UTI In Elderly

[Lallybroch]

My mum is 74, not in good health and is having recurring UTI's. These literally knock her off her feet, causing her to be more unbalanced than normal. Last week she was on the floor for 3 hours before we found her (an alarm should be delivered tomorrow). Is there anything I can suggest to her (other than drinking more water), that may help prevent further problems?

It may sound obvious, but has the cause been identified?

Has she had any tests?

My MIL, who is 88, is on low level antibiotics for this. Seems to have helped her. Might be worth asking about?

I know you said other than drinking more water but.... do you know how much she actually does drink?

Only reason I’m asking is because when I was working in care a lot of the older people would need reminding to drink a lot otherwise they would happily choose just one or two drinks all day, especially when mobility made it hard work to be getting up and down constantly. You say she is in poor health and her balance is worse during an episode so there is a chance she leaves it until she really needs a drink as getting water may be hard work for her or she could worry about her balance. It’s a big part of the reason why care homes ensure jugs of squash or water are on residents side tables and kept topped up and why glasses are constantly refilled in communal lounges, as well as tea trolleys multiple times a day.

Obviously get everything checked medically and ensure she isn’t struggling to take care of her personal hygiene ( improper washing and wiping will all cause UTI even in people less prone) but it might be worth making water more accessible, maybe with a not too heavy water filter jug and glass available next to the chair she uses most. If you visit top it up so she doesn’t have to.

Can you increase her package of care to push fluids and also walk her to the toilet and find her if she falls. Some areas will also have a community falls team who can assess the house for falls safety (I’m west of Scotland and have referred to them before).

She needs to keep mobile and keep drinking - lack of fluids leads to low BP, which leads to falls, it's as simple as that. Older people drink less as it's harder to get to the loo, but they don't realise the consequences could be falls, broken bones and head injuries! UTIs also cause temporary delirium in the older patient ie confused state.
If she needs one, get her a walking frame, encourage her to practice getting up from the chair more often, even get her a commode for downstairs if she needs it or incontinence pads. Explain why drinking enough is so crucial, as this is a major cause of hospital admissions in older people.

What's the situation? Is she living alone? Does she have any carers going in daily either family/friends or official?

It's very common in the elderly and as pps have said there are behavioural reasons why it happens.

I'm not even elderly and I'm guilty of doing the same! Because it hurts me to move and going to the toilet is problematic for me I'm reluctant to drink but I make myself or try to. I have some drinks in my room as well as in kitchen to try and motivate myself to drink more.

They're reluctant to drink because fetching a drink is a pain (literally) also because they get fed up going to loo a million times a day, which may also be causing them pain.

They may also be worried/embarrassed about incontinence issues. Which ironically are more likely with repeated uti's. So honest conversation and address the issues here. Consider incontinence pants (actually quite comfy) or other equipment.

Making it easier physically to have drinks - a flask of hot or cold preferred drink or jug of water placed easily to hand, lightweight mugs/cups to use, mobility aids to make getting drinks, getting to loo easier.

Also consider high water snacks, melon, grapes, oranges, soups, even ices as a way to get more fluid into them and stimulate their desire to take in more fluids.

Is the loo easy to use/comfortable? Does the seat height need adjusted? Does she need a handrail? Has she got to go upstairs to go? Would a soft seat be helpful?

What's the situation for needing loo when in bed? Is it hard to get out of bed, is the loo downstairs and she is put off by that?

Lots to consider.

You can buy home testing kits, in some chemists. My elderly mother suffers with U.T.I.'s, I test her every month, as she tends to lose the plot, when she has one. I encourage her to drink more, but it's never easy.
It's better to catch it early on, before it really takes hold.

Thanks everyone, you have all given me lots to think about. My brother lives with her, but she has a really strong personality so he doesn't argue with her if she says she doesn't want to do something. I don't think she drinks enough and need to sit down and have a chat about the consequences I think. I had a stair lift put in, so no problem getting to the bathroom and she will use the frame that I put around the toilet,, but not the riser seat. I also bought a walking frame, which she was refusing to use but since her fall last week she is using it a bit more. I think it might be a good idea to talk to the nurse/gp about how often they are recurring.

Find out from GP what bacteria are causing the UTIs (assuming they've tested). If E. coli, try a supplement called Waterfall D-Mannose. It's bloody brilliant; I suffered recurring UTIs for years, tried this and they disappeared never to return. Only works for E. coli though.
In addition, make sure her fluid intake is good. Lemon Barley water is good for the bladder.

If the UTIs are recurring it might be a good idea to ask if she can go on a longer course of antibiotics to try and properly clear it up and then to take one a night to try prevent them coming back. Rather than her having loads of UTIs it could be the same one that hasn’t properly gone. Dipstick tests and lab results dont reliably show whether someone has an infection but if she’s going a lot, if the urine is cloudy, strong and possibly smelly and especially if she’s extra wobbly or confused then odds on she has, regardless of what any tests show.

UTIs can be very stubborn and hard to get shot of and the short courses prescribed often just damp them down temporarily and a few weeks later all the symptoms are back again. I ended up forking out to see a specialist in London with a similar problem and whereas dipstick tests often say +2 for leukocytes at my GPS this guy looked at a sample under a microscope and measured them at 120. I’m on a double dose of antibiotics for possibly up to a year. While mine is an extreme case, it might be that 3-7 days of antibiotics aren’t clearing up your DMs infections.

Often older people’s sense of thirst diminishes and while she doesn’t need to drink loads she does need to drink enough to keep her BP levels ok and to not be dehydrated. If plain water isn’t something she’ll have easily then anything she likes is ok - fruit juice,tea etc are fine.

Cranberry juice or cranberry tablets every morning ????