Older adults may not always show the classic symptoms of a UTI. They may experience other symptoms, including confusion and lethargy.

The classic symptoms of a urinary tract infection (UTI) are burning pain and frequent urination, but UTIs may not cause these symptoms in older adults. Instead, older adults, especially those with dementia, may experience behavioral symptoms such as confusion.

Although the connection between UTIs and confusion has been establishedTrusted Source, the reason for this connection is still unknown.

The urinary tract includes:

  • the urethra (the opening that carries urine from your bladder)
  • the ureters
  • the bladder
  • the kidneys

If bacteria enter your urethra and your immune system does not fight them off, they may spread to your bladder and kidneys, resulting in a UTI.

According to older research cited in a 2015 reviewTrusted Source, UTIs were responsible for around 10.5 million doctor’s visits in the United States in 2007. UTIs occur more oftenTrusted Source in women because they have shorter urethras than men.

UTI risk increases with age. According to older research cited in a 2013 reviewTrusted Source, more than one-third of all infections that occur in people living in nursing homes are UTIs. Other studies cited in the review found that more than 10% of women over age 65 and almost 30% of women over age 85 had reported having a UTI within the past year.

Men also tend to experience more UTIs as they age.

It may be hard to figure out that an older adult has a UTI because they may not experience the classic symptoms. This may be a result of a slowed or suppressed immune response.

Classic UTI symptoms include:

Some older adults, such as those who have dementia or Alzheimer’s disease, may not be able to tell you if they are experiencing classic UTI symptoms. They may instead show symptoms such as confusion, which can be vague and mimic the symptoms of other conditions.

Other UTI symptoms may include:

Other symptoms may occur if the infection spreads to the kidneys. These severe symptoms can include:

The main cause of UTIs, at any age, is usually bacteria. Escherichia coli is the primary cause, but other organisms can also cause a UTI.

In older adults who use catheters or live in a nursing home or another full-time care facility, bacteria such as Enterococci and Staphylococci are more common causes.

Certain factors may increase the risk of UTIs in older people.

Certain conditions that are common in older adults — including Alzheimer’s disease, Parkinson’s disease, and diabetes — may lead to urinary retention or neurogenic bladder, increasing the risk of UTIs.

People with these health conditions may need to wear incontinence briefs, and if the briefs are not changed regularly, an infection may occur.

Several other factors can also increase an older adult’s risk of developing a UTI:

In women

Postmenopausal women are at risk of UTIs because of low estrogen levels. Estrogen may help protect the vagina and urethraTrusted Source from an overgrowth of E. coli. When estrogen decreases during menopause, E. coli may take over and trigger an infection.

In men

The following factors may increase the risk of UTIs in men:

Vague, uncommon symptoms such as confusion make UTIs challenging to diagnose in many older adults. If a doctor suspects a UTI, they will likely order a urinalysis along with other tests to determine the true cause of the symptoms.

A doctor may perform a urine culture to determine the type of bacteria that is causing the infection and the best antibiotic to treat it.

At-home UTI tests are available to check urine for nitrates and leukocytes, both of which are often present in UTIs. Because the urine of older adults often contains some amount of bacteria, these tests are not always accurate. Contact your doctor if you take a home test and get a positive result.

Not every UTI requires treatment with antibiotics. For example, older adults staying in hospitals or residential care facilities who do not have UTI symptoms are usually not prescribed antibiotics because of the risk of drug resistance and even more dangerous opportunistic infections.

When indicated, antibiotics are the treatment of choice for symptomatic UTIs. A doctor may prescribe amoxicillin and nitrofurantoin (Macrobid, Macrodantin).

More severe infections may require a broad-spectrum antibiotic such as ciprofloxacin (Cetraxal, Ciloxan) or levofloxacin (Levaquin).

If your doctor prescribes antibiotics, you should start taking them as soon as possible and should take them for the entire recommended duration of treatment. Stopping treatment early, even if your symptoms resolve, increases your risk of recurrence and antibiotic resistance.

Antibiotic overuse also increases your risk of antibiotic resistance. For this reason, your doctor will likely prescribe the shortest possible course of treatment. Treatment typically lasts no more than 7 days, and the infection should clear up in a few days.

It’s important to drink plenty of water during treatment to help flush out the remaining bacteria.

If you experience two or more UTIs in 6 months or three or more UTIs in 12 months, you can use prophylactic antibiotics. This involves taking an antibiotic every day to prevent UTIs.

Older adults who are in generally good health may want to try over-the-counter UTI pain relievers such as phenazopyridine (Azo), acetaminophen (Tylenol), or ibuprofen (Advil) to ease burning and frequent urination.

A heating pad or hot water bottle may help relieve pelvic pain and back pain. Older adults who have other medical conditions should not use home remedies without first consulting a doctor.

It’s not possible to prevent all UTIs, but the following strategies may help reduce your chances of contracting one:

  • drinking plenty of fluids
  • changing incontinence briefs frequently
  • avoiding bladder irritants, such as caffeine and alcohol
  • keeping your genital area clean by wiping front to back after using the bathroom
  • not using douches
  • urinating as soon as the urge hits
  • using vaginal estrogen

Proper nursing home or long-term care is critical in preventing UTIs, especially for people who cannot move around without help or take care of themselves, as they rely on others to keep them clean and dry.

If you or a loved one is a nursing home resident, you can talk with the facility’s management about how they manage personal hygiene. Make sure they’re aware of UTI symptoms in older adults and how to respond.

A UTI can cause confusion and other symptoms of dementia in some older adults. Taking preventive steps and looking out for UTI symptoms should help prevent these infections. If your doctor diagnoses a UTI early, your outlook is favorable.

Antibiotics can cure most UTIs. However, without treatment, a UTI can spread to your kidneys and bloodstream and may lead to a life threatening blood infection. Severe infections may require hospitalization for intravenous antibiotics and can take weeks to resolve.

Get medical attention if you suspect that you or a loved one has a UTI.