Why are urinary tract infections so common in Alzheimer's patients?

Piver asked...

What are symptoms for Urinary Tract Infection? Why is it apparently so common with Alzheimer's patients?

Expert Answer

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

This is a great question. First, the symptoms of urinary tract infections (UTI) include urgency and frequency of urination, painful urination, fever, and cloudy urine. In frail and demented elders, the symptoms of UTI can be much more subtle. They may have increased incontinence, foul smelling urine, increased confusion, abdominal pain or even boody urine.

All women are at risk for UTI. The female urethra, which is the tube that connects the bladder to the vaginal area, is shorter than a man's (they are 3 x longer). So, it is easier for the bad bacteria to travel up into the bladder of women.

As we age, we will lose estrogen due to menopause, which changes the bacterial makeup in the vaginal area. There is a marked reduction in lactobacilli (a good bacteria), which is protective. Once this bacteria is reduced, fecal bacteria like E. coli can flourish, making UTI more likely.

Next, incontinence can increase the risk of bladder infections. This is due to sitting in soiled pads or panties, which allows the bacteria to travel to the bladder more easily.

Some women will have a hard time emptying their bladders effectively due to medications or gynecological problems. If the bladder doesn't empty completely, the urine will become stagnant, which of course is a breeding ground for bacteria.

Your next question was about Alzheimer's patients being at high risk for UTI. Due to the nature of the disease, it can increase the risk due to: 1) Fluid/ hydration issues: many of these patient's do not drink enough fluid, and therefore the urine becomes concentrated. This increases the likelihood of bacteria contamination, as a strong urine flow flushes bacteria out of the urethra. 2) Issues with hygiene: there is increased incontinence of bowel and bladder as the disease progresses. Often, people do not realize they are soiled. Or, they will resist being changed or cleaned up after an incontinence episode. This increases the risk of UTI. 3) Medications: dementia medications can increase the risk of urine retention. 4) Frailty: as people become less able to walk, they will often not be able to sit up to urinate. This may cause the bladder to not empty well, as there is no gravity to help it empty completely.

Hope this was helpful!