in an old person, what might happen if a UTI and breast cancer are left untreated?

[maxmissie]

My grandma, who is 91, has had a UTI almost permanently for the last year, if not longer. She has had several rounds of ABs, which temporarily clear it up but then it comes back. The GP has said that the option now is for her to either have a permanent course of ABs but my dad and aunt (who care for her) don't seem too keen on this because taking ABs permanently can make you more susceptible to picking up other things instead. Don't know if this is true or not but just wondered what could happen if she wasn't given ABs? It appears it could be very painful and could lead to blood and kidney infections which presumably in a 91 yo with dementia and limited physical capability would not be easy to fight off?

Also she has had a lump for a few years which has stayed the same until recently when apparently it has become inflammed and harder. It will be too difficult to take her to see the consultant again and in any case it would be too risky/difficult for surgery or chemo/radiotherapy. Therefore does anyone know what is likely to happen now in terms of implications for her health from this?

Thanks.

Is quite common and very useful to use low dose antibiotics to prevent uti, helps to prevent recurrent infection, usually use an antibtioic with narrow spectrum like trimethoprim which helps to prevent diarrhoea etc ass with antibiotic use. Shouldn;t effect her immune system really.

Re breast lump- could you talk to your GP- even without official diagnosis she could be referred to local palliative care team- will be very useful in terms symp control etc as well as letting you, your dad and your aunt know what to expect

As she is so old any cancer will be very slow growing indeed-she is much more likely to die of an untreated UTI.If her GP says she needs antibiotics she needs them.It is surely better to relieve the extreme discomfort she must be in now rather than worry about the future which at 91 is unlikely to be prolonged.It is surely cruel to deny her medicine.I would be very surprised if her GP accepts your dad's refusal of medication.

I've currently got a UTI, it's horrendous. I didn't go for antibiotics because last time they made me' ill, I'm very much regretting that at this moment in time. At your grandmas age I think I'd go with making her more comfortable and taking the small risk of further infections by getting her antibiotics.

She needs the abs. Untreated the UTI will cause her distress, make her acutely unwell and send her completely round the twist. UTI is the first thing to rule out when the elderly start behaving oddly.

The breast lump is likely to be another matter altogether. She's 91. If it is breast cancer then it's not going to noticeably shorten her life at this point. What's needed is symptom control - so if she gets pain that can be managed in the community. Other than tha I wouldn't be inclined to proble too much.

I'm not medically trained but I think that cancers in elderly people tend to spread very slowly. My aunt had breast cancer at 85, her doctor advised no treatment and she died from unrelated causes 4 years later.

I think UTIs can become very serious. I believe her kidneys could become badly affected. I believe that kidneys which are not operating properly can cause major health issues including heart failure.

In older people, low level UTIs can be responsible for mental confusion. Not to mention the pain that she could be in.

It doesn't sound at all sensible to limit antibiotics in her case. Some people have to take low doses of antibiotics all of their lives. Her doctor will have balanced the risks and suggested the best course of action.

Taking long term ABs will protect her kidneys and general health.

If she has breast cancer, then doing nothing can be very unpleasant. Radiotherapy to control it locally is very straightforward, and with very little side effect, so please get it looked at

CMOT - depends where the lady lives. Radiotherapy for patients living in my mid sized city requires a 30 mile journey each way. It's pretty knackering for the elderly - or anybody else.

I would worry about not letting her have antibiotics - surely she is in pain from the UTI? - also as someone else said, UTI's in the elderly can be quite nasty - my Dad used to get them and he would fall and lose use of his legs for several days and become very confused.

Regarding BC, - again I would want it to be investigated - it may not be BC and might be able to be treated fairly simply if it is some kind of infection.

If it is BC, radiotherapy could help her although I would think it would be hard to get a person with dementia to lie still for the machines, - you can't move around at all, and you are left in the room on your own which possibly she might find distressing.

I don't know if surgery would be an option for her - possibly it the lump could be removed.

I doubt that a lady of her age would be offered chemo - the chances of her surviving such aggressive treatment especially when she is poorly anyway, are not good unfortunately.

But as others have said it is definitely worth talking to experts about what can be done to help her - palliative care, drug treatment that is not chemo, MacMillan would also be able to advise on caring for an elderly person with cancer when they also have dementia.

So sorry your Grandma is poorly - what a worry for you and your family

Northern - where I live, patients travel up to 2 hours each way for rt. But the frail patients are admitted and have short courses to minimise impact.
But compared to the horror of fungating breast tumours it is worth it

Oh dear ,this issue of " should we go ahead with further ,possibly invasive treatment /cure might be worse than the symptoms " is such a hard one .

I saw my friends 96 year old mum having day visits ( up at 7 am for hospital transport ,not back until 7pm ,flat out for rest of week ) to treat Bowens disease .
And I really wonder if worth it .

