Urinary Tract Infections:

An Unexpected Culprit in Sudden Behavior Changes

THE SITUATION

Out of the blue, your loved one with dementia is continually running to the bathroom, having aggressive outbursts or displaying a sharp decline in mental function. Don’t let sudden changes in routines, behaviors or other symptoms like these fool you. While caregivers may think these actions are a natural progression of the disease, that’s not always the case: sudden changes can also be brought on by other conditions—and a urinary tract infection (UTI) can be one of the main culprits. When bacteria enter the urinary tract—composed of the bladder, kidneys, ureters and urethra—a UTI can occur. Elderly people have more susceptibility to infection due to a weaker immune system and weaker bladder muscles that come with advanced age. UTIs are also fairly common among people with incontinence aids or catheters. Since UTIs can be very uncomfortable and some even life-threatening, and some people with dementia might not have symptoms or express how they are feeling, it is important to take steps to try to prevent infections and to take action if they do occur.

THE SOLUTION

  • Drink fluids. Ensure that your loved one drinks six to eight glasses of water or other clear fluid per day. It helps to provide a beverage that the person likes, have fluids within reach, and offer them frequently. Avoid caffeine and alcohol that might irritate the bladder.
  • Eat the right food. Meals and snacks should include fruits, vegetables and other foods high in fiber to avoid constipation, since this can increase the risk of UTIs. Research shows that consuming cranberry juice or other cranberry products may help reduce UTIs.
  • Set a routine. Holding in urine for too long or not emptying the bladder completely, which can cause or be a result of weak bladder muscles, can be problematic. So make sure that the person urinates regularly by setting alarms, using post-it notes, taking someone to the bathroom before and after every meal, or giving verbal reminders every few hours.
  • Monitor urination. Keep a chart or diary to help determine if someone is holding in urine or going to the bathroom too often—both are possible red flags
  • Ease the route to the bathroom. It helps to indicate where the toilet is located, such as a marked path to the bathroom and an illustrated sign on the door. Hallways should be well-lit and free of clutter.
  • Maintain good hygiene. While it may avoid problems if people with Alzheimer’s disease follow bathing patterns set prior to the onset of the disease (i.e., time of day, shower versus bath), it’s best, if possible, to regularly take a shower rather than a bath to help prevent UTIs. Wash the genital or “private” area at least once a day with mild soap, and avoid bath oil and talcum powder. Women—more prone to UTIs than men, although both sexes can get them—should wipe from front-to-back when using the toilet.
  • Urinate before and after sexual intercourse. This can help flush out any bacteria that might enter the person’s genital area.
  • Stay dry. Buy loose-fitting cotton cloth underwear and change at least once a day, if not more frequently. If your loved one is using adult incontinent products or urinary catheters, which may up the risk for UTIs, make sure the products are changed frequently. Discuss the proper cleaning of catheters with healthcare professionals.
  • Know the “body” signs of UTIs. Common symptoms include an urgent need to urinate; urine that looks cloudy, dark, has a strong smell, or traces of blood; painful or burning urination; fatigue; or pain or pressure in the lower abdomen, back or sides. In some cases, there may be low fever, nausea, vomiting or chills. Look for visual cues that may indicate symptoms that are not verbalized, such as holding their back, making facial expressions or pulling on clothing.
  • Watch for behavior changes. UTIs can also cause sudden delirium, aggressive behavior, extreme confusion, hallucinations, restlessness and sleeplessness. Again, while these might be symptoms of Alzheimer’s disease, the point of distinction is “sudden” onset.
  • Seek medical attention. Check out any warning signs of a UTI immediately at the doctor or, if necessary, a hospital. Clinicians usually collect a urine sample and may perform other tests to diagnose the condition and determine the appropriate treatment—usually antibiotics. The good news: mostly, UTIs are treatable with few complications if caught early.

PREPARE IN ADVANCE
Have the name of a urologist handy if your loved one experiences recurrent UTIs.