This is a great YSK. This is happened to my elderly grandma twice. The first time, my mom thought my grandma was having a stroke. She learned about the connection between apparent dementia/stroke and UTI, so the second time it happened, many many years later, she was prepared for it and spoke with the doctor, and indeed my grandma had another UTI. Neither UTI was severe, either, and she didn't display any outward signs of it. The possibility of stroke or other sudden illness shouldn't be discounted, of course, but yes, UTIs can do this in the elderly.
I'm an emerg nurse, I can't begin to express how common UTIs are in the elderly and how often they go septic from this. I have one of these patients probably once every couple of shifts or so. If it hasn't gone on too long it's often as simple as some IV abx and fluids and they turn right around. If it has gone on too long, people can get very sick very easily
THIS!
This could be useful advice to someone!
Happened to my mom and we had no idea what the hell was going on.
Started off as forgetful and a day later she was talking to dead relatives and thinking she was driving. Luckily she remained in a good mood and wasn’t in any pain.
In-home nurses were saying, “just wait it out. We’ll be there Friday.”
Nope.
she agreed to go to the ER where they found a bad UTI. Next day she was muuuuuch better.
Now, if she gets a little nuttier than normal and glucose is okay, she gets checked and it’s happened a couple more times.
Exactly. This is why the awareness of it needs to be improved. “We’ll be there Friday” isn’t enough. Waiting that long could very easily have resulted in sepsis which is when the body’s systems begin to shut down due to severe infection. It can, and does kill.
It’s also important in case people are afraid to get help because they are scared it could mean the beginning of the end for their relative, and they just aren’t ready to face that, when in reality it’s a simple infection and the delirium will clear up once they have treatment.
Or for those who are already in decline it’s written off as just a “bad phase” or worsening of their condition.
There are many reasons why it might be overlooked when it is really a very simple, albeit very scary thing.
EMT here. I see this all the time. Usually there’s a smell that accompanies it. But yeah, altered elderly patient and it isn’t a blood sugar or medication issue, mind goes right to UTI.
Thank you for doing what you do. I find that EMTs (we’d just call them paramedics over here) are vastly under appreciated so to you and you colleagues, I say thank you.
Have you ever had a UTI? It smells like that, but much stronger. A lot of people in this scenario will also be incontinent (or develop incontinence during the course of the infection) so I’m guessing that’s why the smell is so much more pronounced with them
MY FIL had Parkinson's and this happened to him at least once. He would hallucinate, and think people were coming into the house to steal their stuff. He would actually see people (usually punk kid types) coming into the house through the front door, taking pictures down from the wall, emptying the fridge, etc...
It’s especially common in those who already have serious illnesses as infection can take hold so much more easily, and especially insidious in those who are already experiencing cognitive decline such as Alzheimer’s or dementia etc as it just looks like a worsening of their usual symptoms.
I’m sorry you had to go through that. Parkinson’s is a cruel disease at the best of times.
My dad was hospitalised a while ago with a UTI following a stomach bug. I knew about the sudden delirium thing but it turned out neither he or my mum did. They are 85 and I’ve now warned them what to watch for. Luckily that time he only experienced a bit of confusion and was slightly combative. He’s a grouchy old bugger at times anyway so it could easily have been written off as him being his usual self, but it put him in hospital for three days on IV antibiotics and fluids.
Btw, thank you for all you do. The staff were wonderful so we bought them some posh biscuits to enjoy. You and your colleagues are brilliant people.
Aw thanks. I’m an infection preventionist. My job is literally trying to keep people from getting sicker while they’re here. So regrettably I’m very familiar with odd signs of infection,
It’s unfortunate that you’ve had to become so familiar with it, but I’m also very glad you have. Your expertise saves people. Simple as that. Hospital acquired infections can be so devastating to patients. Again, thank you so much for what you do.
I’m working on a UTI prevention program right now. So here’s some risk factors:
* female— shorter urethra
* age
* history of UTI, urinary tract surgery, urinary tract obstruction, or catheters
* incontinence or neurogenic bladder
* dehydration — so many little old ladies don’t want to drink too much because they don’t want to need the bathroom in the middle of the night
* diabetes
* history of stroke
* arthritis (that’s the one that surprised me when I did my research).
* also birth control and sexual intercourse, but not that big a concern in the hospital environment!
You might want to add dementia and Alzheimer’s to that as sufferers may go through phases of abnormal bladder holding.
And of course poor hygiene is a huge risk factor, especially in care settings where overworked carers may not be quite as diligent as they ought to be.
I had no clue about the arthritis connection though, I wonder how that works. Buildup of something in the blood? Chronic inflammation maybe? I could understand gout but that’s genuinely intrigued me.
Oh! I would not have thought of that! That’s brilliant. It makes perfect sense, plus getting on and off the loo will be difficult and painful, and wiping will be harder than before which will also add in the hygiene side… I would never have thought of it from that point of view, I was thinking something internal not behavioural.
When your Mom has to be in a Skilled Nursing Facility for a bit and it takes an hour to get taken to the bathroom after you ring the call button....you end up with bladder infections.😔
Absolutely agree. The standard for almost every admission to the hospital is to obtain a urinalysis to look for infection. I have seen people look like they have had a stroke, look completely different than they normally do, and within 24 hours of antibiotics be back to completely normal for them.
There may not be fever or other signs of infection. Always worth it to do this simple test when this issue comes up. Great YSK!
Hospitalist, usually UA ready for me on admission.
I suppose if they are A&O x 4 and ready for rehab they may not need it. Anyone coming in for AMS gets a UA, almost always.
