Dr Chun Tang Sits Down To Discuss The Risks Of UTIs Within The Elderly

Dr Chun Tang Sits Down To Discuss The Risks Of UTIs Within The Elderly

UTI’s also known as Urinary Tract Infections affect millions of individuals up and down the country each year, however, the issue seems to pose a significant worry to elderly individuals in care.

Each year UTI infection leads to 150,000 hospitalisations, costing the NHS £380 million annually due to incorrect diagnostic techniques and antibiotic resistance.

In this Homelium article, we speak to Pall Mall Medical’s General Practitioner Dr Tang to explore the importance of raising awareness of UTIs and why they are so common amongst elderly individuals. 

What Is A UTI?

"UTI stands for Urinary Tract Infection.

"We have the kidneys, which are connected by tubes to the bladder and normally infections come from the skin surface or the bowels.

"Any bacteria that goes through the tubes to the bladder will proliferate, and that could cause a bladder infection, which will eventually lead to a kidney infection."

Why Are UTIs Dangerous?

"UTIs can be dangerous because if it's untreated, it can spread towards the kidneys to the upper level which can lead to an upper kidney infection. That could then become quite serious because the upper kidney is needed at all times.

"It can cause sepsis which could result in you ending up in hospital, especially if it's an elderly patient, then they can have severe consequences."

What are the consequences of not detecting a UTI?

"Consequences could be fatal. It can spread from the kidneys into the blood, and it could affect the kidneys and the renal function. If it's in the blood, then it can be quite lethal.

"With UTIs, you can have a bacteria in the urinary system that doesn't cause any symptoms, so normally you don't need to treat those.

"Sometimes you have bacteria in the urine system that causes symptoms, those are the ones that need to be treated.

"It's just recognising the two and treating the one that needs to be treated appropriately and if you don't treat it, then eventually can go upwards to the upper kidneys, eventually to sepsis."

"Consequences could be fatal. It can spread from the kidneys into the blood, and it could affect the kidneys and the renal function. If it's in the blood, then it can be quite lethal."

Dipsticks are not always reliable for UTIs. Is that correct?

"Yes, there are certain tests and some tests are diagnostics.

"So once you do the test, then it means that you have definitely got the diagnosis. In the past they thought using a dipstick is diagnostic, but in fact, it's not diagnostic.

"It helps to aid us with the diagnosis, but it doesn't actually give us the actual picture.

"That is the definite urinary tract infection. What we need is a clinical diagnosis, we need to get the history, we need to examine the patients, then we can do a urine dipstick, we can do a urinary test at a central laboratory, and with all that information, we can make an accurate diagnosis for urinary tract infection."

What are the dangers of misdiagnosing and prescribing antibiotics?

"If you're using the urine dipstick as a diagnostic test. If you see an elderly patient whose seemingly confused, and you persist on just using the urine dipstick to test it, and it shows that you have some protein, and then you just diagnose a urinary tract infection, you treat it, and you might be missing other diagnosis that could be causing the symptoms.

"It could be another issue such as a chest infection, because when you do urine dipstick, you may detect just normal bacteria in the urine system that actually isn't causing the urine tract infection.

"There may be other things that could be making the patient unwell.

"It would be good to do a full history, full examination, and consider all different types of causes of the symptoms before making a diagnosis and not using the dipstick alone as a diagnostic tool."

Do Antibiotics Ever Get Prescribed In A Misdiagnosis And Can They Have Side Effects If Not Treating a UTI?

"If a clinician doesn't examine the patient fully and just uses the dipstick and just assumes that it's a water infection, they might be missing something else.

"Because with elderly patients, they can get alternative symptoms compared to young people with, like, confusion, falls, incontinence.

"It could be a chest infection, it could be a kidney disease or it could be a stroke.

"There's many different causes. It's good to do before history examination and look at all causes before just jumping onto a urinary tract infection."

"I think Public Health England wants to push people away from just using a dipstick alone and use the full amount of information from history examination to make a diagnosis or urinary tract infections."

"If a clinician doesn't examine the patient fully and just uses the dipstick and just assumes that it's a water infection, they might be missing something else."

Why Are UTIs More Prominent In Elderly Individuals?

"In younger people, you get the usual symptoms of pain on passing water, passing too much water, back pain, abdominal pain, quite obvious symptoms, and you can treat those appropriately.

