Caitlin Whyte (Host): Welcome to another enlightening episode of Flourish, the podcast where we bring you valuable health and healing advice from the trusted experts at PRISMA Health. I'm your host Caitlin Whyte, and today we're diving deep into a topic that affects many seniors, urinary tract infections or UTIs.

We're excited to have Dr. Pooja Ghai on the show, a Geriatrician with Senior Primary Care. Dr. Ghai is here to share her extensive knowledge on why UTIs are more prevalent among the elderly and how they could be accurately diagnosed.

So, Doctor, can you tell us today, what are the common symptoms and primary causes of UTIs in older adults, and how do they differ from those in younger individuals?

Pooja Ghai, DO: Yes, very good question. So, urinary tract infections, the symptoms they present with most commonly, kind of depends on where the infection is. So, for example, if the infection is in the bladder, symptoms may include a burning sensation during urination. So what providers recall a dysuria, frequent urge to urinate even when the bladder's empty what we call frequency, cloudy, bloody urine, even a feeling of fullness or pain or pressure in the lower abdomen. And then if that infection in the bladder ascends up to the kidneys, common symptoms that patients would present with would include fevers with or without chills, back or side pain, nausea, emesis, or even tenderness on the back where the lower ribs meet the spine and all these symptoms should prompt all patients to call the doctor's office and consult with your provider immediately.

Host: And why are UTIs more prevalent in the elderly population, and what are the potential complications if they're left untreated?

Pooja Ghai, DO: Yes. So UTIs are more prevalent in the elderly population, compared to the younger population, and we see that very frequently for multifactorial reasons truly. So, one is that the changes that occur in the urinary tract, so for instance, for women, we have menopause, post menopause, menopause, where we have decreased estrogen, whereas for men, they have something called very commonly benign prosthetic hyperplasia, which can cause urinary retention and thus increase those risks of UTIs in men. Additionally, there's comorbid conditions such as diabetes, incontinence, which are so prevalent in our elders and are associated with the increased risk of UTIs.

And then finally, functional disabilities such as immobility, dementia, even indwelling catheters, which play a role with directly allowing a pathway for pathogens to enter the urinary tract. So a lot of risk factors and a lot of changes as we age, that predisposes us to a higher risk of UTIs. And the complications of UTIs, if left untreated can be very serious.

So things like pylonephritis. So this is what we call the infection that ascends to the kidneys. And if that UTI goes up from the bladder to the kidneys and enters the bloodstream, it can result in sepsis or death. So very, very serious complications if left untreated.

Host: Well then how are UTIs typically diagnosed and treated in our elderly patients, and what steps can be taken to prevent a misdiagnosis?

Pooja Ghai, DO: Yes. So to diagnose UTIs in our elders, it depends on the setting first that the elders are coming from. So is it the ambulatory setting, the community dwelling individual versus the nursing home resident? So for the ambulatory setting in the community, elders should present with usually symptoms such as dysuria, worsening urinary frequency or urgency, fevers, suprapubic pain, CVA tenderness, gross hematuria. These are very common symptoms to diagnose a person with a UTI in the community, and also they should have a positive urine culture as well. Versus in the nursing home residents, we have a criteria called the Loeb criteria.

So for this criteria to diagnose a UTI for the nursing home resident, they must satisfy one of the following two scenarios. So either just have the burning on urination or have a fever plus new or worsening urgency, frequency, suprapubic pain, gross hematuria, CVA tenderness or incontinence. Andfurthermore, also if the patient's in the nursing home setting have an indwelling catheter, it's a set of different criteria to diagnose the UTI, and that's usually either having rigors or temperaturethat is 37.9 degrees Celsius or 1.5 degrees above their baseline, new onset delirium, or even new CVA tenderness.

Host: Well, that leads me into my next question, what is that connection between UTIs and cognitive issues like confusion or delirium in older adults? And how can these complications affect their overall health and quality of life?

