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Wellness Wednesday for

April 17, 2013

UTIs (Urinary Tract Infections) can cause behaviors in the elderly!

 

How many of us caregivers have experienced this phenomenon?! I can remember this was more often than not the cause for behavior swings and increased confusion and excitability with my Grandmother while she had dementia. I can recall, while she was on hospice, before I was her full-time caregiver, that the nurses would find her on the floor, having crawled out of her hospital bed (because her legs were so weakened from her battle with viral encephalitis, which exacerbated her dementia). She would either be next to the bed or be trying to crawl down the hall to get wherever she thought she was supposed to be. What usually followed, was cloudy urine in her catheter bag and a subsequent Urinary Tract Infection.

I experienced the same phenomena when we were able to bring her home. When she went through extreme swings in behavior and especially the need to be somewhere, we could be sure to expect cloudy or dark urine and the start of a UTI and a call to her doctor to get an antibiotic prescription.open-uri20130202-21449-1qj7jn0

A UTI is an infection of the urinary tract, most commonly the bladder. For most people, the need to urinate frequently and/or urgently are two key symptoms of a UTI. So is a burning sensation when you go, and urine that is an off color or has an odor. Sometimes, a small amount of blood in the urine is visible. But in older adults, those symptoms are often missing. Instead, older adults may suffer from unexplained incontinence, vague fatigue or significant changes their behavior and mental status.

"Older people can get markedly confused, agitated, or sleepy," says Dr. Smith. "Sometimes they can see things that aren't there, like bugs crawling on the ceiling. They can have false beliefs and become paranoid."

In my grandmother's case, eventually we learned that she wasn't as able to communicate that she had discomfort urinating, so we had to be more proactive about maintaining better hygiene and toileting. It meant more work for me, to get her to the toilet more often, to ensure better cleanliness (instead of taking her word for it that she wiped appropriately), to try and get her a little more physically active (which was difficult because she really had severe limitations with mobility), but it was worth it because we were able to decrease the prevalence of UTIs, and to not just help her physically, but to help her emotionally by warding off more bouts of confusion and anxiety. A lot of effort, but well worth it!

What are symptoms that you experienced? How did you treat it or help with prevention?

depressed-senior-woman-150Please read on to understand how UTIs can really affected mental status of the elderly. I always say, start simple and work from there. So, if your loved one is starting to show irrational or altered behaviors, investigate the possibility of a simple Urinary Tract Infection.

http://m.agingcare.com/Articles/urinary-tract-infection-symptoms-151547.htm?utm_source=Newsletter&utm_medium=Email&utm_campaign=Newsletter%20-%20June%2027,%202012

UTIs Cause Behavioral, Not Physical Symptoms in Elders

Denise Altman's 81-year-old mother suffers from chronic depression which often makes her sad and agitated. When her mom acted confused on the phone or had a glassy-eyed look in person, Altman and her sister, who shared in their mother's caretaking duties, figured the symptoms were just a result of their mom's depression. The confusion would last a few days and was often followed by a fever, and then their mother complained of painful urination a few days later. Finally, a doctor diagnosed Altman's mother with a urinary tract infection, or UTI. But the infection would reoccur, causing the sisters concern.

Altman's sister began charting their mother's symptoms. Each time she suffered the confusion and fever, a UTI diagnosis came just days later.

"It took us a while, several months actually, to determine that when our Mom got into these states, it wasn't just the depression," recalls Altman. "It never occurred to my sister and me that the symptoms could be a UTI."

That's because older adults often present different symptoms of a urinary tract infection, explains Amanda Smith, M.D., medical director at the Byrd Alzheimer's Institute at the University of South Florida. In fact, UTI symptoms in older people are often behavioral.

A UTI is an infection of the urinary tract, most commonly the bladder. For most people, the need to urinate frequently and/or urgently are two key symptoms of a UTI. So is a burning sensation when you go, and urine that is an off color or has an odor. Sometimes, a small amount of blood in the urine is visible. But in older adults, those symptoms are often missing. Instead, older adults may suffer from unexplained incontinence, vague fatigue or significant changes their behavior and mental status.

"Older people can get markedly confused, agitated, or sleepy," says Dr. Smith. "Sometimes they can see things that aren't there, like bugs crawling on the ceiling. They can have false beliefs and become paranoid."

According to Dr. Smith, a UTI is the most common cause of a sudden increase in confusion in an older person with dementia. The medical community isn't sure why older people have these heightened behavioral symptoms, although with dementia patients, the inability to communicate may be part of the reason.

So why do people get UTIs in the first place? In younger people, urinary tract infections are sometimes related to frequent sexual activity. But in older folks, hygiene changes may come into play, either because of confusion or physical limitations – such as arthritis or suffering a stroke – which can make it difficult for a person to keep themselves clean.

Caregivers play an important role in recognizing a UTI. Dr. Smith suggests that caregivers be on the lookout for these six symptoms:

  • The need to go to the bathroom frequently or urgently
  • Complaints of discomfort while urinating
  • Frequently touching themselves
  • Cloudy, dark, or foul-smelling urine
  • A new onset of incontinence
  • Any sudden change in mental status such as lethargy, hallucinations, restlessness or yelling when it was not present before

Dr. Smith also warns caregivers to seek medical attention as soon as possible if their loved one becomes difficult to wake up, since this can be a sign of delirium, which is considered a medical emergency.

Urinary tract infections sometimes resolve on their own, but they are easily treated with antibiotics. When left untreated, UTIs can lead to chronic incontinence. But UTIs can spread to the kidneys and cause damage. When that happens, patients often experience a fever and severe pain. More importantly, the infection could spread to the bloodstream and cause sepsis or even death in some cases.

Once Altman recognized the behavioral symptoms that often accompany her mother's UTI's she and her sister could be more vigilant about having their mother tested and prescribed medication. "It's nice to have that early warning," she notes. "It's well worth sending in a specimen when the symptoms become apparent, as early treatment saves our mom days of feeling bad and being more confused than usual."

The Community for Family Caregivers is an online forum created to Support Caregivers of Elderly and Aging Parents. The material of this web site is provided for informational purposes only. AgingCare.com does not provide medical advice, diagnosis or treatment; or legal, financial or any other professional services advice.

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