment and care. Here, we are sharing more information on what UTIs are, why older adults tend to be more susceptible to them, symptoms to watch out for, potential complications, how they can be diagnosed, treated and prevented, how to manage recurring UTIs, and how caregivers can best support an older loved one with a UTI. At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about caring for an older adult with a UTI, we can help. 

What causes a UTI to develop, and why are older adults more susceptible to them?

UTIs are usually caused by bacteria from faeces entering the urinary tract via the urethra, and this most often happens due to sex, pregnancy, a condition that blocks the urinary tract (such as kidney stones) or a condition that makes emptying the bladder more difficult (such as an enlarged prostate). Incidences of UTIs tend to increase with age, and people over the age of 65 years old are reportedly five times more likely to develop one at some point. According to NHS data, from 2022 to 2023 older adults over age 65 made up 56% of UTI cases. Studies suggest that in older adults, cystitis is the most prevalent UTI, with 37.6% experiencing this. This is closely followed by asymptomatic bacteriuria (ASB) which affects 31.9% of older people, pyelonephritis which affects 13.9%, urosepsis which affects 10.2%, and prostatitis which affects 6.4%. Older adults tend to be more susceptible to UTIs due to age-related factors. These include:

• A weakened immune system – As people age, their immune system becomes weaker which makes it more challenging to fight off infections. 
• Prostate enlargement – In men, prostate enlargement can cause incomplete bladder emptying, which increases bacteria in the bladder and leads to UTIs. 
• Incontinence and catheter use – The use of catheters can introduce bacteria into the urinary tract, meaning there is an increased risk of UTIs with a catheter inserted. Studies recommend the careful use of urinary catheters to reduce UTIs. You can learn more in our article: Living With A Long Term Catheter For Older Adults
• Postmenopausal changes – In women, the postmenopausal period brings on a number of changes, such as a drop in oestrogen, thinning vaginal walls, and a reduction in protective bacteria which can increase the risk of a UTI. 
• Dehydration – Dehydration is common in older adults, and could lead to concentrated urine which promotes the growth of bacteria. You can learn more about this in our article: Symptoms of Dehydration in Older People
• Personal hygiene issues – Mobility issues can make it harder for an older adult to maintain their personal hygiene, which can lead to the development of UTIs. Also, older people with dementia are at an increased risk of developing a UTI due to reduced personal hygiene. You can read more in our guide to understanding the consequences of poor hygiene in older adults.

The above factors, plus the limited mobility many older adults face, can mean UTIs are more frequent in the older population and could be more difficult to detect if symptoms are mild or look similar to other conditions. UTI-related mobility issues can also negatively impact an older person’s quality of life, so the prompt treatment of these conditions is crucial. 

How can UTIs be diagnosed in older adults?

When diagnosing a UTI in an older individual, typically a doctor will start by discussing the symptoms and arrange for a urine sample (urinalysis) to be taken, along with any other laboratory tests they believe to be necessary. Urinalysis will check for the presence of certain bacteria and other elements indicating infection. If needed, additional tests may be done to identify the specific bacteria causing the infection and determine the most effective antibiotic treatment. In older adults, where symptoms can sometimes overlap with other conditions or could be unclear, doctors must also rule out other potential problems such as dehydration or cognitive decline before confirming a UTI is present. Studies suggest older people are not only more susceptible to UTIs, they are also more likely to experience comorbid conditions.Ultimately, older adults should be checked for UTIs as soon as any signs or symptoms are identified, in order to provide prompt treatment and avoid complications. 

What are the treatment options for UTIs in older adults?

Treatment options for UTIs usually involve antibiotics, as this is the quickest and safest way to eliminate the bacteria causing the infection. However, the specific type of antibiotic a doctor prescribes will depend on the severity of the infection and the results from any laboratory tests done to identify the bacteria. In more severe cases where the infection has spread to the kidneys or the bloodstream, an older person may require hospitalisation in order to be given intravenous (IV) antibiotics which can enter their system and provide results more quickly. During treatment, it is important for older adults to remain hydrated, as this can help to flush bacteria from their system. Also, pain relief medication such as paracetamol can be used to alleviate any discomfort felt during this time. A doctor may first suggest waiting longer to see if symptoms go away on their own. If antibiotics are prescribed, it is important to finish the course to ensure the infection is fully treated. Also, sometimes there can be side effects and allergic reactions when using antibiotics, such as raised or itchy skin, coughing or wheezing, tightening of the throat or breathing difficulties, skin sensitivity to light, aches and pains, and more – carers should keep an eye out for potential side effects and discuss these with the older person’s doctor. 

