Elderly, UTI's and Behavioural Changes
Dec 1, 2015
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Bantam girls are quite stinky. This surprised me again on the weekend as I stood near a team of grade 8 & 9 girls. They were on their way back out onto the ice after the break between periods. I've watched this group of girls play hockey for many years now. I know they skate hard, make some nice plays and shots and they get quite chippy in the corners and in front of the net. They get up when someone knocks them down and they play through injuries. Bantam girls hockey is fun to watch. But for whatever reason, I guess I didn't expect them to smell so much like hockey players when I started following the team.
When I started working in long term care homes, I didn't expect a simple infection to have such unusual effects. Let's look at an example. Grandma is living comfortable in her care home. She enjoys the afternoon activities with bingo, muscians and games of crib. There are a few ladies she has lunch with everyday, and she gets along well with them. Your grandma has some dementia and that is the main reason she is in the care home. But she remembers who you are on most days. On others she thinks you are her son or her long dead husband. But by and large she is comfortable and happy in her care home.
Then one day, grandma just seems to lose her mind. She doesn't recognize anyone in the family anymore. She won't use a knife and fork at lunch. She not only eats with her hands, she starts throwing her potatoes at anyone she sees. What has happend to Grandma to make her go down hill so suddenly.
It could be variety of things. On the very serious side, it could be a stroke or an aggresive brain tumor. It could be that her medications were changed and she doesn't tolerate the new regime. You and your family are very distraught, but your Grandma's nurse doesn't seem too surprised or alarmed. She says she is going to do a urine test on Grandma and get the results sent to the doctor.
Why would the nurse do a urine test? This response to a patient whose behaviour suddenly changed surprised me when I started working in care homes. When I asked, the nurse said they were checking for a bladder infection. As a pharmacist, this surprised and confused me even more. Bladder infections or UTI's are common and usually have symptoms like feeling like you have to go to the bathroom right now (urgency), feeling like you have to go to the bathroom every few minutes (frequency), pain going to the bathroom and maybe fever. But, as I learned, the elderly are different.
Although it was news to me, it has been written about in medical literatures for over a hundred years that older adults can have severe infections without having typical signs and symptoms. Fever, which is a hall mark of many infections, is doesn't happen in 30 to 50 percent of frail, older adults when they have infections. Fever can even be missing in elderly who have serious infections like pneumonia or a heart infection called endocarditis. It is not uncommon for older adults to experience unusual symptoms instead. Increased confusion, falling and loss of appetite can be symptoms of infection in the elderly.
Urinary tract infection (UTI) is the most common infectious illness in adults age 65 and older. It turns out they often don't complain about urgency or frequency or pain on unrination. Sometimes, a UTI causes our frail elderly to change their behaviour. Often this behaviour change is a quite significant decline in function and ability. This was definitely not a reaction to a UTI that I was taught in pharmacy school.
It is remarkable when an elderly person's behaviour is changed by a UTI. If grandma's behaviour has changed and her urine test comes back positive for a bladder infection, the doctor will write her a prescription. The prescription will be for a standard oral antibiotic. The infection will be cured in about a week and grandma's mental state will go back to the way it was before the infection.
I don't want to give anyone false expectations. Sometimes behavioural changes is our older loved ones are caused by strokes which are not reversible. Sometimes it is a worsening of their dementia, and again that is not reversible. But sometimes what appears to be a dramatic turn for the worse in Grandma's behaviour can just be a bladder infection. And if it is, when we cure the UTI, the behaviour gets better fast as well.
Bantam girl hockey is fast, aggressive and fun to watch. They dig hard in the corners, their defence knock their opponents off the puck and their goalie's stand on their heads. It shouldn't have surprised me that when you play hockey hard, you will smell like a hockey player. Now go hit the showers ladies. I want them to let us into Dairy Queen in Neepawa when we stop for a blizzard on the way home.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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