Why Does a Urinary Tract Infection (UTI) Cause Confusion in Older Adults

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Urinary tract infections (UTIs) are one of the most common infections seen in a healthcare professional's office. When you think of UTI symptoms, burning during urination (peeing) or needing to urinate more often probably come to mind. These classic symptoms are what most people with UTIs experience. But some groups of people, like older adults, might show less common symptoms, like confusion, or what's known as "UTI delirium."

Let's take a closer look at how confusion can develop from a UTI and how it can be diagnosed and treated.

What is UTI confusion and delirium?

In medical terms, delirium is a condition in which someone becomes confused over a short period of time (a few hours or days). It's different from dementia, which is a slow decline in mental abilities over months and years. Although delirium is more common in older adults and people with dementia, it can happen in anyone.

Delirium can be caused by many different things, including medications, anesthesia, and infections. A common cause of delirium - especially in older adults - is a UTI. In fact, delirium may be the only symptom that an older person with a UTI has. Because of this, it's important to understand what to look for and what to do about it.

What are other UTI symptoms in the elderly?

Confusion can be serious and worrisome. But it isn't the only symptom of a UTI in older adults.

Some other symptoms of a UTI include:

• Pain or discomfort above your pubic bone

• Burning sensation during urination

• Needing to urinate frequently

• Fevers or chills

• Low back pain

• Constipation

• Decreased appetite

• Urinary incontinence

• Blood in your urine

How does a UTI affect the brain?

You may be wondering how an infection in the urinary tract affects your brain. Scientists haven't found the exact link between UTIs and delirium. But in older adults, it appears that the brain is more affected by the inflammation and stress hormones the body produces to fight the infection.

Here's what experts believe happens during an infection:

• Your immune system kicks into gear to fight it off.

• Your body releases chemicals that cause inflammation, leading to symptoms like fatigue or fever.

• The effects of this inflammation and stress on the brain are what show up as delirium.

Can a UTI cause confusion in young adults?

So, why don't young, healthy adults get delirium with infections like UTIs? It has to do with the blood-brain barrier, a special protection between your brain and the rest of your body. The blood-brain barrier keeps bacteria, viruses, and fungi that threaten the health of your brain from reaching it. This barrier isn't as strong in older adults, so the inflammation from an infection has a higher risk of affecting the brain. Keep in mind, not all older adults with a UTI get delirium. And not all people with delirium have a UTI.

How is a UTI diagnosed in a person with delirium?

The diagnosis of delirium is made using specific criteria, like making sure the change in mental status has occurred over a short amount of time and that these changes are different from the person's usual behavior. For example, if someone with dementia is usually calm but suddenly becomes violent, this may mean they're experiencing delirium.

To confirm a diagnosis of delirium, the healthcare professional will look for a cause. They'll usually start by doing a thorough physical exam and asking the person or their caretaker about their symptoms. Testing can also help with this process, including:

• Blood work: Blood tests can check for infection, inflammation, dehydration, medication overdose, or poor kidney function.

• Imaging: In some cases, a CT scan of the brain may be needed to rule out brain-related causes of confusion, like a brain bleed.

• Urine sample:Urine tests can check for bacteria and other evidence of infection in the urine.

Making a UTI diagnosis in a person with delirium isn't always straightforward. It can be hard to tell if adults who are bedbound or have dementia are experiencing pain with urination or the need to urinate more often. They may not be able to communicate their symptoms. Plus, if an older adult wears diapers because of bowel or bladder leakage (incontinence), it can be hard to tell how often they're urinating.

But healthcare professionals are trained to look carefully for infections and other underlying causes in any person who experiences sudden confusion. If you have a loved one with dementia, any change in their usual behavior should be checked out as soon as possible.

How is a UTI with delirium treated?

Since most UTIs are caused by bacteria, they're treated with antibiotics. Antibiotics work by either stopping the bacteria from spreading or directly killing them. By stopping the bacteria, the immune response to the infection is reduced, which should lead to improvement in delirium as well.

If a person is a danger to themselves or others because of their delirium, a low dose of a sedating medication like haloperidol (Haldol) may be given to help calm them down. Because these medications can worsen delirium, they're only used as a last resort.

What can happen if a UTI goes untreated?

Not treating a UTI properly can be dangerous. Bacteria can grow and spread to other parts of your urinary tract. Even worse, the bacteria can enter your bloodstream and travel to other organs, including your brain. Without treatment, a UTI can lead to sepsis, a dangerous and life-threatening response to an infection.

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