Urinary Tract Infections in Nursing Homes
A urinary tract infection (UTI) happens when bacteria inflames any section of the urinary system: kidneys, ureters, bladder, and urethra.
It is most prevalent in women, but aging adults in general experience more UTIs, with as many as 30% of women over the age of 85 experiencing a UTI in the past 12 months, according to the National Institutes of Health.
Several factors increase the likelihood of urinary tract infections in nursing homes, including:
- Catheter use
- Co-existing medical conditions, which can hide or worsen symptoms of UTI
- Higher rates of cognitive illnesses, like dementia, which can lead to confusion or difficulty explaining symptoms
- Weakened immune systems from aging
“The UTI is the second most commonly diagnosed infection in long-term care residents, compromising a third of all nursing home-association infections.” – National Institutes of Health
Some symptoms of a UTI are:
- A strong, persistent urge to urinate
- Burning sensation while urinating
- Cloudy urine
- Pain in the center of the pelvis and the pubic bone area (in women)
- Red, bright pink or cola-colored urine, signaling blood in the urine
- Urine with a strong odor
If left untreated, UTIs can cause long-term complications like:
- A narrowing of the urethra in men
- Blood poisoning, or sepsis
- Permanent kidney damage
- Recurrent infections
All of this adds up to a painful, potentially deadly, health risk for seniors in nursing homes.
Causes of UTIs in Nursing Home Residents
There are many types of UTIs, but the source is the same: bacteria entering and infecting the urinary tract system. The most common point of entry is the urethra.
- Infection of the bladder is typically caused by Escherichia coli (E.coli). It can be caused by sexual intercourse or when bacteria travel from the anus to the urethral opening and infect the bladder.
- Urethritis, or infection of the urethra, is also caused by bacteria from the digestive system infecting the urethra. Sexually transmitted infections like chlamydia, herpes, and gonorrhea are also culprits, especially in women.
- Suppressed immune systems caused by diseases like diabetes or the result of cancer treatments can heighten the risk of a UTI.
- The use of catheters to help people who cannot urinate on their own brings a higher chance of a UTI.
Many urinary issues in the aging population are tied to dehydration. Older adults drink less because they know they have difficulties in the bathroom or they are afraid of incontinence. This leads to more concentrated, bacteria-rich urine.
Older women experience estrogen deficiency, which impacts the vagina’s protective bacterial colonization. Aging men have difficulty with their prostate, leading to urine retention and bacteria entrapment.
Negligent nursing home staff mishandling catheters are a common source of UTIs in the elderly. Conversely, a diligent staff educated in catheter safety can make a huge difference in cutting down instances of UTI.
A study presented at the American Geriatrics Society annual meeting reported that nursing homes using a toolkit with proven infection-prevention practices saw a 54% drop in UTIs at 404 nursing homes.
Signs and Symptoms of UTIs
Some of the signs and symptoms of a UTI include:
- A burning association with urination
- A persistent urge to urinate, but with only a few drops passed
- Pain or pressure in the lower stomach or pubic area
- Strong-smelling urine
If a UTI is left unchecked or if it progresses into the kidneys, the symptoms become more dangerous and pronounced.
These symptoms include:
- Fever and chills
- Lower back pain
- Nausea and vomiting
UTIs and Delirium
Delirium has long been linked as a symptom of UTIs, but recent evidence brings that connection in question.
The long-standing argument is that advanced infections pollute the bloodstream and negatively affect the brain. Other medical evidence suggests that both delirium and UTIs are already common in the elderly, so a positive test result develops a false link between the two.
Complications Related to UTIs
UTIs are relatively common at every stage of life and are easily treatable with antibiotics. However, failure to remedy a UTI, either through nursing home negligence or ignorance, can cause long-term issues.
Just about every infection can eventually lead to sepsis. Commonly referred to as “blood poisoning,” sepsis happens when the body releases chemicals into the bloodstream to stop an infection. This flood of chemicals causes disorder in the body and can damage multiple organs.
Septic shock follows sepsis, causing a dangerous drop in blood pressure and eventually death.
UTIs in the kidneys can result in permanent kidney damage.
A lifetime of recurring UTIs (two or more in a six-month period) can also be the result of untreated infections.
Preventing and Treating Urinary Tract Infections
Prompt medical attention and antibiotics will clear up most urinary tract infections in roughly 48 hours. If UTIs are a persistent problem, doctors will take a closer look at what’s causing the infections.
Some diagnostic techniques include:
- Analyzing a urine sample for white blood cells, red blood cells or bacteria
- Identifying the bacteria causing a UTI through lab tests
- Inserting a scope into the urethra and bladder to scan for problems
- Searching for abnormalities in the urinary system using imaging like an MRI or CT scan
Some general preventative measures include:
- Cranberry juice is not medically proven to prevent UTIs, but it is a commonly accepted preventative measure
- Frequent water drinking and urination keeps the urinary system flushed and clear of bacteria build-up
Steps for Family Members
When you entrust your loved one to a nursing home, you should expect the highest-quality care. However, diligence is necessary to make sure that care is provided.
Some steps you should take include:
- Communicating with staff about special needs and following up on those instructions
- Ensuring prompt medical care for any health concerns or consulting with nursing home medical staff
- Regularly checking in with your loved one
There are also legal steps a family can take if their loved one suffered a serious UTI due to nursing home staff negligence.
Legal Options for Urinary Tract Infections
UTIs can occur at any age, but the elderly are among the more vulnerable populations.
A variety of factors, including prostate and vaginal weaknesses related to aging, weakened immune systems, and frequent catheter use, increase the risk.
Proper sanitation habits can reduce the odds of a UTI developing, and prompt medical attention can clear up a UTI in as little as 48 hours. However, when nursing home negligence keeps this from happening, the impact can cause permanent damage to a loved one’s health.