What is the link between Urinary Tract Infections (UTIs) and dementia?

If the person you’re caring for seems more confused than usual, it may be because they keep developing urinary tract infections (UTI). Find out what causes them and how to treat them

In a nutshell

It may sound strange, but urine infections can affect people with dementia in ways you might not normally expect. In young people, a bladder infection causes fairly obvious symptoms such as a burning pain when urinating, or the urge to 'go' more often than necessary. But in older people – and those living with dementia – symptoms can be more complex and difficult to detect.

Symptoms of urinary tract infections (UTIs) in people with dementia can include:

• Sudden confusion, known as delirium
• Fatigue
• Sudden worsening of incontinence
• General malaise

Risk factors for urinary tract infections

1. Urinary tract infections (UTIs) are more common in elderly people. This is because urine tends to sit in the bladder for longer as we age, increasing the likelihood of bacterial contamination.

2. Urinary tract infections (UTIs) are more common in women than men – around 50 per cent of women will have a UTI in their lifetime. This is because the opening to the urethra is much closer to the anus, which can increase the chance of bacteria entering, particularly if you don't wipe 'front-to-back'.

3. Poor personal hygiene can be a risk factor for UTIs. This is a particular challenge for people with dementia, particularly if they have incontinence and need to wear pads.

4. As men get older, prostate problems can make it harder for them to empty their bladder. This can mean urine is held in there for longer and is at risk of developing bacteria.

5. Having a catheter inserted (especially if it is done on a regular basis) can increase the risk of developing urinary tract infections.

How can a urine infection cause confusion?

It may seem an unlikely connection, but it can be explained. A bladder infection puts stress on the body, physically and emotionally. If the person already has Alzheimer's or another form of dementia, this stress can result in more confusion and changes in behaviour. This then causes a sudden – though often temporary – decline.

How can urinary tract infections be treated?

UTIs are usually treated with a course of antibiotics. However, in order for your loved one to be prescribed the medication, you may need to collect a sample of urine to be analysed. Not surprisingly, this can be a particularly tricky activity to do for someone with dementia, particularly if they don't understand why you're doing it. There are some products that help to detect the presence of the bacteria that can cause UTIs in the urine and can be useful.

How can you be certain they aren't simply deteriorating?

Generally, if their confusion lessens after a short course of antibiotics, (standard treatment for a UTI) then you can assume that a urinary tract infection (UTI) was the most likely cause.

Did you know? Older people tend to be more prone to bladder infections than younger people. If they already have another underlying condition – such as diabetes – they're also at greater risk. Poor personal hygiene after using the loo can sometimes be to blame, too (because it causes bacteria to spread). This, unfortunately, often gets worse as dementia progresses.

You could also use a urinary tract infection testing kit, which can detect bacteria in the urine that could cause the infection. Buy it here.

Four ways to prevent urinary tract infections (UTIs)

1. Make sure your loved one drinks plenty fluids – six to eight glasses per day. Use cups they can see and hold easily and top them up regularly with drinks you know they enjoy.

2. Give as much assistance as they will allow with personal hygiene. Easy-to-reach wet wipes in the bathroom might help. If they have physical mobility issues which make it harder for them to wipe, there are plenty of products which could make the process easier.

3. Constipation can make it more difficult to empty the bladder, which may, in turn, make a urine infections more likely. Encouraging a healthy, varied diet will lessen the risk of constipation and reduce the chances of another urine infection.

4. Look out for dehydration, as that can increase the risk of urinary tract infections, too. If they struggle to drink fluids (because of swallowing problems), you can still boost their fluid levels through food as well as drink (think watery foods such as oranges or melon). Thickening agents can also be added to some liquids to make them easier to swallow.