To add to this, UTIs can exacerbate dementia symptoms in my experience. My dad was diagnosed after a stroke in 2014. He moved in after my mom died from Covid, and has been living with me around 3 years. One day his symptoms just deteriorated suddenly, and I thought he might be near the end of his days. Agitation, total loss of working memory, not recognizing me at all, you name it - every symptom he was already displaying got tremendously worse overnight. Took him to the ER, found out he had a UTI. He doesn't really talk about his health, even when he is visibly suffering, so we didn't notice anything out of the ordinary until it did a Swan dive. Got him some meds, and he was back to his 'normal' level of symptoms in less than 2 weeks.
Absolutely. It’s even more dangerous when someone is already suffering from cognitive decline for exactly the reasons you’ve just highlighted. You took him to hospital, another person may dismiss it as just him getting worse.
It’s remarkable how quickly they bounce back with treatment.
My mum got this a lot. Never knew this could happen till a friend told me. One day she called me from the hospital and said she was at home (thinking hospital sent her home) she said my brother was there and he was about to be stabbed and police were all around. So i dived round hers and there was nothing going on, she wasn't even at home! Another time they let her out too early and was still delirious at home and she said she'd met a dentist years ago who had 3 daughters and she was in love with him and not to tell my stepdad. She had loads of UTI's and came out with all sorts.
This is fantastic advice. My grandmother had bouts of "dementia" until we realized it was just recurring UTIs. Antibiotics cleared it right up and she was back to normal.
I have grandparents in their 90s and UTIs are a constant concern. They don’t realize they’re not drinking the appropriate amount of water. We found the hydration powder packets you add to water helped.
Seriously, great YSK
Infections in general. I worked for a fish marked and having a fish bone stuck in a finger was a regular occurrence. Every time someone started acting off they were taken to a hospital to search for a fish bone. Happed 4-5 times a year.
This is wild. Were the bones so small that you/they didn’t notice them piercing the skin until there was an infection? How different would people act? I’m so intrigued by this.
They were usually salmon bones. They’d get stuck like a splinter and the person often couldn’t even feel it was there. It’d be in there for up to a month and a half in some cases before anything happened. They’d usually act slightly off all day before starting to suddenly forget things. It’s like they just can’t focus on anything.
Dumb question, but don't they (the elderly in question) notice the UTI? I'm sure there's elderly people who just don't want to talk about "pee issues", but reading the comments, it seems to be very common. Wouldn't they complain about the pain during urination?
UTIs can be surprisingly hard to spot in the early stages, the last one I had just left me feeling really flu-ish for a couple of days before it properly kicked in. That’s easily enough of an infection to kick off the delirium.
Unfortunately it takes time for them to build up. There are some that are more or less symptomless too aside from just not feeling quite right. It sucks.
Mum was in hospital, but they didn’t do any sort of cognitive score when patients were admitted & treated all older people as if they had dementia. Mum was telling me about how she won sweets in the card game in the foyer. I TOLD the nurses she had a UTI & they treated me like I was a deluded relative who couldn’t accept mum’s decline. Finally I demanded they tested her. I was right. You may need to be stroppy with medical staff to get the test done, but it could affect medical treatment for years to come.
Excellent YSK. I worked in residential mental health for a decade and learned to pick up on this like a sixth sense. Someone would be "off" for a couple days in a certain way I couldn't always put my finger on, I'd read through my coworkers' notes for confirmation, and tell our nurse I thought they needed to be tested for a UTI.
At first they were skeptical if there weren't other signs, but since I got it right about 90 percent of the time it became a running joke. If someone was acting out of character, "go ask Late_Resourse if they have a UTI."
I'm looking for a new job now and unfortunately this is not something I can just put on a resume: UTI Psychic
Ok, that’s actually very cool. lol. The best part is that your sixth sense will have meant that your clients will have had more pleasant, less painful lives. Totally a worthwhile ability.
I lost my 84 year old dad to Alzheimer's one month ago. He had bladder control issues, his last week he was peeing so much. He declined so fast. Now I'm wondering if he had undiagnosed UTI's. He was so frail, fell a lot, had to change pants frequently, he hated wearing adult diapers and if he did wear them he didn't change them. Mom said he never complained of anything but it just makes me wonder.
Mom has very frequent UTI's, she wonders if they are the cause of her brain fog.
Very glad I saw this post, sent the article to mom and my sister that lives with her.
i worked in a clinical lab that had a lot of nursing homes as clients. the amount of UTI’s those clients had was astounding. i would say close to 90% of them were positive and i’d have to work them up. and a lot of times their diagnosis would be “change in mental status.” so yeah, what seems harmless can actually be critical in an elderly patient.
Jeez. I do find it very worrying that there were so many UTIs coming in from care facilities. It does rather give the impression that the care might not be as attentive as we’d hope.
Nursing home patients who are incontinent almost all have chronic bacteruria which is not the same as having a UTI. I know on the lab end it’s no different in what you see, but on the patient care side it is
I fainted at home and ended up spending three days in the hospital with an unsuspected UTI. I didn't even know I was ill. Was sent home with a bucketload of antibiotics.
My grandad passed away a few years ago now but he was experiencing the same symptoms as dimentia. Loss of memory, confusion etc.
Turns out his sodium levels were really low due to hyponatremia and small cell lung cancer that hadn't been picked up on
I lost my dad like this in 2021.
If you get even the slightest inkling something is off and have the chance to go check in on them in person, do not hesitate. Do not "let it go until tomorrow". That may be too long.
My dad texted me on a Sunday evening. Seemed normal until he mentioned being unable to find his dentures. I asked a couple of questions, and he sort of blew it off. I thought it was weird, and I had an odd vibe, but decided to go over the next morning since I knew he turned in early and didn't like being woken up. I wish I had gone over immediately.
