How Urinary Tract Infections Affect People with Dementia

Sample, Please. A Urinalysis Can Detect a UTI in Dementia
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What Are Urinary Tract Infections (UTIs)?

UTIs are infections that occur anywhere in the urinary tract system. They are most often caused by bacteria but fungi and viruses can also cause them.

Symptoms of a UTI

  • Burning feeling while urinating
  • An increased need to urinate
  • Pain in lower abdomen, side or back
  • Blood in the urine
  • Urine that appears cloudy, dirty or has mucous strands
  • Urine with a foul odor
  • Fever

Symptoms of a UTI in Dementia

When someone with dementia develops a UTI, it can be more difficult to identify the signs. Because of word-finding difficulty, the person might not be able to express an increase in discomfort or identify an increased need to urinate.

Often, people who have dementia and who develop a UTI will experience significant behavioral changes. Any infection can trigger delirium, and UTIs are a frequent cause of delirium in dementia. You might see the following symptoms of a UTI in someone with dementia:

  • Increased falls
  • Changes in behavior such as increased aggression, agitation or anger
  • Changes in appetite
  • Sleeps more or less than normal
  • An increase in confusion and disorientation 
  • An overall decline in functioning not explained by another condition and that arises suddenly

Why Risks of UTIs Are Higher in Dementia

  • Hygiene problems: People with dementia are prone to use improper wiping techniques after using the bathroom, such as wiping from back to front instead of front to back. This can increase the spread of bacteria.
  • Women: Approximately two-thirds of people with dementia are women. Women also have an increased risk of a UTI because of how their urinary systems are structured.
  • Incontinence: As dementia progresses, the ability to control bladder and bowel urges declines. Low-quality adult incontinence pads can add to the problem because they don’t absorb urine well, which then causes it to sit right against the skin and increases the risk of infection, as well as skin problems such as pressure sores. Soiled incontinence products should be changed as soon as possible.

Should Catheters Be Used?

Catheters historically have been thought of as a way to respond to problems with incontinence, but their use is not recommended unless absolutely medically necessary. The insertion of a catheter can introduce more bacteria into the urinary system and this increases the risk significantly for UTIs. A UTI that develops in someone using a catheter is called a Cather Associated Urinary Tract Infection (CAUTI), and the medical community has worked hard to reduce these (often) preventable infections.

Catheters are appropriate for some conditions such as urinary retention, where someone is unable to completely empty their bladder, but they are not recommended without a specific medical condition that makes the necessary.


Most often, UTIs are treated with antibiotics. A sample of your urine is tested at a laboratory to identify which antibiotic is likely to be effective in treating it. Sometimes, physicians will start you on one antibiotic and then change it to a different one after lab results are available.

"I Know My Mother Has a UTI. Why Are They Waiting to Treat It?"

One of the challenges in healthcare is managing the use of antibiotics. Historically, antibiotics have been overused, and this has resulted in an increase in infections that are resistant to typical antibiotics. In other words, the bacteria have grown stronger and the usual antibiotics aren't always effective.

It's not unusual for a urine test of an older person to test positive for a UTI even if a person has no symptoms. In these cases, an antibiotic is not always needed, and over-prescribing them can trigger the bacteria to strengthen and become resistant, thus requiring stronger and stronger antibiotics.

In order to test for a UTI, many organizations such as nursing homes follow the McGreer Guidelines which require at least three of the following symptoms (fever, pain, increased confusion, change in urine appearance or odor, urgency or frequency) to be present before they will test and eventually order an antibiotic. These limitations were developed with the goal of using antibiotics wisely.

Preventing UTIs

The following strategies can help decrease the chance that a person with dementia will develop a UTI:

Encouraging adequate fluids can help reduce the chance of UTIs.

The person with dementia may need some extra assistance with cleaning themselves and wiping properly after urinating or having a bowel movement. Additionally, after sex, women should be encouraged to urinate because of the increased risk of a UTI.

  • Don’t Wait to Urinate

Holding your urine too long can increase the risk of a UTI.

  • Encourage Clothing that Can Breathe

Clothing that is too tight or underwear made from nylon as opposed to cotton can trap moisture and increase the risk.

Does Cranberry Juice Help?

Research has come up with different results on this question. Some studies have found a slight benefit of cranberry juice in reducing the risk of UTIs. Others have not found a difference when cranberry juice was ingested. You should check with you doctor first before adding cranberry juice to your diet on a regular basis because it can interact with other medications such as Coumadin (warfarin).


Advance Healthcare Network for NPs and PAs. UTIs in Nursing Home Residents: Better diagnosis would reduce antibiotic overuse. September 5, 2012.

Alzheimer’s Society. Urinary tract infections (UTIs) and dementia. Accessed February 2, 2016.

Center for Disease Control and Prevention (CDC). Urinary Tract Infection (UTI) Event for Long Term Care Facilities. August 24, 2012.

Clinics (Sao Paulo). 2012 Jun; 67(6): 661–667. Cranberries and lower urinary tract infection prevention.

Cochrane. Cranberries for preventing urinary tract infections. October 17, 2012.

Journal of the American Medical Directors Association. 2016 Feb 1;17(2):183.e1-183.e16. Antimicrobrial Stewardship in Long-Term Care Facilities: A Call to Action.

National Institutes on Health. The National Institute of Diabetes and Digestive and Kidney Diseases. What I Need to Know about Urinary Tract Infections. September 2013.

Palmer, R.  Eastern Virginia Medical School. November 2, 2011. Urinary Tract Infections: LTC Facilities.

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