Urinary Tract Infection and Confusion

Delirium is an acute process, usually reversible and leads to a disturbance in attention and awareness that develops in a short period of time and can fluctuate throughout the day.
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Urinary Tract Infection (UTI) is very common in elderly people. For women over age 65, the incidence rate of UTIs is over 10 per cent and the incidence rate can increase to almost 30 per cent for women over age 85. Risk factors for developing urinary tract infections in the ageing population are different to those in younger adults. Age-associated changes in immune function and an increasing number of co-morbidities put the elderly at an increased risk for developing an infection.

In a person with memory impairment or dementia, it is always a challenge to get the correct diagnosis as infection in urine can cause sudden and severe confusion which in medical terms is known as ‘delirium’.A person with pre-existing dementia (memory issues) who gets an infection in urine may not be able to communicate especially if they develop an acute state of confusion due to delirium.

Therefore, it is very important to be familiar with the symptoms of urinary tract infection (UTI) and also the signs and symptoms of delirium in the elderly in order to seek medical help on time for prompt diagnosis and treatment.

If a lower urinary tract infection also called bladder infection (cystitis) is not diagnosed and treated on time it can progress to involve the kidneys and cause a more serious infection in the kidneys called pyelonephritis.

In adults’ symptoms of a bladder infection (cystitis) involve increased urinary frequency, burning sensation on urination (kahrun), blood in urine or change in urine colour and foul-smelling urine.

Fever is usually absent in bladder infection but can be a sign of infection in kidneys (pyelonephritis). Other symptoms might be nausea, vomiting, and abdominal pain, especially in the lower abdomen.

As against adults first, sign of bladder infection in the elderly might unfortunately present as confusion. It is very important to think about UTI if and when the elderly person suddenly looks confused, agitated or indifferent.

Delirium is an acute process, usually reversible and leads to a disturbance in attention and awareness that develops in a short period of time and can fluctuate throughout the day​. There are three subtypes of delirium - hyperactive, hypoactive, and mixed.

Patients with the hyperactive subtype may be agitated, disoriented, and delusional, and may even experience hallucinations (seeing or hearing something that does not exist). Patients with the hypoactive subtype of delirium are usually quiet and apathetic.

They may have blunted affect, decreased appetite, decreased motivation, and disrupted sleep patterns. Delirium in these patients may go unrecognized or be confused with depression or even dementia. The mixed subtype can have symptoms that might vary and be somewhere in between the hyperactive and hypoactive subtypes.

Institutionalised adults (those who stay in a nursing home, old age home, long term care facility) generally have more functional impairments, and a greater number of medical conditions compared with older adults living in the community.

All of these characteristics predispose this population to higher rates of urinary tract infection. The most significant risk factors associated with UTI in institutionalised older adults are the presence of a urinary catheter.

Medical conditions, such as stroke and dementia, which may predispose individuals to bowel and bladder incontinence (not having control over urine or stool), have been associated with UTI in this population.

Older adults who have difficulty with activities of daily living are also at a higher risk.

When an older adult looks confused or agitated a lot of people in Kashmir might go to the pharmacy and get some sleeping pills to calm the elderly patient, but it can actually worsen the situation as the underlying infection might go undiagnosed and lead to infection in the kidneys and eventually spread via the bloodstream to the whole body – a condition called sepsis.

It is important that family and friends who know the person well seek medical help if they see a sudden change in behaviour of an elderly family member. If the confusion is due to infection in urine, seeking consultation from a physician who specialises in treating elderly patients (Geriatrician) might be very helpful to get appropriate treatment. While family members are seeking help from appropriate doctors it is important that an elderly patient who is confused or agitated is offered support and measures are taken to keep them safe.

Dr. Mir is MD, FAAFP, Family Medicine Physician in Texas, USA

Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.

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