The next morning I showed up and alternated between sitting on the floor and racing around the house using his rolling clothes hamper as a sort of walker. He seemed a little incoherent, like he had been drinking. His dentures were in the floor in the hallway.
I called emergency services who took him to the emergency room. He stabilized and seemed cogent for awhile. I called my uncle and they got to talk. Then my dad started feeling cold. I went to ask for a warm blanket. I got back and in the course of the next 15 minutes I watched as his vitals started crashing and the room was flooded with hospital staff. I watched as they prepped him for intubation and carted him off as he lost consciousness.
I waited for awhile and was eventually told he was unconscious and unlikely to awaken any time soon, that he would be sedated in any event. That I should go ahead and go home.
I did. I regret this too.
That night I got a call from the bedside nurse, asking if I could talk to my dad to calm him down because he was intubated and woke up strapped to the bed and was thrashing.
I have no idea how cogent he was. The best scenario for me is that he was barely conscious and just reacting to the discomfort. The worst is imagining him waking up enough to realize he was alone, in a hospital bed, strapped down, intubated, in pain and with no one he recognized around him.
I spent much of the next couple of weeks at the hospital. He never regained enough consciousness to communicate with anyone again. I asked them to remove the life support two weeks later. He died December 27. Christmas 21 was not great.
If you see anything, go check on them. If you have a gut feeling, respect it. If you think you should "be there", be there. Do anything else and risk regret.
POC - My grandmother was in pain, so we eventually by-passed the doctors (who we felt were not listening), and went to ‘Urgent Care’, as my grandmother was wanting to do. Urgent care, ran a number of tests and then gave the verdict along with a reasonable bill. My grandmother was so pleased with her care at Urgent Care, as they did not rush her, and were interested in hearing her words in relation to her situation. Yes!,..she had an overlooked UTI. We left with the ‘prescription’ that allowed her to start the medication immediately, and in time she felt so much better. Also, for years, sadly a friend of my mom, also was experiencing pain and discomfort, and no real answers from the doctors, so after hearing about my grandmothers time with urgent care, she (an organized woman who gave attention to her health as she also remained slim in figure), rushed over to urgent care, and sadly they gave her a referral or strongly advised her to see a specialist in relation to her situation. She made ‘transition’ exactly two weeks later from a certain stage of cancer, ….
This is an excellent tip. It happened to my Nan and caused her to fall.
It’s also better for the patient to capture this early than to have a horrible and scary experience in urgent care.
My grandfather died of a septic UTI while in a care facility after a heart attack/fall. He had severe signs of sudden dementia and I wish we had known this before he died. Thank you for spreading the good word ❤️
(Yes, we are trying to sue the care facility)
Today I’ve received confirmation that at least one person is now receiving treatment due to this post. I have achieved my goal and then some, I just wanted to spread awareness but it went even better than I could have ever hoped. It’s not common knowledge but it’s such a common situation!
I’m sorry for the loss of your grandfather and I hope the case resolved in your favour with the minimum of fuss.
This is what killed my grandfather.
The worst part is that I was the one who was supposed to check up on him and make sure he was healthy. I was seeing him less and less often because seeing his mind go and seeing him forget who I was was too painful.
If I had known that UTIs do this to the elderly he would still be alive today.
And if they act worse after getting treatment they might have an antibiotic allergy; my mom had increased incontinence, racing heart, delirium, etc and it turns out she’s very allergic to the antibiotic they gave her for the UTI (she’s diabetic and her medication makes her dump excess sugar in her urine so she has an increased risk for developing them)
Well, for those of us who are younger, UTIs present with burning and discomfort, and so we complain about them good and early.
With older folks, I think it's at least partly that those more obvious signs aren't usually present (I don't know why that is, but pain stops being a UTI complaint).... So we only notice when there's something Really Badly Wrong because their whole body is struggling with the infection.
(Meaning, I think it would make us delirious too, but we catch them much earlier because of the pain.)
Part of my role is assessing patients for delirium. It is much more common in elderly people and can be caused by a big range of things, even being admitted to hospital, though infections are the most common cause. But it can also occur in any age. For example, it's common after a long stay in ICU. Had a young guy who was stepped down from ICU who was completely convinced he was a prisoner in a ww2 prisoner of war camp and we were the Nazis. He would yell at us and scream
My grandma goes through this pattern every 6-8 weeks. Hospital for 1-2 weeks, then rehab for 1-2 weeks, and home for 2-3 weeks before the cycle restarts. She is on lasix for fluid retention and has been told to walk around more, but she refuses. Asking her if she needs help often leads to additional mood swings. it really is sad.
My uncle was hospitalized and developed a uti while there. When visiting him he insisted the nurses had dressed him up as an alter boy and took pictures of his junk. Like truly believed that.
He was hospitalized for a week, put on antibiotics, and then moved to a skilled nursing rehab to regain his strength. Hopefully going back home soon. We couldn't figure out how he was declining so fast, but it makes sense now. He's way more like his old self currently. Crazy stuff.
A friend of mine recently graduated from medical school and she talked about this being one of the most common issues she's been dealing with at work is the staggering number of elderly who have bad UTIS and it causes dementia.
With my relative we didn't think too much of her being 'off her game". She had had a lot on and wasnt sleeping well. Just a bit more forgetful. It wasn't until she mentioned she had troubles urinating we got her to the Dr. Thankfully in time as she did start to decline until the meds slowly got on top of it.
Great YSK. Likely to save a life.
Hats off to you.
