Is The Diagnosis Of A UTI Different For Older Adults?
It’s a common misperception that older adults have different symptoms or that they may have a UTI without symptoms, says Parker-Autry. “To be correctly diagnosed with a UTI, a person needs to have overgrowth of bacteria in the urine and symptoms that are consistent with a urinary tract infection,” Dr. Parker-Autry says.
Some symptoms that people assume indicate a UTI, such as a change in urine odor and confusion in older adults, often result from other conditions. A doctor should rule these out before testing for a UTI. Generally, a doctor shouldn’t order a urine culture unless patients have symptoms consistent with a urinary tract infection, including burning during urination, frequent urination, or abdominal pain or tenderness in the back near the lower ribs.
“Often, there can be an assumption that when an older adult comes in with confusion, this is associated with urinary tract infection because they have an overgrowth of bacteria in the urine,” says Parker-Autry.
But one thing that does change with age is that this overgrowth of bacteria, called asymptomatic bacteriuria (ASB), is more common than in younger adults, says Parker-Autry. “Asymptomatic bacteriuria is the presence of bacteria in the urine of a person who has no signs or symptoms of a UTI, and it’s not the same as having a urinary tract infection, or UTI,” she says.
It’s estimated that 20 percent of older males and up to 50 percent of older females in nursing homes have ASB, according to a review.
The distinction is important because most people with asymptomatic bacteriuria will never develop a UTI and won’t benefit from treatment. However, an inability to completely empty the bladder, or urinary retention, can heavily affect the risk of asymptomatic bacteriuria becoming a full-blown UTI, as well as other complications like sepsis. Doctors should also check post-void residual volume (how much urine remains in the bladder after a person goes to the bathroom) as part of their workup.
Home UTI Tests
“Taking an at-home UTI test is a convenient option,” says Ronan Factora, MD, a physician at the Center for Geriatric Medicine at Cleveland Clinic in Ohio. “You just have to be careful that you do that test in the context of the presence of other symptoms, because if you test positive, the next question is, ‘What are you going to do about it?’” he says.
The person undergoing testing should have UTI symptoms that make you think there’s something going on, says Dr. Factora. “If they have the symptoms of a urinary tract infection, do the test, and that way, if it’s positive, they can receive treatment as if it’s a true infection. But if there are no symptoms, and you do it, and it’s positive, that needs a different approach as it doesn’t necessarily indicate a UTI,” he says.
A urine culture offers an advantage, especially if a person has had recurrent urinary tract infections or they’ve been on a lot of antibiotics, says Factora.
“That’s because the results of that culture can show which bacteria are causing the infection, and therefore which antibiotics will or will not work to treat the infection in that person. That’s not something that the home test will tell you,” he says.
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