Prevention of Urinary Tract Infections in Elderly Care Homes

Those who have cystitis often urinate, complain about burning sensation when they urinate. They may have pain over the bladder and feel a bit chilly. Sometimes there may be a little blood in the urine. The elderly can become confused by infections. It is unusual to have a fever with cystitis. Urinary tract infections (UTIs) are common in older people and can be particularly troublesome in nursing homes. They can cause discomfort, exacerbate existing health problems, and lead to unnecessary hospital visits. To ensure the well-being of the elderly and minimize the risk of UTI, it is important that nursing homes implement preventive measures.

Why are urinary tract infections common in the elderly?

Older people are more susceptible to urinary tract infections for several reasons:
Decreased immune system: Aging often involves a weakened immune system, making it harder for the body to fight infections.
More risk factors: The elderly often have several underlying health conditions, such as diabetes or bladder problems, which can increase the risk of UTI.
Reduced bladder function: Aging can affect bladder function, which can make it harder to completely empty it, thereby increasing the risk of infection.

Symptoms of urinary tract infection in elderly women

Suspicion of urinary tract infection (UTI) in elderly women is common as they have an increased risk of being affected. UTI can be more serious for older people and is therefore important to pay attention to.

- Instead of the typical symptoms such as burning during urination, frequent urination and abdominal pain, older people may experience general or increased confusion, increased weakness or fever. It is important to be aware of these less obvious signs.
- Elderly women often take several medications at the same time. This can complicate the diagnosis and treatment of UTI as there may be connections between medications and other health problems.
- UTI in older women can quickly lead to serious complications such as kidney infections or sepsis. Early detection is therefore important to prevent serious consequences.
- Testing and proper medical examination may be needed to rule out other underlying causes of the complaints.
- The treatment must always be based on the patient's conditions. Allergies, previous infections and other conditions need to be taken into account when the doctor prescribes antibiotics.
- After treatment, it is important to follow up with the patient to ensure that the infection has healed and that there are no recurring symptoms or complications.

Preventive measures in the nursing home

Hygiene: A basic measure is to ensure that the elderly have access to proper hygiene. This includes proper toilet habits and cleaning after defecation or urination.
Drinking enough Encourage the elderly to drink enough fluids, preferably water, to dilute the urine and reduce the risk of bacterial growth.
Bladder emptying: Ensure that the elderly empty their bladders regularly and completely to avoid stagnant urine, where bacteria can multiply. This also includes reminding about toilet visits and ensuring that the elderly can sit in peace and quiet.
Proper hygiene when using catheters: If catheters are used, follow strict hygiene routines to prevent infections.
Avoid unnecessary use of antibiotics: Do not use antibiotics if it is not necessary. Overuse of antibiotics can create antibiotic-resistant bacteria. As a result, urinary tract infections can become more difficult to treat.
Education and awareness: The staff at the nursing home should be trained to recognize early signs of UTI and take action in time.
Personal hygiene: Helping the elderly with personal hygiene, including regular care of intimate areas, can reduce the risk of UTI.
Proper washing technique: Teach the elderly and caregivers the right washing technique, especially when using the toilet, to avoid bacterial transmission.

Those who have a urinary tract infection that needs treatment usually feel quite sick. In addition to the symptoms of cystitis, the person often has a fever and may feel nauseous. Pain in the side of the stomach or lower back is also common. Older people sometimes only have a high fever without other symptoms. This must always be treated.

Often it is confusion and bad-smelling urine that makes the staff at the nursing home suspect UTI. If cystitis or urinary tract infection is suspected, a nurse should always be contacted.

For women, it is good to drink a lot during cystitis. Paracetamol can relieve the discomfort. People with catheters are often too easily diagnosed with UTI. Burning, urgency, and urinary leakage as a result of mechanical irritation are common side effects of the catheter. To suspect UTI, the person should have a fever or there should be an acute stop in the catheter.

If you are going to take a urine test, it is good if the person who is going to give the test first gets to urinate a little before you start collecting the urine test. Ideally, the person giving the test should not have urinated for four hours before the sampling. If the person has a catheter, the safest way to take a sample is to put a new catheter and take the first urine that comes out of the tube for the test. Sometimes a temporary catheter is used to take a urine test, for example when the person cannot participate.

A urine stick can indicate that there is an infection, but a blank stick does not rule out a urinary tract infection. It is also important that it is not "kind" bacteria that are treated. Then the treatment itself can make room for worse bacterial strains.

Reflection questions urinary tract infection
Care staff:
- How do you usually notice that one of your residents has a UTI?
- Do you have routines for how to take clean urine samples?
- Do you go through clearly about the care of the lower toilet with newly hired substitutes?
- Can all colleagues perform intimate hygiene in a correct way?

Manager, nurse, occupational therapist and physiotherapist:
- How is UTI with mild complaints handled by you?
- Do you have safe routines when it comes to urine sampling?
- Is there a risk that UTI is over-treated by you and thus does more harm than good?

Residents and relatives:
- Does your relative have recurring urinary tract infections?
- Do you think your relative is suddenly confused without reason?

Please watch the video - Urinary tract infection in the elderly - an (all too) easy diagnosis?

https://www.youtube.com/watch?v=lScaDEumleE

The Care Handbook www.vardhandboken.se has good descriptions for the care of intimate hygiene.

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day