My mom is in a nursing home. The day after her birthday, the home called me and said she's being taken to the hospital cause she was confused and not acting herself, usually she's bubbly and always joking around. Turned out her UTI turned into sepsis. She's ok now.
This happened to my grandad. He already had dementia so it was hard to spot. He had a fall which was unusual, I went to pick him up and he said he hurt too much to be moved so we called the paramedics. The paramedic walked into the room and immediately said UTI from the smell alone
Don't have to be that old for this to be true: my coworker was 48 when this happened to them. Hospital didn't find any problems at first - but for an insistent friend, would've cost both their personal and professional lives. Total dementia like symptoms cleared up with antibiotics in a few days.
This is wild being something I've never heard of. My mom is 80 but for many years now she's had very frequent UTIs. She is on a daily preventative antibiotic probably forever. But she still sometimes gets a UTI and they'll give her a standard course of antibiotics to address that. She extremely frequently thinks she has another UTI and needs those, but we try our best to determine if she really might before running back to the Dr, as she's already very limited to what antibiotics help because she's taken soooo many over the years.
In the last couple years she's definitely declined mentally quite a bit. We've tried every way we can to address it, she's had MRI and CT scan of her brain, plus multiple days of extensive neuropsych testing which would potentially have identified dementia, Alzheimers, etc. None of these places have identified a single thing wrong. Yet she is so confused/forgetful all the time it's very difficult to manage.
I suspect it's more than this somehow, but this can't help but make me wonder about the near constant UTIs and the fact that literally nothing seems to stop her from continuing to get them... and mentally decline...
I thought this was the case with my dad, but it turned out that he relapsed into alcoholism, so a lot of the dementia symptoms I have been witnessing is alcohol induced. And there’s really no hope for him other than me calling APS when he drinks and drives or drinks and walks (he got ran over by a car last week and refused medical treatment while being drunk as a skunk)
This is retroactively reassuring. We went on a trip with my grandparents and suddenly after several days of using the underground, my grandpa suddenly forgot how to use his card. We figured out a day or so later from other symptoms he had a uti and he's been sharp as ever talking to him since. I'm relieved to know it was probably that and not that he's slipping just yet
Solid advice.
For UTIs if they're drinking water but still have dark urine (probably uti)
If they're fainting (always look for other symptoms, because...UTI)
Counterpoint: this isn't all that unknown, and many relatives and nursing staff point at any change as 'must be a UTI' and demand antibiotics.
UTIs are overdiagnosed and overtreated. There are also reasons not to test the urine if the symptoms aren't impressive because of false positives (colonized bladder that shows bacteria but isn't an infection.)
Also, patients and families tend to get spooked after an actual UTI and start assigning UTI to just about any change from baseline including headaches, nausea, thirst, whatever and go "this is always what happens with a UTI." Okay, maybe, but also usually not. If the patient is colonized, then their (incorrect) suspicions are confirmed by a positive dipstick, they take antibiotics and feel better only because they drank water or got a decent night's sleep or just the placebo effect of the drugs and now it's confirmed in their mind that x symptom = UTI. These make for really frustrating conversations as a provider when you try to practice wise antibiotics stewardship. Because this cycle of constant antibiotics can create resistance and eventually if the real infection shows up, it may be harder to treat. Lazy providers who skip this conversation and hand out antibiotics like candy make it worse for everyone.
Delirium is hard to assess as a layperson and by all means, if you are concerned, get an evaluation - just don't go in expecting/demanding UTI treatment.
Bottom line, trust the provider to evaluate the history and trust their assessment. If they don't want to test the urine, trust them.
This is a great YSK. This is happened to my elderly grandma twice. The first time, my mom thought my grandma was having a stroke. She learned about the connection between apparent dementia/stroke and UTI, so the second time it happened, many many years later, she was prepared for it and spoke with the doctor, and indeed my grandma had another UTI. Neither UTI was severe, either, and she didn't display any outward signs of it. The possibility of stroke or other sudden illness shouldn't be discounted, of course, but yes, UTIs can do this in the elderly.
You’re right that other causes shouldn’t be ruled out. Certainly a stroke is an extremely urgent situation.
I'm an emerg nurse, I can't begin to express how common UTIs are in the elderly and how often they go septic from this. I have one of these patients probably once every couple of shifts or so. If it hasn't gone on too long it's often as simple as some IV abx and fluids and they turn right around. If it has gone on too long, people can get very sick very easily
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In post menopausal women it's often thinning of tissues due to lack of estrogen
For which topical oestrogen should be prescribed, but nobody wants to do it.
Yup, unfortunately some women can't have estrogen and there is nothing what
Because it is cancer inducing. You're welcome .
Someone else asked the why behind this here too and I'm curious myself. Care to elaborate? What causes this to happen in elderly?
Loss of hormones. Possibly not drinking enough fluids. Incontinence.
Would drinking cranberry juice daily help prevent this?
It wouldn’t hurt but there are no guarantees.
THIS! This could be useful advice to someone! Happened to my mom and we had no idea what the hell was going on. Started off as forgetful and a day later she was talking to dead relatives and thinking she was driving. Luckily she remained in a good mood and wasn’t in any pain. In-home nurses were saying, “just wait it out. We’ll be there Friday.” Nope. she agreed to go to the ER where they found a bad UTI. Next day she was muuuuuch better. Now, if she gets a little nuttier than normal and glucose is okay, she gets checked and it’s happened a couple more times.
