Preventing Urinary Tract Infection and Unnecessary Hospitalization for your Elder

I recently spoke with a friend who was concerned about her mother. Her mother had become so ill she required hospitalization for treatment of a urinary tract infection. She then had to spend some time in a skilled nursing facility to finish recovery before returning to her assisted living facility.

The concern involved prevention of a similar occurrence in the future. My friend was amazed that something as simple as a bladder infection could make someone so ill.

Our conversation made me realize that there are probably many people caring for, or concerned about, their Elders becoming severely ill for the same reason.

Maybe some people don’t even realize there is such a great risk.

So, I thought I would talk about prevention of UTI’s (urinary tract infections).

UTI’s (or bladder infections) are actually quite common in elders, women more than men. The reasons for this are:

• Elders don’t like to drink enough fluids (makes them want to go to the bathroom too often).
• Elders often don’t feel thirsty.
• Elders, especially women, are often incontinent of urine.
• Incontinent elders may not want the fuss and bother (or expense) of changing incontinent briefs as often as they should.
• Elders very often have difficulty with hygiene after toileting, thus encouraging the growth of bacteria.
• Elders often have an impaired immune system due to degenerative diseases, and/or poor nutrition.

The solution, or rather the prevention, of bladder infections is really simple, as long as your Elder will cooperate.

Nutrition and hydration (I know, I keep harping about this) is important to keep the immune system functioning, and the kidneys functioning so that the urinary tract is flushed out. Bacteria won’t have a chance to sit around and multiply, thereby causing the infection. Some simple preventatives:

• 8 oz. of water at least 3 times per day (given with medications is perfect).
• 8 oz. of orange juice daily. Better yet, eating one orange (or grapefruit) every day.
• 8 oz. of cranberry juice (unsweetened is best, or sweeten with apple juice) once or twice a day has been known to be helpful in keeping bacteria from “sticking” to the walls of the bladder and urethra. Plus it also has Vit. C.
• Before eating grapefruit or drinking grapefruit juice, please check the link (on the left side of the blog) “List of meds that interact with grapefruit juice.
• Total fluids, including coffee, tea, milk, juice, beer (whatever) should total around 2000 cc (or 2 quarts) at least (unless the Elder’s physician has specified another amount).
• Someone needs to actually give or offer these fluids to your Elder. Don’t rely on your Elder to remember to drink that much on her/his own. Work it into a daily routine.
• Your Elder needs to eat enough protein, vegetables and fruits to get adequate amounts of protein, carbs, vitamins and minerals to be able to maintain an immune system and heal damaged tissues. If you are unsure if your Elder is eating enough, check out “MyPyramid.gov” (listed in “Links for your Assistance” at the left side of the blog).

Incontinent Care: cleanliness is everything. Elders don’t change often enough, and are unable usually to clean well enough after toileting. Also, most elders don’t bathe every day. So, keep mindful of 1) growing bacteria 2) spreading bacteria, and 3) prevention. Bacteria growing in disposable briefs, underwear, or on your Elder’s skin can easily travel up the urethra to the bladder. The bacteria usually responsible for causing infection come from the bowel.

• Help your Elder develop a sensible toileting schedule. She/he should be toileting 5 to 6 times a day. Most common: upon arising in the morning, mid-morning, mid-afternoon, after dinner, before going to bed at night. Then again about 2-3 hours after going to bed (kidneys work better for lots of elders when lying down; this can help with night time incontinence).
• Even if your Elder is fully incontinent, toileting regularly will also help to get her/him moving around; get cleaned and changed often; and encourage some continent episodes. If the Elder is not able to get onto a toilet, then changing the incontinent brief and good cleansing is essential soon after the incontinent episode.
• Allowing an Elder to wear a wet (and especially soiled) incontinent brief for any length of time can encourage the growth of bacteria that can travel up the urethra into the bladder. This is especially true for women. So change the brief if wet or soiled at all (yes, even a little bit) every time the Elder toilets.
• Use baby wipes to cleanse your Elder after toileting. It’s much more effective for you to do it. Wear gloves, stand behind the Elder and ask her/him to lean forward, then cleanse from (their) front to back.
• Wash your Elder’s “periarea” with soap and water at least once per day, twice is better. You need 3 washcloths, disposable gloves, moisturizing body wash.
• Wear gloves
• Wet 2 washcloths with warm water.
• Use a small amount of body wash on 1 washcloth to wash (you from the back, elder leans forward while sitting on the toilet) from front to back.
• Use 2^nd wet wash cloth to rinse. You may need 2 to rinse thoroughly.
• Then pat dry with the 3^rd dry washcloth.
• Wash any linens used for pericare with laundry soap and some bleach.

All of this accomplishes a few things: your Elder feels better and cleaner, smells better, hopefully has more continent episodes, and no worries of unnecessary infection, all of which add up to greater dignity, more peace of mind, and hence Pleasant Days.

Symptoms of a UTI in an Elder:

• More frequent urination than usual.
• Feeling of low abdominal cramping, or urgency (feeling like you have to go, but hardly anything comes out)
• Unusual confusion/disorientation or delusions. A drastic change in the Elders cognitive ability is sometimes the only clue that she/he is sick.
• Burning on urination
• Cloudy and/or very smelly urine
• Fever is hardly ever present unless the infection is severe.

If drinking more fluids doesn’t help in one day, call the Elder’s physician. If the Elder has fever, severe pain or blood in the urine, call the physician right away.

Antibiotics are not always needed, but if the infection is causing fever, blood in the urine or severe pain, or your Elder is not able or willing to drink enough fluids to flush out the bladder, treatment is necessary to prevent a more serious infection higher in the urinary tract (the kidneys) and a possibly life-threatening situation.

So there it is. Maybe not so easy, but far better than lengthy hospitalizations, risk of kidney infections that could be painful and life-threatening, and a real risk of even longer stays in a skilled nursing facility with the inevitable declines in function and cognitive ability than result. Very Unpleasant.

Wishing all of you and your Elders Pleasant Days!!