Urinary Tract Infections in Older Adults: Dehydration
Urinary Tract Infections in Older Adults: Dehydration
August 3, 2024
Joy Stepinski, MSN, RN-BC
Urinary tract infections (UTIs) are a common problem in older adults. General symptoms include painful urination, the urge to void frequently, bloody urine, and lower abdominal pain or cramping [1]. The infection can migrate to the kidneys, causing chills, nausea, vomiting, and low back pain. Of note, the older adult can have a much different clinical presentation, in which atypical symptoms may manifest as confusion, delirium, lethargy, and new incontinence [2].
The prevalence of UTIs is quite high. In the community setting, UTIs are the second most common infection among older women and the most frequent infection in hospitals and long-term care. Certain risk factors include female gender, advanced age, chronic disease, previous UTIs, and the insertion of a urinary catheter in the healthcare setting. Physiologically, women have shorter urethras and may be prone to intestinal bacteria. UTI recurrence (three episodes in 12 months or two in six months) can happen in 20 – 30% of women [3]. Often, treatment consists of antibiotics. Yet without prudent use, these medications can cause multidrug-resistant organisms, an imbalance of the gut microbiome, and other consequences.
Nonpharmacological strategies are discussed in the literature. in the literature, including increased water intake. Dehydration, even mild, can be a culprit. Drinking water may not be prioritized, especially when older adults experience swallowing difficulties, fear of falling when using the toilet, or diminished thirst.
One 2019 study had positive results from encouraging 150 residents, more than half diagnosed with dementia, to increase water intake. Staff encouraged the residents to drink water seven times during the day. The goal was for each resident to drink 6 – 8 glasses daily. The results showed that the amount of UTIs requiring antibiotics decreased by 58% and hospital admissions by 36%. The results were sustained for two years before publication.
Similar research of 116 senior residents showed dehydration increased UTIs by 40 times [4]. Factors associated with UTI development were analyzed, along with urine samples. The authors related that the relationship between diuretic use and dehydration was notable. Diuretics cause urinary frequency and increased incontinence, as well as dehydration due to increased water elimination [5]. The drugs can increase a UTI diagnosis by three times. Staying hydrated is one solution to prevent infection.
References:
1. Rodriguez-Mañas, L. (2020). Urinary tract infections in the elderly: a review of disease characteristics and current treatment options. Drugs in Context, 9. https://doi.org/10.7573/dic.2020-4-13
2. U.S. Government Accountability Office. (n.d.) Prescription drug spending. https://www.gao.gov/prescription-drug-spending
3. Lean, K., Nawaz, R. F., Jawad, S., & Vincent, C. (2019). Reducing urinary tract infections in care homes by improving hydration. BMJ open quality, 8(3), e000563.
4. Silva, J. L. A. D., Fonseca, C. D. D., Stumm, E. M. F., Rocha, R. M., Silva, M. R. D., & Barbosa, D. A. (2021). Factors associated with urinary tract infection in a nursing home. Revista Brasileira de Enfermagem, 74(Suppl 2), e20200813.
5. Puga, A. M., Lopez-Oliva, S., Trives, C., Partearroyo, T., & Varela-Moreiras, G. (2019). Effects of drugs and excipients on hydration status. Nutrients, 11(3), 669.