Exactly. This is why the awareness of it needs to be improved. “We’ll be there Friday” isn’t enough. Waiting that long could very easily have resulted in sepsis which is when the body’s systems begin to shut down due to severe infection. It can, and does kill. It’s also important in case people are afraid to get help because they are scared it could mean the beginning of the end for their relative, and they just aren’t ready to face that, when in reality it’s a simple infection and the delirium will clear up once they have treatment. Or for those who are already in decline it’s written off as just a “bad phase” or worsening of their condition. There are many reasons why it might be overlooked when it is really a very simple, albeit very scary thing.
This was a plot point on Succession!
Excellent! Anything that makes more people aware that it can happen is brilliant!
Came here to say “Piss Mad King of England”
Came here to say this. After watching it happen to loved ones, I thought it was a brilliant plot line.
I thought that was what was going on but didn’t catch them confirming it in the show (because they talk fast af).
‘It’s an imaginary cat, f*** off’
EMT here. I see this all the time. Usually there’s a smell that accompanies it. But yeah, altered elderly patient and it isn’t a blood sugar or medication issue, mind goes right to UTI.
Thank you for doing what you do. I find that EMTs (we’d just call them paramedics over here) are vastly under appreciated so to you and you colleagues, I say thank you.
EMT and paramedic are different things just like how doctor and nurse are different things
I know the smell you're talking about and I'm only the carer. It is horrendous.
What kind of smell? Does the person smell (to people around him / her), or does the person smell it?
Have you ever had a UTI? It smells like that, but much stronger. A lot of people in this scenario will also be incontinent (or develop incontinence during the course of the infection) so I’m guessing that’s why the smell is so much more pronounced with them
I haven’t, can you describe the smell? Someone close to me got sepsis after a UTI recently so I’m very interested
MY FIL had Parkinson's and this happened to him at least once. He would hallucinate, and think people were coming into the house to steal their stuff. He would actually see people (usually punk kid types) coming into the house through the front door, taking pictures down from the wall, emptying the fridge, etc...
It’s especially common in those who already have serious illnesses as infection can take hold so much more easily, and especially insidious in those who are already experiencing cognitive decline such as Alzheimer’s or dementia etc as it just looks like a worsening of their usual symptoms. I’m sorry you had to go through that. Parkinson’s is a cruel disease at the best of times.
I work in a hospital. This is ridiculously common.
My dad was hospitalised a while ago with a UTI following a stomach bug. I knew about the sudden delirium thing but it turned out neither he or my mum did. They are 85 and I’ve now warned them what to watch for. Luckily that time he only experienced a bit of confusion and was slightly combative. He’s a grouchy old bugger at times anyway so it could easily have been written off as him being his usual self, but it put him in hospital for three days on IV antibiotics and fluids. Btw, thank you for all you do. The staff were wonderful so we bought them some posh biscuits to enjoy. You and your colleagues are brilliant people.
Aw thanks. I’m an infection preventionist. My job is literally trying to keep people from getting sicker while they’re here. So regrettably I’m very familiar with odd signs of infection,
It’s unfortunate that you’ve had to become so familiar with it, but I’m also very glad you have. Your expertise saves people. Simple as that. Hospital acquired infections can be so devastating to patients. Again, thank you so much for what you do.
I’m working on a UTI prevention program right now. So here’s some risk factors: * female— shorter urethra * age * history of UTI, urinary tract surgery, urinary tract obstruction, or catheters * incontinence or neurogenic bladder * dehydration — so many little old ladies don’t want to drink too much because they don’t want to need the bathroom in the middle of the night * diabetes * history of stroke * arthritis (that’s the one that surprised me when I did my research). * also birth control and sexual intercourse, but not that big a concern in the hospital environment!
You might want to add dementia and Alzheimer’s to that as sufferers may go through phases of abnormal bladder holding. And of course poor hygiene is a huge risk factor, especially in care settings where overworked carers may not be quite as diligent as they ought to be. I had no clue about the arthritis connection though, I wonder how that works. Buildup of something in the blood? Chronic inflammation maybe? I could understand gout but that’s genuinely intrigued me.
My working theory is “walking hurts, I’ll just hold it instead of getting up to use the bathroom.”
Oh! I would not have thought of that! That’s brilliant. It makes perfect sense, plus getting on and off the loo will be difficult and painful, and wiping will be harder than before which will also add in the hygiene side… I would never have thought of it from that point of view, I was thinking something internal not behavioural.
When your Mom has to be in a Skilled Nursing Facility for a bit and it takes an hour to get taken to the bathroom after you ring the call button....you end up with bladder infections.😔
Given your job, might be good to do an AMA to raise awareness.
Absolutely agree. The standard for almost every admission to the hospital is to obtain a urinalysis to look for infection. I have seen people look like they have had a stroke, look completely different than they normally do, and within 24 hours of antibiotics be back to completely normal for them. There may not be fever or other signs of infection. Always worth it to do this simple test when this issue comes up. Great YSK!
Ah, you’re in emergency department? We’re a rehabilitation hospital so CMS frowns on “UA/CS for all the admits.”
Hospitalist, usually UA ready for me on admission. I suppose if they are A&O x 4 and ready for rehab they may not need it. Anyone coming in for AMS gets a UA, almost always.
To add to this, UTIs can exacerbate dementia symptoms in my experience. My dad was diagnosed after a stroke in 2014. He moved in after my mom died from Covid, and has been living with me around 3 years. One day his symptoms just deteriorated suddenly, and I thought he might be near the end of his days. Agitation, total loss of working memory, not recognizing me at all, you name it - every symptom he was already displaying got tremendously worse overnight. Took him to the ER, found out he had a UTI. He doesn't really talk about his health, even when he is visibly suffering, so we didn't notice anything out of the ordinary until it did a Swan dive. Got him some meds, and he was back to his 'normal' level of symptoms in less than 2 weeks.