Pooja Ghai, DO: That is such a good question to ask, so it can be confusing. So having bacteria in the urine and delirium are both very common in our elder population. Thus, it can be so difficult to understand the relationship between these two conditions. However, I'll say the most important thing to remember is that a urinary tract infection is diagnosed based on the traditional symptoms we reviewed. So that dysuria, that frequency, urgency, CVA tenderness, gross hematuria. And these symptoms may also be associated with delirium, but there is no evidence that delirium, falls or confusions are symptoms of a UTI in the absence of these classic urinary tract symptoms such as the dysuria, the frequency, the CVA tenderness that we talked about.

So you can have those urinary tract symptoms and have delirium, have confusion. But if someone comes in that is confused or has delirium, we can't say, because you have delirium, it seems like you have a UTI. We have to really do diligence and investigate further because the truth of the matter is delirium, the most common causes are usually dehydration, medication. So must do a thorough workup and really speak to the patient and see what else is going on before saying they have a UTI because of delerium. Can't say that.

Host: Wow. So what preventative measures can caregivers and healthcare providers take to reduce the risk of UTIs in seniors, including lifestyle changes and home remedies?

Pooja Ghai, DO: Love this question. So,I would say, my acronym, my favorite acronym to use when I'm talking to my patient is H and H. So hydration and hygiene. And hydration is so important to hydrate, flush out that bladder. And for hygiene, keeping that urogenital tract clean is so important. So what that means is when you're using the restroom, wiping front to back every time.

Also in when you are having intercourse or sex, making sure that you're using the restroom afterwards to flush out that bacteria that may have been introduced. And one more thing I do want to add too is for our healthcare providers, there is evidence to support the use of vaginal estrogen, cranberry supplementation, D-Mannose which is an over-the-counter dietary supplement. All of this has evidence to prevent urinary tract infection. So definitely important measures to consider when our patients present with frequent UTIs.

Host: I'd love to dive into one of those Hs, as we close out here today. How important just is that hydration in preventing UTIs among older adults and what other daily habits could help?

Pooja Ghai, DO: Yes, hydration is so important. And not just to prevent UTIs, but our kidneys love hydration. Our skin loves hydration. It is a necessity. It is so important.So I definitely would encourage our patients to stay hydrated adequately each day.In fact, right next to me, I have a bottle that has some of these encouraging logos of get started, remember to drink your water, keep chugging, and that helps me stay accounted. And then some other lifestyle habits or measures I recommend to my patients too is just avoiding soda or juices. That type of fluid at nighttime especially can really irritate the bladder and cause urinary frequency.

So, I love water, and water is so good for you.

Host: I love it. And my last question here today, can you share any personal stories or experiences related to UTIs in elderly patients? And what advice would you give to families and caregivers?

Pooja Ghai, DO: So I have seen UTIs present in just so many different ways, and it's almost like a new way each week, really.I've seen it in an elder who was walking fine, just one minute with her walker. And then the next moment she comes in to see me and she's requiring two people to help her transfer and get up and sit down.

And it's terrifying for the patient and for their caregivers who are just so confused and saying what is going on with my loved one here. So it can be really, really tricky, to diagnose and to treat a UTI, but truly it is so important for us to establish that baseline with our elders, with our patients.

Really take that moment providers and get to know your patient, and establish that relationship and also that baseline and clearly state that baseline so that way when you and your colleagues see that patient, you're able to better understand what is normal. And what is not normal for your patient and really dive deep.

And for our patients and our caregivers, I would advise you to always talk to your doctors, your nurse practitioners, your PAs, your providers, really patients, when you feel something does not feel right, you know your body better than anyone else does, so please don't hesitate to reach out.

We are here to help you, and communication is truly key in Geriatrics. And if that means sending us a message on MyChart weekly or calling the nurses line, it is okay to reach out because at the end of the day, reaching out and being seen by your primary care provider might have just saved you a night of worry, a night in the ED or even a hospital admission.

So talk to your PCP. We are here for you and we are your partners in your healthcare journey, and we love it.

Host: Doctor, thanks for joining us today and thank you for listening. We hope the insights shared by Dr. Ghai help illuminate the complexities of UTIs in seniors, offering you practical strategies for prevention and care. Remember, taking proactive steps can drastically improve the quality of life for our elderly loved ones.

And for more information and resources, please go to prismahealth.org/flourish.