My own mother is 92 and I worry each time I ask for investigations into any of her many problems .
It always seems that the HP just see and respond to the wound/lump/symptom and dont explain the treatment involved or the outcome of investigations .

Sorry I realise I'm off track here - UTI obviously needs treating ( but maybe GP not properly explained to OP's relatives ? ) - just feeling overwhelmed at the moment .

Many elderly seem to carry on into mid /late 90's .

This is my Nana's story, at 79 she was diagnosed with breast cancer, no treatment was given due to her age, at 86 she had the tumor removed as it was causing discomfort again no further treatment and she choose not to have other scans to see had it spread, she died at 98 so obviously in her case the lack of treatment was better then the side affects of treatment and probably gave her more time with us.
She was also prone to UTI [afraid of not making it to the toilet in time and so limited her fluid intake also lack of hygiene such as changing pads often enough] she was on antibiotics long term for a while and then we insisted they do tests and see what type of infection it was then she was blasted with very strong antibiotics which cleared it and we then had to monitor fluid intake to ensure that she did not become dehydrated and start a UTI again, we had a course of antibiotics to start her on at the first sign of infection as it was always a bank holiday or weekend.
Maybe a meeting with her DR who can explain the reasoning behind the treatments would help

Good post canyou

It is so hard to do the right thing in these situations, it is made a bit easier in that we are a medical family and know or can find out the options and explain and understand them through family members, we are also very practical to the point where it may seem cruel at times. We have the same feelings as any other person facing the same situation but we know that the path of least resistance may provide a better quality of life. We were lucky the path provided a better quality of life that gave an extended life span which while not with out stress and worry for us allowed Nana to enjoy her Great Grandchildren, our weddings and most importantly a cup of tea and a chat with a hug only a Nana can provide.
I hope what ever decision is made that you and your family can say we did everything possible she was happy and we have no regrets.

My grandfather died a painful miserable filthy death because he refused treatment for a uti. His kidneys failed in the end but not before weeks of chronic incontinence and him wasting away to nothing.

Give her the abs

SummerRain I am so sorry you went through that, it is so frustrating that when at their most vulnerable and ill [and not in a good place mentally] that people cannot help because the person said no. I do not agree with forcing medical treatment on anyone but something that causes confusion and temporary dementia that can be cured by antibiotics makes the situation so complicated, scary and with awful outcomes is so frustrating

Thanks for all your posts. I've been to see my grandma and dad today. The GP came out to see her last week and my aunt is going to see the GP again on Thursday to discuss my grandma's various ailments.

Re the UTI, it has definitely come back but at the moment doesn;t seem to be bothering her too much although this is probably because it's only in its early stages again. Going to give sample to GP I think but my dad was much more amenable to my grandma having ABs, I think he realises that the risks associated with ABs are much less than what would be likely to happen if she didn't have them.

Re the lump, it is definitely breast cancer, she saw a consultant fairly regularly a few years ago but as the lump wasn't doing anything or causing any problems I think she had tamoxifen and possibly other drugs for a bit but don't think she is taking anything specific for it anymore. My dad and aunt have agreed she won't be having any specific treatment or investigations other than for them to manage it (with pain relief etc) and I'm inclined to agree with them, it would be 30 mile round trip to the hospital for a completely confused old lady who can barely move and even with help it's almost impossible to get her to move across the room. She would be very distressed and confused by any attempts to get her out of the house, to have treatment and if required to stay in hospital. Also I imagine there would be a high risk attached to her having any treatment of her not surviving it.

She is also not sleeping very well, waking in the middle of the night and not going back to sleep and getting agitated and my dad doesn't know why. She then sleeps in the day ass she's tired and presumably then is into a cycle of sleeping at the wrong times. He gave her some morphine-based medicine last night which seemed to calm her down but he doesn't know if she went back to sleep or not. I think they are going to ask for some sleeping pills for her (which she's had before) to see if they will help.

She also appears to be having some pain in her hip - which I think she's had since having a hip replacement about 10 years ago or so. My dad and aunt don't know how much pain she is in and what might be causing this pain as she can't properly relay this info to them.

Hopefully the GP can give them some more info and the right medication to deal with each issue.

Thanks again for all the comments.

I've got to posts and run but just wanted to say my late granny became very confused when she had a UTI. She didn't have any symptoms other than being confused and slightly agressive- especially at night. GP did a urine test and lo and behold she had a UTI and was prescribed ABs straight away.

GP explained older people often get confused as the result of UTIs.

We had to sleep at her home until she was better as she was so confused at night.

She was much much better after her antibiotics. I would query why her doctor has not sorted antibiotics ASAP- its unlikely to be a good idea to delay as these things can get more serious quite quickly.