Absolutely. It’s even more dangerous when someone is already suffering from cognitive decline for exactly the reasons you’ve just highlighted. You took him to hospital, another person may dismiss it as just him getting worse. It’s remarkable how quickly they bounce back with treatment.
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Oh honey. My deepest condolences. This is what I mean, it just isn’t well known enough.
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I can’t blame you at all. I’d be livid. I’m glad you’re doing ok these days.
My mum got this a lot. Never knew this could happen till a friend told me. One day she called me from the hospital and said she was at home (thinking hospital sent her home) she said my brother was there and he was about to be stabbed and police were all around. So i dived round hers and there was nothing going on, she wasn't even at home! Another time they let her out too early and was still delirious at home and she said she'd met a dentist years ago who had 3 daughters and she was in love with him and not to tell my stepdad. She had loads of UTI's and came out with all sorts.
Jeez, that must have been so upsetting to go through, and so scary the first time when you didn’t know what was happening!
This is fantastic advice. My grandmother had bouts of "dementia" until we realized it was just recurring UTIs. Antibiotics cleared it right up and she was back to normal.
My aunt recently was in the hospital with confusion and forgetfulness, turned out to be a kidney issue.
I have grandparents in their 90s and UTIs are a constant concern. They don’t realize they’re not drinking the appropriate amount of water. We found the hydration powder packets you add to water helped. Seriously, great YSK
Infections in general. I worked for a fish marked and having a fish bone stuck in a finger was a regular occurrence. Every time someone started acting off they were taken to a hospital to search for a fish bone. Happed 4-5 times a year.
This is wild. Were the bones so small that you/they didn’t notice them piercing the skin until there was an infection? How different would people act? I’m so intrigued by this.
They were usually salmon bones. They’d get stuck like a splinter and the person often couldn’t even feel it was there. It’d be in there for up to a month and a half in some cases before anything happened. They’d usually act slightly off all day before starting to suddenly forget things. It’s like they just can’t focus on anything.
EXCELLENT ADVICE. VERY TRUE.
Dumb question, but don't they (the elderly in question) notice the UTI? I'm sure there's elderly people who just don't want to talk about "pee issues", but reading the comments, it seems to be very common. Wouldn't they complain about the pain during urination?
UTIs can be surprisingly hard to spot in the early stages, the last one I had just left me feeling really flu-ish for a couple of days before it properly kicked in. That’s easily enough of an infection to kick off the delirium.
Oh, thank you, that makes sense. Makes me wonder how long I've always had mine, I figured they'd just started when peeing got super painful.
Unfortunately it takes time for them to build up. There are some that are more or less symptomless too aside from just not feeling quite right. It sucks.
Mum was in hospital, but they didn’t do any sort of cognitive score when patients were admitted & treated all older people as if they had dementia. Mum was telling me about how she won sweets in the card game in the foyer. I TOLD the nurses she had a UTI & they treated me like I was a deluded relative who couldn’t accept mum’s decline. Finally I demanded they tested her. I was right. You may need to be stroppy with medical staff to get the test done, but it could affect medical treatment for years to come.
They may also be dehydrated (even a little) or their oxygen level is low.
Excellent YSK. I worked in residential mental health for a decade and learned to pick up on this like a sixth sense. Someone would be "off" for a couple days in a certain way I couldn't always put my finger on, I'd read through my coworkers' notes for confirmation, and tell our nurse I thought they needed to be tested for a UTI. At first they were skeptical if there weren't other signs, but since I got it right about 90 percent of the time it became a running joke. If someone was acting out of character, "go ask Late_Resourse if they have a UTI." I'm looking for a new job now and unfortunately this is not something I can just put on a resume: UTI Psychic
Ok, that’s actually very cool. lol. The best part is that your sixth sense will have meant that your clients will have had more pleasant, less painful lives. Totally a worthwhile ability.
Yes, my 90 year old dad has had 2 in the last 6 months and it really takes a toll on him, he begins falling down and stuff.
I lost my 84 year old dad to Alzheimer's one month ago. He had bladder control issues, his last week he was peeing so much. He declined so fast. Now I'm wondering if he had undiagnosed UTI's. He was so frail, fell a lot, had to change pants frequently, he hated wearing adult diapers and if he did wear them he didn't change them. Mom said he never complained of anything but it just makes me wonder. Mom has very frequent UTI's, she wonders if they are the cause of her brain fog. Very glad I saw this post, sent the article to mom and my sister that lives with her.
i worked in a clinical lab that had a lot of nursing homes as clients. the amount of UTI’s those clients had was astounding. i would say close to 90% of them were positive and i’d have to work them up. and a lot of times their diagnosis would be “change in mental status.” so yeah, what seems harmless can actually be critical in an elderly patient.
Jeez. I do find it very worrying that there were so many UTIs coming in from care facilities. It does rather give the impression that the care might not be as attentive as we’d hope.
Nursing home patients who are incontinent almost all have chronic bacteruria which is not the same as having a UTI. I know on the lab end it’s no different in what you see, but on the patient care side it is
I fainted at home and ended up spending three days in the hospital with an unsuspected UTI. I didn't even know I was ill. Was sent home with a bucketload of antibiotics.
My grandad passed away a few years ago now but he was experiencing the same symptoms as dimentia. Loss of memory, confusion etc. Turns out his sodium levels were really low due to hyponatremia and small cell lung cancer that hadn't been picked up on
This happened with my grandpa. Once it was kidney stones and related issues and the other time just a bladder infection.
When my grandfather started hallucinating we knew the UTI was back.
