Differentiating between urinary tract infection and asymptomatic bacteriuria can be a challenge in older adults. It can be difficult to identify patients who have atypical symptoms to make a diagnosis of urinary tract infection. In the absence of classic symptoms and positive urine cultures, there is often unnecessary prescription of antibiotic therapy. Asymptomatic bacteriuria can persist in older people and evaluation of other signs and symptoms like abdominal pain and urinary frequency can be difficult in confused or cognitively impaired patients. This review describes the epidemiology and risk factors for urinary tract infection in older adults, the role of urine dipstick testing and urine cultures, the treatment of uncomplicated urinary tract infection, catheter‐associated and complicated urinary tract infections, and antibiotic prophylaxis for recurrent urinary tract infections.
Orthostatic hypotension (OH) is common in older people and is associated with a range of adverse outcomes. Although agerelated changes like decreased baroreflex sensitivity make older people prone to OH, medications are often a contributor. Diagnosis of OH can be challenging in older people, because the condition may present with atypical or non-specific symptoms, such as visual disturbances, shortness of breath, mental fluctuation. Non-pharmacological management is often a starting point for OH treatment. Fludrocortisone and midodrine remain the most studied drugs for pharmacological management, but newer agents are being tested. In this review we present the current evidence for existing and emerging treatments for OH and address the management of supine hypertension associated with the treatment of OH in patients with autonomic failure. In the management of OH, it is imperative that treatment is tailored to the individual, rather than focusing on attaining an arbitrary blood pressure target.
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