"But with elderly patients, they get other symptoms too. They may have a fall, they may become confused, they may feel a bit dizzy, they may feel sick.

"It confuses the whole picture completely. It's quite difficult to diagnose. That's why we need to do a full history examination before we make a diagnosis of a urinary tract infection."

Why Do UTIs Vary In Elderly Individuals?

"I think it's probably due to reduced immunity, multiple medications, multiple pathologies.

"Elderly individuals are more vulnerable to just ordinary infections, like a urinary tract infection, compared to young people. They get a multitude of symptoms."

Is There A Direct Link Between Catheter Use and UTI Infections? 

"Using any foreign bodies that enter the human body is at risk of infection.

"Having a catheter in, the longer it is, the more risk it is for urinary tract infection.

"It’s always good to keep an eye on the catheter, keep it as short as possible, make sure it's properly used for proper reasons, and make sure it's flowing, make sure there's no cloudy urine, and generally check the patient doesn't have any fevers, office food, and unwell."

How Can UTIs Be Prevented?

"Drinking the fluids at least two litres to three litres per day will help to keep the urine system flowing, that help to prevent urinary tract infections.

"But some genders, like females, are more prone to urinary tract infections and elderly people or people with certain diseases make them more prone to infections.

"It varies, but generally the elderly are more prone compared to younger people."

Do You Have Any Tips On How To Keep Elderly Individuals In Care Hydrated?

"If they're living at home, it is important that family members keep on reminding them to drink extra fluids.

"In nursing homes, they can do flow charts that can calculate every quarter how much fluid they're taking in.

"It's just general encouragement to get them to drink more.

"You can also check the urine. If the urine is looking clear, they're not thirsty, they're not looking dehydrated, and that's a good sign."

Is There A Connection Between Elderly Individuals With Dementia Not Receiving The Correct Amount Of Fluids?

"Absolutely! If they have dementia they may not be able to verbalise that they’re thirsty or that they’re feeling unwell.

"It really relies on the healthcare giver to notice those early signs of a UTI so that it is treated as soon as possible which would include dry lips, breathing fast, darker urine and also confusion."

If You’re Caring For An Elderly Individual What Would Be The First Signs To Look Out For In Regards To A UTI?

"Pain on passing water, back and abdominal pain which may lead to a fever.

"With more elderly individuals you will notice signs of confusion and there may be falls due to dizziness."

What Is The Best Thing To Do If You Suspect A UTI?

"If the patient is well without a fever and they’re eating and drinking and are verbal then the best course of action would be to call a practitioner who would be able to provide an assessment however if the patient is feeling very unwell with a fever and is very confused it would be best to call 999."

How Long Does It Usually Take To Recover From A UTI?

"If the patient is well and it is a simple UTI it can be resolved within 3 days as antibiotics will clear it up, however certain individuals will be resistant to the antibiotics and they may require a further course which may take another 3-7 days.

"It’s always good to send in a urine sample so the practitioner can find out exactly what bug is in the urine so they can treat it correctly."

Are UTIs Linked To The Growing Antibiotic Resistance In The UK?

"More than likely!

"A lot of chest infections and respiratory tract infections are often treated incorrectly with the wrong medication which has led to general resistance within the community.

"As UTIs are pretty common I’m sure that it has also had an impact on resistance within the UK."

Why Do You Believe There Is Such Resistance In The UK To Antibiotics?

"If you take antibiotics too much then the bacteria will adapt to your body and they will not be as effective anymore.

"This will then lead to less ways to be able to treat patients who are unwell.

"Overall we want to reduce the resistance or control it so we have more antibiotics to use in the future."

Do You Believe That Being Attentive To The Preventative Measures Of A UTI Can Result In Less Antibiotic Resistance?

"Absolutely!

"If we follow the guidelines and guidance on how to treat and diagnose a UTI in an appropriate way then this will help antibiotic resistance developing in the future because if we carry on just using urine dipsticks and just diagnosing UTIs then we may be contributing to antibiotic resistance."

Be UTI Aware

"As people begin to age, their immune systems may weaken, and various health conditions can increase which includes the implication of occasional UTIs.

"It is important that we recognise and address UTIs promptly. It is crucial to prevent more severe complications and ensure the overall well-being of the elderly."

You can catch the full interview with Dr Chun Tang below.