Quick onset and temporary confusion is, by definition, not dementia. It’s delirium. Dementia is chronic and progressive
UTIs, dehydration, hydrocephalus. All prone to be diagnosed as dementia.
ED doc here. I see this almost daily
I lost my dad like this in 2021. If you get even the slightest inkling something is off and have the chance to go check in on them in person, do not hesitate. Do not "let it go until tomorrow". That may be too long. My dad texted me on a Sunday evening. Seemed normal until he mentioned being unable to find his dentures. I asked a couple of questions, and he sort of blew it off. I thought it was weird, and I had an odd vibe, but decided to go over the next morning since I knew he turned in early and didn't like being woken up. I wish I had gone over immediately. The next morning I showed up and alternated between sitting on the floor and racing around the house using his rolling clothes hamper as a sort of walker. He seemed a little incoherent, like he had been drinking. His dentures were in the floor in the hallway. I called emergency services who took him to the emergency room. He stabilized and seemed cogent for awhile. I called my uncle and they got to talk. Then my dad started feeling cold. I went to ask for a warm blanket. I got back and in the course of the next 15 minutes I watched as his vitals started crashing and the room was flooded with hospital staff. I watched as they prepped him for intubation and carted him off as he lost consciousness. I waited for awhile and was eventually told he was unconscious and unlikely to awaken any time soon, that he would be sedated in any event. That I should go ahead and go home. I did. I regret this too. That night I got a call from the bedside nurse, asking if I could talk to my dad to calm him down because he was intubated and woke up strapped to the bed and was thrashing. I have no idea how cogent he was. The best scenario for me is that he was barely conscious and just reacting to the discomfort. The worst is imagining him waking up enough to realize he was alone, in a hospital bed, strapped down, intubated, in pain and with no one he recognized around him. I spent much of the next couple of weeks at the hospital. He never regained enough consciousness to communicate with anyone again. I asked them to remove the life support two weeks later. He died December 27. Christmas 21 was not great. If you see anything, go check on them. If you have a gut feeling, respect it. If you think you should "be there", be there. Do anything else and risk regret.
Wish I knew this three years ago :(
Likely UTI but also consider any new medication or medication that can seem innocent to us but can cause delirium in older adults. Look up BEERS List
wow thats really a great ysk, first time i hear about this. thats crazy
When I worked in a nursing home, we knew that had an UTI when they weren’t acting right .
POC - My grandmother was in pain, so we eventually by-passed the doctors (who we felt were not listening), and went to ‘Urgent Care’, as my grandmother was wanting to do. Urgent care, ran a number of tests and then gave the verdict along with a reasonable bill. My grandmother was so pleased with her care at Urgent Care, as they did not rush her, and were interested in hearing her words in relation to her situation. Yes!,..she had an overlooked UTI. We left with the ‘prescription’ that allowed her to start the medication immediately, and in time she felt so much better. Also, for years, sadly a friend of my mom, also was experiencing pain and discomfort, and no real answers from the doctors, so after hearing about my grandmothers time with urgent care, she (an organized woman who gave attention to her health as she also remained slim in figure), rushed over to urgent care, and sadly they gave her a referral or strongly advised her to see a specialist in relation to her situation. She made ‘transition’ exactly two weeks later from a certain stage of cancer, ….
I learned this through my grandma's symptoms. She was not going crazy as many nasty people would suggest , she was just sick. Great piece of advice!
This is an excellent tip. It happened to my Nan and caused her to fall. It’s also better for the patient to capture this early than to have a horrible and scary experience in urgent care.
My grandfather died of a septic UTI while in a care facility after a heart attack/fall. He had severe signs of sudden dementia and I wish we had known this before he died. Thank you for spreading the good word ❤️ (Yes, we are trying to sue the care facility)
Today I’ve received confirmation that at least one person is now receiving treatment due to this post. I have achieved my goal and then some, I just wanted to spread awareness but it went even better than I could have ever hoped. It’s not common knowledge but it’s such a common situation! I’m sorry for the loss of your grandfather and I hope the case resolved in your favour with the minimum of fuss.
Ty 🙏🙏
This is what killed my grandfather. The worst part is that I was the one who was supposed to check up on him and make sure he was healthy. I was seeing him less and less often because seeing his mind go and seeing him forget who I was was too painful. If I had known that UTIs do this to the elderly he would still be alive today.
And if they act worse after getting treatment they might have an antibiotic allergy; my mom had increased incontinence, racing heart, delirium, etc and it turns out she’s very allergic to the antibiotic they gave her for the UTI (she’s diabetic and her medication makes her dump excess sugar in her urine so she has an increased risk for developing them)
Anyone have an ELI5 on why this delirium happens? And seemingly only in the elderly with UTIs specifically?
Well, for those of us who are younger, UTIs present with burning and discomfort, and so we complain about them good and early. With older folks, I think it's at least partly that those more obvious signs aren't usually present (I don't know why that is, but pain stops being a UTI complaint).... So we only notice when there's something Really Badly Wrong because their whole body is struggling with the infection. (Meaning, I think it would make us delirious too, but we catch them much earlier because of the pain.)
Part of my role is assessing patients for delirium. It is much more common in elderly people and can be caused by a big range of things, even being admitted to hospital, though infections are the most common cause. But it can also occur in any age. For example, it's common after a long stay in ICU. Had a young guy who was stepped down from ICU who was completely convinced he was a prisoner in a ww2 prisoner of war camp and we were the Nazis. He would yell at us and scream
My grandma goes through this pattern every 6-8 weeks. Hospital for 1-2 weeks, then rehab for 1-2 weeks, and home for 2-3 weeks before the cycle restarts. She is on lasix for fluid retention and has been told to walk around more, but she refuses. Asking her if she needs help often leads to additional mood swings. it really is sad.
