Suffering in Silence - Older Adults and the Prevalence of Urinary Tract InfectionsJune 9, 20213 min read
Considering the impact of urinary tract infections (UTIs) across the life course they are both underdiagnosed and under acknowledged particularly among older adults who are at an increased risk. With countries around the world experiencing unprecedented population ageing, it is important now more than ever to acknowledge and address the significant burden of urinary tract infections on older adults.
In a recent article entitled “Urinary Tract Infections 101: Improving Well-Being with Knowledge & Supports” CanAge, a leading advocacy organization in Canada has examined in detail the effects of both incontinence and UTIs across 6 key areas; 1) Violence and Abuse Prevention, 2) Optimal Health and Wellness, 3) Infection Prevention and Disaster Response, 4) Caregiving, Long-term Care, Home Care and Housing Resources, 5) Economic Security and 6) Social Isolation.
While UTIs affect people of all ages, older adults may experience more frequent serious complications such as sepsis leading to hospitalization. Understanding why older adults are at increased risk is crucial to determining opportunities to address this issue. Changes to hormonal, physical, and immunological responses to infections represent the broadest risk factors and can lead to changes in the function and structure of the bladder. Certain medical conditions often seen in older people such as stroke, diabetes, Parkinson’s disease and multiple sclerosis by their aetiology may also lead to changes in the normal functioning of muscles and nerves needed to control the bladder, leading to an increased risk for UTI development.
Diagnosis of UTIs in older people impact timely management and treatment. Hallmark symptoms such as pain when urinating or the frequent/urgent need to urinate may not be present in older adults or communicated effectively due to other conditions such as cognitive changes. Equally important is that health care professionals (and families) either may not be listening or hearing the nuanced conversations about symptoms that may be evident. Not all people, and not all older people are comfortable talking about their bodily functions.
The use and misuse of urinary catheters for older people is a growing concern in long term care facilities (LTCFs) and represents an additional risk factor. UTIs were the third most common reason for residents to be transferred to a hospital and across three surveys conducted in 18 Canadian hospitals, they were the most common healthcare-associated infection, with people aged 65 years and over consistently accounting for ~50% of these infections.
Increasing awareness of UTIs and their causes is imperative in driving preventative efforts. A systematic review of interventions to reduce urinary tract infections in nursing home residents reported that measures such as proper hand hygiene, reduced catheter use and duration, infection surveillance, better staff training, and standardizing diagnoses may contribute to improve care and reduced rates in long term care facilities. For older adults living independently simple lifestyle decisions such as staying hydrated, avoiding foods and beverages that irritate the bladder, healthy voiding habits and keeping pelvic floor muscles strong can be powerful habits for fostering urinary health across the life course.
For more information about the impact of urinary tract infections on older adults and strategies for prevention, diagnosis and treatment contact Ms Laura Tamblyn Watts, President and CEO of CanAge, and member of the IFA Expert Centre. Future articles in this invaluable CanAge UTI 101 series will explore prevention and treatment strategies, the stigma and social isolation associated with urinary incontinence, and the global health crisis of antibiotic resistance.
Laura Tamblyn Watts, LLB President and CEO
Nationally and internationally recognized expert on law and aging issues, with a specialty in law reform, policy, partnerships, and more.