If you’ve ever had a urinary tract infection (UTI), you know how disruptive it can be. The urge to pee can make you feel like you can’t stray far from the bathroom. Meanwhile, painful urination may make you feel anxious to use the toilet. It can be easy to recognize UTI symptoms in our own bodies. Noticing them in others, such as older people with dementia, can be much harder but it’s crucial for their health and well-being.

UTIs can affect older adults differently — especially those with cognitive impairment, such as problems with thinking, memory, or focus. Their UTI symptoms may be broad and include cognitive and behavioral changes. A family member with dementia may be unable to let you know if they’re experiencing discomfort, pain, or other symptoms.

Learning the signs of a UTI can be helpful both for people with early-stage dementia and their caregivers. Here are some details on UTIs in people with dementia, including what to watch out for and how to help prevent them.

What Are UTIs?

UTIs are infections that occur when bacteria (germs) or other microorganisms enter the urinary system. Most often, bacteria enter through the urethra — the tube that connects your bladder to the outside of your body. Once in the urethra, bacteria may travel to other parts of the urinary tract, like the bladder and kidneys. Around 90 percent of bladder infections are due to E. coli bacteria.

UTIs are common — around 8 million to 10 million people are treated for them every year. UTIs are especially common among females, according to Cleveland Clinic, and older adults. A 2020 study found that people with dementia were more than twice as likely to be diagnosed with a UTI than people without dementia.

Risk Factors for UTI

According to Cleveland Clinic, UTIs are more common in females, partly because of differences in anatomy. Females typically have a shorter urethra than males, and it’s located closer to the anus. This makes it easier for bacteria like E. coli from the digestive tract to enter the urinary system

The risk of developing a UTI also increases with age. This risk is particularly high for women after menopause, according to Cleveland Clinic. Every year, UTIs are diagnosed in more than 10 percent of women older than 65 and around 30 percent of women older than 85. Lower estrogen, the thinning of tissue separating the urethra and vagina, and weaker bladder and pelvic floor muscles can all increase the risk of UTIs.

Older men with enlarged prostates also have a higher risk of UTI, according to Cleveland Clinic. The enlarged prostate can obstruct urine flow, preventing complete bladder emptying and creating a breeding ground for bacteria.

Other factors that can increase the risk of UTIs include:

• Catheter use, especially those that remain in the bladder
• Poor personal hygiene, such as wiping “back to front” after using the toilet
• Sexual activity
• Diabetes or other health conditions that cause a weakened immune system
• Pelvic surgery or radiation
• Some medications

Older people with dementia have a higher risk of UTIs due to:

• Difficulty practicing good hygiene — Things like bathing, changing clothes, and toileting can become harder as dementia progresses.
• Cognitive impairment — People with dementia may not be able to understand and identify UTI symptoms. Also, they may forget to drink water or refuse or forget to use the toilet.
• Use of incontinence products — These products, while helpful, can create a warm, moist environment that encourages bacterial growth if not changed regularly, increasing the risk of infection.
• Being in a long-term care facility — Maintaining optimal hygiene and frequent toileting can be more difficult in some facility settings. If the facility is short staffed, there may be fewer changes of catheters and incontinence products or other hygiene issues.

Types of UTIs

The urinary system includes the urethra, bladder, kidneys, and ureters (tubes that connect the kidneys and bladder). The different types of UTIs are categorized by which parts of the urinary tract are affected.

Lower UTI

An infection that involves only the urethra and bladder is called a lower UTI. With a lower UTI, physical symptoms may include:

• Pain or burning sensations when peeing
• Urgent need to pee
• Urine that smells bad or appears cloudy or bloody
• A feeling of not being able to empty your bladder fully
• Lower abdominal pain
• Urinary incontinence (leaking urine)
• Low fever (101 degrees Fahrenheit or below)

In elderly people, confusion or delirium may occur with a lower UTI. Delirium is a change in mental state that can affect awareness, attention, and cognition. It often appears as a series of sudden changes over the course of one or two days. One study reported that around 29 percent of older adults with UTI had delirium.

