Urinary tract infections (UTIs) are the most common type of bacterial infection in older adults. Seniors often experience different UTI symptoms than younger or middle-aged adults. In severe cases, UTI symptoms in seniors can include other systemic and psychological symptoms, like fatigue, agitation, delirium, and changes in behavior. When left untreated, UTIs in the elderly can be dangerous, even resulting in permanent kidney damage or sepsis — a life-threatening infection. It’s important for family caregivers to understand how UTIs affect the elderly, how to recognize symptoms of this common infection, and how to prevent them.
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Seniors may not notice a mild UTI infection right away, as the physical symptoms may be more subtle in older adults. Physical symptoms of a UTI include:
Sometimes a senior may not have physical symptoms at all until the infection has become severe.[01] For instance, burning during urination may not be present, but flu-like symptoms might.[02]
Symptoms of a severe UTI in the elderly may include:
The immune system of an older adult reacts differently to infection compared to younger people.
“A bladder infection places stress on the body,” says Dr. Mary Ann Forciea, an associate clinical professor at the University of Pennsylvania Health System in Philadelphia.
That stress can result in confusion and abrupt changes in behavior in older adults with a UTI. And for seniors with Alzheimer’s disease or other types of dementia, the infection can make dementia symptoms worse.
“Any kind of stress, physical or emotional, will often make dementia temporarily worse,” Forciea says.
Seniors tend to have weaker immune systems and can have more problems emptying their bladder completely, causing bacteria to develop in the urinary system. Men and women older than 65 are at greater risk for UTIs, with those over 85 at an even greater risk.[01]
Other risk factors for UTIs in older adults include:[02,03]
In older men, UTI risks can also involve a common condition called benign prostatic hyperplasia (BPH) or an enlarged prostate gland. The enlarged prostate blocks the flow of urine and prevents the bladder from fully emptying.
As women age, the bladder muscles can weaken and prevent the bladder from emptying completely, increasing the risk of UTI. Women also produce lower amounts of estrogen after menopause. This can create an imbalance of bad bacteria in the gut biome, which can lead to more infections.[02,03]
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UTIs are diagnosed using a simple urine test called a urinalysis, which can confirm the presence of bacteria in the urine. Some UTI tests can be provided over the counter in a drug store. To get the most accurate test — one that can identify the specific type of bacteria behind the infection — it’s best to visit a doctor’s office.
Depending on the health of the senior and whether their urinary tract infections are considered “recurring,” antibiotics are typically the first course of action by doctors. However, even with the presence of bacteria in the urine, antibiotics may not always be the best course of action. Overuse of antibiotics can potentially make a urinary tract infection worse in the long run, with antibiotic-resistant UTI bacteria becoming increasingly common.[03]
To best avoid this, doctors should request a “culture and sensitivity test” of the UTI bacteria to identify the best type of antibiotic to combat it.[02] If the UTI is recurring, even after a course of antibiotics, doctors may suggest other options that focus more on prevention. Treatment for a UTI may take several weeks, involving lifestyle changes, and, for senior women, it could even involve hormone therapy.[02,03]
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The American Medical Association and the National Institute of Aging suggest these lifestyle strategies to help prevent UTIs in the elderly:[02,04]
Dr. Forciea recommends older adults drink at least four to six 8-ounce glasses of water a day. Consult with a doctor to ensure your liquid intake is right for your needs. Forciea further notes that drinking pure cranberry juice or taking cranberry tablets can make urine less inviting for bacteria.
If your loved one has symptoms of a UTI, it’s important to make an appointment with their doctor right away. If symptoms are severe, call the doctor immediately to determine whether a trip to the emergency room is necessary.
Yes, seniors can die from complications related to a UTI infection. Seniors with a UTI are at a higher risk of death from this infection than any other age group due to complications with persistent systemic infections.
Yes, chronic UTIs can contribute to both high blood pressure and low blood pressure in elderly adults.
Yes, a UTI can cause paranoia in the elderly, especially if the senior already has a dementia diagnosis or symptoms and if the infection is in advanced stages.
Yes, a UTI can cause hallucinations in the elderly, especially if the UTI has progressed to a severe level.
Yes, chronic and severe UTIs can cause dizziness and delirium in the elderly.
Supplements that can help treat or prevent UTIs include pure cranberry juice or tablets along with D-mannose, vitamin C, and probiotics. Doctors also recommend avoiding sugar, sugar substitutes, alcohol, and caffeine.
Yes, UTIs are a risk factor for seizures in people with a history of seizures.
No, you should not treat asymptomatic UTIs with antibiotics, as antibiotics might only worsen the condition in the elderly. Instead, you should work to prevent future UTIs with lifestyle choices to promote a healthy gut biome and keep the unhealthy bacteria low.
Rowe, T.A. & Juthani-Mehta, M. (2013, October). Urinary tract infection in older adults. Aging Health.
American Medical Association. (2023, March). What doctors wish patients knew about UTI prevention.
Cleveland Clinic. (2018, March). The truth about UTIs in older adults.
National Institute on Aging. (2022, January). 15 tips to keep your bladder healthy.
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