Urinary tract infections (UTIs) are the most common type of healthcare-associated infection in both the acute and long term care setting. UTIs are the most difficult nosocomial infection to control and eradicate, and contribute substantially to patient morbidity, mortality, healthcare costs, annual doctor visits, and antibiotic use. With advancing age and debilitation the risk for a UTI increases. However, infections in the elderly pose special problems since they are difficult to diagnose due to their atypical presentation or the older person's inability to mount a typical reaction to infection. Rather than presenting the usual symptoms of frequency and dysuria, they may instead demonstrate decreased functional capacity, increased incontinence or number of falls, or worsening mental status.
Women, in particular, are susceptible to UTIs and are also noted to present with atypical symptoms, such as feeling irritable, hot, tired, weak, restless, or, generally unwell. Older women may have additional risks: increased vaginal pH, vaginal atrophy, incomplete bladder emptying or urinary retention, weak pelvic floor muscles, and general debility.
In dealing with UTIs, consider the following: A complete and careful assessment at the start is vital. Treatment of bacteriuria without the accompanying symptoms is NOT recommended. For the elderly treatment of asymptomatic UTIs does not reduce morbidity or mortality.
Discriminate use of antibiotics. Antibiotics are generally NOT recommended for the asymptomatic person despite pyuria or a urine culture suggestive of a UTI.
Diligent hand washing, hygienic practice, and use of aseptic technique are recommended. This may mean more frequent perineal cleansing, showers, or changes of urinary pads or underwear; antibacterial soaps for pericare; softer pads, toilet tissues, or underwear; instruction in or assistance with personal hygiene, e.g. gentle wiping from front to back after toileting; reduction of urinary retention or residual urine by complete and frequent bladder emptying. Urologic consult and treatment may be needed for frequent or recurrent UTIs.
While cloudy or foul-smelling urine does not always necessitate a UTI workup, a workup should be considered if the person has a previous history of UTI. Consider prophylactic cranberry supplements such as juice, capsules, tablets, or dried cranberries.