Delirium may present as:

• Restlessness
• Agitation
• Trouble concentrating
• Delusions or hallucinations
• Extreme tiredness or withdrawal

While UTIs don’t cause permanent damage to the brain or truly accelerate the underlying dementia, they can cause Alzheimer’s disease or other types of dementia to progress more quickly. So, any existing dementia symptoms, such as impaired cognitive function, may become more severe with a UTI but can also typically improve once the infection is treated.

Other symptoms of a UTI to look out for in older adults include:

• Dizziness
• Falling
• Poor motor skills
• Loss of appetite
• Inability to get dressed

Upper UTI

An upper UTI is an infection that involves the kidneys and ureters. These types of UTIs are more serious and can lead to kidney damage. This kind of infection is also called pyelonephritis.

Upper UTIs may present with similar symptoms as lower UTIs. Other symptoms specific to upper UTIs may include:

• High fever (above 101 F)
• Nausea with or without vomiting
• Shaking or chills
• Pain or tenderness in the loin or flank (the area above the hip and below the ribs on the side of the body)

This type of infection can also result in bacteriuria (bacteria in the blood), which can become a life-threatening condition called sepsis.

How UTIs Are Treated

UTIs can worsen dementia symptoms and lead to serious complications like sepsis (an extreme response to an infection). Because of this, it’s important that UTIs are diagnosed and treated quickly.

UTIs are usually diagnosed by urine culture — a urine sample that’s tested for bacteria. People with positive urine cultures and UTI symptoms are treated with antibiotics. Lower UTIs are often treated with a three-day course of antibiotics. Upper UTIs may be treated with a seven-day or 14-day course of antibiotics. More severe upper UTIs may require IV antibiotic treatment at a hospital.

To determine the cause of certain UTIs in males, a urologist (a doctor who specializes in the urinary tract and the male reproductive system) may perform more tests. Conditions like prostate disease and bladder stones can prevent the bladder from emptying and cause UTIs. Treatment depends on the underlying cause.

Tips To Help Prevent UTIs in People With Dementia

There are several things you can do to help your loved one with dementia lower their UTI risk. The best way to prevent UTIs is to empty the entire bladder every few hours. Caregivers should prompt their loved ones to use the toilet regularly and after sex. Make it as easy as possible for them to find and use the toilet.

Other ways to help your loved one lower their UTI risk include:

• Encourage hydration — Make drinks they enjoy available and easy to find. Aim for six to eight glasses a day and limit or avoid alcohol.
• Keep track of their fluid intake — Dehydration can result in concentrated urine that may be painful to pass.
• Help them to maintain good hygiene — Genitals should be washed one or more times a day with fragrance-free soap. Wiping the vagina “front to back” after using the toilet is important.
• Avoid constipation — If they’re constipated, they may not be able to empty their bladder completely. To avoid this, help them to follow a high-fiber diet, drink enough water, and exercise.
• Follow protocol to prevent catheter infections — If they use a urinary catheter, ask their provider for advice on how to best prevent infection.

For people with dementia who use diaphragms for birth control, consider switching to another method, as diaphragms can prevent the bladder from emptying fully. If condoms are used, choose a brand without spermicidal lubricant, which may irritate the urinary tract.

General tips to help prevent UTIs in older people include:

• Wearing cotton underwear
• Taking a shower instead of a bath
• Avoiding feminine hygiene products
• Limiting caffeine intake
• Limiting catheter use
• Drinking 100-percent cranberry juice or taking cranberry or vitamin C supplements.
• Taking probiotics or D-mannose supplements

Before starting any supplement, it’s important to talk with your healthcare provider. They can help you decide if it’s likely to help, recommend the right dosage, and guide you toward a reputable brand.

Talk With Others Who Understand

On myALZteam, the social network for caregivers of people with Alzheimer’s disease, members come together to ask questions, give advice, and share their stories with others who understand life with Alzheimer’s.

Has your loved one with dementia had a UTI? What signs did you notice? Share your experience in the comments below, or start a conversation by posting on your Activities page.