Is it possible to prevent UTIs in older adults? 

Yes, it is possible to prevent UTIs in older adults, and there are a number of ways they can do this themselves, or have a home carer help with this. For example: 

• Drink plenty of water to help flush bacteria from the urinary tract
• Maintain good personal hygiene to reduce the risk of spreading bacteria
• Change clothing or incontinence pads as soon as they become wet 
• Urinate regularly, and always avoid holding in urine for long periods of time
• Empty the bladder fully when urinating
• Wipe from front to back (for women) in order to prevent the transfer of bacteria
• Wear breathable, cotton underwear to avoid a buildup of bacteria 
• Avoid irritating personal care products like harsh soaps around the genital area
• Maintain a healthy diet free from excess sugary foods, drinks or alcohol 

How can older adults manage recurring or chronic UTIs?

One study estimated 47.5% of women with a previous UTI experienced a recurrence, and further research shows more than 10% of women over age 65 report having a UTI every year. For this reason, managing recurring UTIs in older adults is important as complications can occur, plus older adults will likely feel their quality of life is impacted due to symptoms. The aforementioned tips for preventing UTIs in older adults are also relevant for anyone with recurring UTIs that want to manage them well and flush them out faster. In addition, doctors may prescribe a long-term, low-dose antibiotic if an older person experiences UTIs on a regular basis, or they might recommend taking antibiotics after specific activities that tend to trigger UTIs. A doctor may also recommend women with recurring or chronic UTIs use a vaginal cream containing oestrogen, or refer them to a specialist for further tests. Cranberry juice or supplements have been considered as a method of managing recurring UTIs, however the evidence on the effectiveness of this method is mixed. A 2024 review looking at 20 trials found that 18 of those trials saw a 54% lower rate of UTIs when cranberry juice was consumed than those who took no treatment, and a 27% lower rate of UTIs than in the placebo liquid. For this reason, regularly consuming cranberry juice or supplements could be a potential way of reducing the recurrence of UTIs, but this is not a treatment and medical treatment should always be sought immediately if a UTI is suspected. Lastly, having good personal hygiene is one of the most important elements of managing recurring UTIs, as well as treating any underlying conditions contributing to this. You can read more in our guide to the importance of personal hygiene care for older adults.

What are the potential complications of untreated UTIs? 

Despite the fact that many UTIs will be simple to treat, untreated UTIs in older adults can lead to serious complications, and this is why they must be addressed as quickly as possible if signs are noticed. Some of the complications that could occur include:

• The infection spreads to the kidneys, which is known as pyelonephritis. This can cause permanent kidney damage. 
• Cognitive impairments occur, such as confusion or delirium which are sometimes mistaken for dementia. 
• A weakened immune system as a result of chronic UTIs and recurrent infections.

One of the most important complications to mention is if the infection enters the bloodstream, leading to a severe infection called sepsis. Sepsis is life-threatening and requires immediate medical attention. If you are caring for an older adult, keep an eye out for symptoms such as acting confused, slurred speech, not making sense, difficulty breathing, breathing very fast, a rash that does not fade when you roll a glass over it (like meningitis), or blue, grey, pale or blotchy skin anywhere on the skin, lips, tongue, palms of the hands or soles of the feet. If you notice these symptoms in an older loved one, call 999 or go to A&E. 

What support is available for older adults with a UTI and their caregivers? 

UTIs can be distressing, painful and embarrassing for older adults, so home carers supporting them must provide effective and compassionate care during the management and treatment of a UTI. When older adults get frequent UTIs, it is important to address the emotional impact this could have, since they may be suffering from anxiety, depression or isolation as a result of their symptoms. Also, caregivers must ensure the person retains their dignity throughout the treatment of their UTI, particularly if their condition is causing issues such as incontinence. You can learn more in our guide to the essentials of incontinence care for older adults.A home carer can help to manage a UTI by supporting an older adult to: 

• Manage their hygiene and personal care to treat UTIs and avoid future UTIs forming 
• Provide frequent changes if incontinence is an issue 
• Provide medication reminders if an older person is taking antibiotics
• Monitor for signs of complications such as delirium
• Support an older person’s mental health while they deal with the symptoms of a UTI
• Help with short-term or long-term catheter care at home if needed 

Respite care services can also provide temporary relief for caregivers who have been looking after an older loved one for a while, by helping to reduce stress and prevent burnout. Our Care Professionals are trained in the treatment and management of UTIs, so we can work in tandem with the medical professionals in charge of care. Reach out to your local Home Instead team to discuss your needs and allow us to create a personalised package to support you. We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.