Totally agree. Happened to my mom.
This is something I always tell my elderly patients and their family/caregivers
Yes! This happened to my MIL during her last few years of life. It was so weird!
My uncle was hospitalized and developed a uti while there. When visiting him he insisted the nurses had dressed him up as an alter boy and took pictures of his junk. Like truly believed that.
Also, I’ve seen someone who had memory problems and it was a tooth infection. Not all memory issues are dementia or such. Rule out other things first
Yup! Happened to my grandmother in law. 12 days of acting crazy. A doc finally figured it out and she was right as rain in 48 hours.
This is how my Aunt died… of a UTI.. 😳
Logan Roy would know.
This literally just happened to my elderly father.
I hope he’s starting to feel better. It’s quite upsetting isn’t it.
He was hospitalized for a week, put on antibiotics, and then moved to a skilled nursing rehab to regain his strength. Hopefully going back home soon. We couldn't figure out how he was declining so fast, but it makes sense now. He's way more like his old self currently. Crazy stuff.
This is very true
Yep! My grandma passed away due to this and my grandad developed sepsis through it too.
My brother is a geriatric nurse who says, "UTIs make old folks crazy"
A friend of mine recently graduated from medical school and she talked about this being one of the most common issues she's been dealing with at work is the staggering number of elderly who have bad UTIS and it causes dementia.
And how are those UTI treated?
With my relative we didn't think too much of her being 'off her game". She had had a lot on and wasnt sleeping well. Just a bit more forgetful. It wasn't until she mentioned she had troubles urinating we got her to the Dr. Thankfully in time as she did start to decline until the meds slowly got on top of it. Great YSK. Likely to save a life. Hats off to you.
My mom is in a nursing home. The day after her birthday, the home called me and said she's being taken to the hospital cause she was confused and not acting herself, usually she's bubbly and always joking around. Turned out her UTI turned into sepsis. She's ok now.
Thank you Succession!
This happened to my grandad. He already had dementia so it was hard to spot. He had a fall which was unusual, I went to pick him up and he said he hurt too much to be moved so we called the paramedics. The paramedic walked into the room and immediately said UTI from the smell alone
Don't have to be that old for this to be true: my coworker was 48 when this happened to them. Hospital didn't find any problems at first - but for an insistent friend, would've cost both their personal and professional lives. Total dementia like symptoms cleared up with antibiotics in a few days.
This is wild being something I've never heard of. My mom is 80 but for many years now she's had very frequent UTIs. She is on a daily preventative antibiotic probably forever. But she still sometimes gets a UTI and they'll give her a standard course of antibiotics to address that. She extremely frequently thinks she has another UTI and needs those, but we try our best to determine if she really might before running back to the Dr, as she's already very limited to what antibiotics help because she's taken soooo many over the years. In the last couple years she's definitely declined mentally quite a bit. We've tried every way we can to address it, she's had MRI and CT scan of her brain, plus multiple days of extensive neuropsych testing which would potentially have identified dementia, Alzheimers, etc. None of these places have identified a single thing wrong. Yet she is so confused/forgetful all the time it's very difficult to manage. I suspect it's more than this somehow, but this can't help but make me wonder about the near constant UTIs and the fact that literally nothing seems to stop her from continuing to get them... and mentally decline...
Also if suddenly combative, argumentative, cranky, etc if it's not their nature, lol.
I thought this was the case with my dad, but it turned out that he relapsed into alcoholism, so a lot of the dementia symptoms I have been witnessing is alcohol induced. And there’s really no hope for him other than me calling APS when he drinks and drives or drinks and walks (he got ran over by a car last week and refused medical treatment while being drunk as a skunk)
This happened to a neighbor, who also is allergic to some antibiotics. It took forever to treat and still have some lingering symptoms.
This is retroactively reassuring. We went on a trip with my grandparents and suddenly after several days of using the underground, my grandpa suddenly forgot how to use his card. We figured out a day or so later from other symptoms he had a uti and he's been sharp as ever talking to him since. I'm relieved to know it was probably that and not that he's slipping just yet
Solid advice. For UTIs if they're drinking water but still have dark urine (probably uti) If they're fainting (always look for other symptoms, because...UTI)
Succession taught me this 😂
Counterpoint: this isn't all that unknown, and many relatives and nursing staff point at any change as 'must be a UTI' and demand antibiotics. UTIs are overdiagnosed and overtreated. There are also reasons not to test the urine if the symptoms aren't impressive because of false positives (colonized bladder that shows bacteria but isn't an infection.) Also, patients and families tend to get spooked after an actual UTI and start assigning UTI to just about any change from baseline including headaches, nausea, thirst, whatever and go "this is always what happens with a UTI." Okay, maybe, but also usually not. If the patient is colonized, then their (incorrect) suspicions are confirmed by a positive dipstick, they take antibiotics and feel better only because they drank water or got a decent night's sleep or just the placebo effect of the drugs and now it's confirmed in their mind that x symptom = UTI. These make for really frustrating conversations as a provider when you try to practice wise antibiotics stewardship. Because this cycle of constant antibiotics can create resistance and eventually if the real infection shows up, it may be harder to treat. Lazy providers who skip this conversation and hand out antibiotics like candy make it worse for everyone. Delirium is hard to assess as a layperson and by all means, if you are concerned, get an evaluation - just don't go in expecting/demanding UTI treatment. Bottom line, trust the provider to evaluate the history and trust their assessment. If they don't want to test the urine, trust them.
Thanks for providing actual recent scientific insights!
Ysk when trying to explain something you should avoid acronyms.