Urinary Tract Infection in the Elderly: A Population Study

Abstract

A study has been made of urinary infections in 466 old people living at home. Bacteriuria was present in 17 per cent of women and 6 per cent of men.Women with urinary infection had a significantly higher parity than those without infection, but there were no significant differences between the two in respect of urinary symptoms, previous operations on the urinary tract, blood pressure, renal function, haemoglobin, white cell count, or erythrocyte sedimentation rate.Comparison between subjects in the community with urinary infection and hospital patients showed that the latter had a higher frequency of infections with organisms other than EschericJria coli, particularly Proteus. Strains of E. colt isolated from hospital patients were conaiderably more often resistant to antibacterial agents than strains from infections in the community.

Mortality in Relation to Urinary Characteristics in the Very Aged

“…Most cases of chronic pyelonephritis originate in early childhood [2,6], and most people with this condition would presumably not live to a great age. This finding is also in accordance with observations that bacteriuria is, mainly, a harmless condition of the lower urinary tract [1,16], although differing views have been put forward regarding old people [17], Antibacterial medication killed the bacte ria in the urine of the very aged but did not produce a decrease in leukocytes [10]. Pyuria, hematuria and albuminuria are probably in dicators of some factor causing higher mor tality, but asymptomatic bacteriuria has no relation to survival, therefore prescribing an tibiotics is irrational in this situation.…”

“…Bacte riuria is, to a large degree, an ailment of old women [1,3,14], In elderly patients asymp tomatic bacteriuria has been associated with increased mortality [4,5,13,15], but the causes of the increase have not been ex plained and may not necessarily be related to the bacteriuria per se [12], People who live long constitute a select group with a large number of urinary findings [ 10]. There are no data on the significance of these urinary find ings.…”

Unique Aspects of Urinary Tract Infection in the Geriatric Population

“…Ta ble I summarizes several studies that re ported the prevalence of bacteriuria in elderlypatients according to their residential status [1,4,5,7,9,10,16,30,32,35,37], Bacteri uria increases with obstructive uropathy, poor bladder emptying, uronephrolithiasis, dementia, stroke, diabetes mellitus, and car diovascular diseases [31. 38], Etiology Healthy, ambulatory young adults with UTI have Escherichia coli as the etiological pathogen in 80-90% of cases [2,36].…”

“…When geni tourinary symptoms are present, they com monly include nocturia, incontinence, stress incontinence, or urgency. However, those same complaints may be present with equal frequency in elderly persons without bacteri uria [1,4], Moreover, such nonspecific or atypical symptoms for UTI as lethargy, an orexia, dementia, or confusion may be the only or initial clinical features of bacteriuria. Some of these manifestations may be second ary to bacteremia or urosepsis.…”

Bacteriuria and urinary incontinence in aged female nursing home residents

“…. J ,,,,,11 1 .1 LU I rrr ated With bactenuna in the female nursing home resident associated with UI which are also assoaated with UTI , , , , , 1 J , ,1 ti jj J 1-who IS already known to be mcontment include age, environment, neuropathic bladder, demenha and unpaired mobihty (Akhtar et al 1972, Brocklehurst et «i 1968, Brocklehurst et al 1972, Creason 1986, Fekety et fjjE PROBLEM «/1984,Ouslanderefa/1982 Brocklehurst et al (1968) mduded noduna, dif&culty in passmg unne, diumal frequency, precipitancy, scalding and mcontmence Sourander (1966) studied a set of symptoms labelled as disturbed voiding which mduded mcreased frequency, difficult voiding, painful voidmg and mcontmence In addihon, the terms cyshhs, bladder lmtahon and bladder dysfunchon are seen throughout the bterature Systemic symptoms of UTI mdudmg fever above 101°F, nausea, vomitmg and costovertebral tenderness are mdicahve of a conconrutant infechon in the kidney or some other part of the body (Braunwald rf fl/ 1987) Unless the presentmg symptoms of the UTI mdude dmically significant manifestahons such as cystitis, bladder lmtation, fever and tachycardia, many physiaans are unwillmg to inshtute anhbiotic therapy for the patient (Fekety et al 1984) Although non-treatment for asymptomatic bactenuna is supported m the bterature (Akhtar ei al 1972, Brocklehurst ei al 1968, Kaye 1980, Sourander 1966 no research has adequately exammed the effects of treatment on those who are also mcontment and/or unable to adequately articulate their symptoms or concems to the nurse…”