Updated on April 11, 2024.
When you think of urinary tract infections (UTIs), you may think of them happening in people in their teens, 20s and 30s. But UTIs in older women are common, too. In fact, they’re the most frequent infection diagnosed in those who live in nursing homes, and the second most common infection among community-dwelling older adults.
Early symptoms can also be less noticeable or harder to recognize among this age group, says Cary Fishburne, MD, a urogynecologist at Summerville Medical Center in Summerville, South Carolina. This may lead to infection being diagnosed later, when it’s more likely to cause complications. Here’s what you need to know about UTIs in older women—so they stay protected.
UTIs in older women
As a woman gets older and goes through menopause, the loss of estrogen actually changes the pH of her vagina, making it less acidic, which in turn makes it easier for bad bacteria to grow, explains Dr. Fishburne. The tissues of her urethra and bladder also thin and dry out, leaving them prone to irritation. This makes them more likely to become infected.
Fishburne adds that both men and women can suffer from conditions that make it harder for them to empty their bladders effectively. That includes enlarged prostate for men, uterine prolapse for women, and other conditions that impede complete emptying of the bladder, such as multiple sclerosis or even uncontrolled type 2 diabetes.
UTI symptoms in older women can be different
In younger adults, symptoms of a UTI can be pretty dramatic: pain and burning during urination, as well as a frequent, often urgent need to pee. But Fishburne notes that UTI symptoms in older women are often less obvious.
It’s not always easy to separate the signs of an infection—like incontinence (loss of bladder control) and the need to go the bathroom more frequently—from other underlying conditions such as overactive bladder, which are more common in the older population. Among older adults, UTIs may cause symptoms not seen in younger people, such as confusion or agitation. That doesn’t mean your loved one definitely has a UTI if they are just showing signs of delirium, Fishburne says. But if they have the symptoms above, lower back pain, blood in their urine or tenderness in their abdomen, they should see a healthcare provider (HCP) immediately.
Some older adults may also present with a fever greater than 100 degrees Fahrenheit, but this does not occur in every situation. It would more likely be a sign that the upper urinary tract or the kidneys are involved. Any of these symptoms should prompt a call to your HCP. At-home test kits aren’t always accurate and may often be unnecessary.
Older adults are more at risk for complications
A UTI is no more serious in an older adult than it is in a younger one, says Fishburne. Regardless of age, a healthcare provider may likely suggest an antibiotic for anyone diagnosed with a UTI. But if an infection is left untreated, it can spread to the kidneys, putting older people at risk of other complications.
“Since they have a less robust immune system, their bodies are less able to fight infection off, which can lead to it spreading to the bloodstream,” Fishburne explains. This can cause sepsis, a life-threatening condition where the body goes into overdrive trying to fight infection, triggering inflammation that can lead to deadly organ failure.
The importance of prompt treatments for UTIs in older adults was recently covered in a study published in February 2019 in The BMJ. Researchers looked at nearly 313,000 cases of suspected or confirmed UTIs among adults over 65. Of that total, antibiotics were prescribed immediately for 87 percent, were delayed but prescribed within a week for 6 percent, and were not prescribed at all for 7 percent. Researchers found the rates of bloodstream infection and mortality within 60 days were significantly higher when antibiotics were delayed or not prescribed than when they were prescribed immediately.
Seniors don’t need to be routinely screened for UTIs
Older adults often provide urine samples during their annual wellness exams. These don’t need to be screened for a UTI if a person doesn’t have symptoms such as fever, urinary pain and/or urinary frequency, says Fishburne.
Many older adults—including up to 16 percent of all women over age 65 and almost 20 percent of women over age 80—have bacteria in their urine with no signs of a UTI at all. If there’s no infection, an antibiotic won’t do anything and can cause other adverse effects, such as nausea, vomiting, diarrhea or vaginal yeast infections. There is also the possibility it can encourage the growth of drug-resistant bacteria.
There are ways to help prevent UTIs in older women
More than half of women over the age of 55 will experience another UTI within a year. A 2014 review published in the Journal of the American Medical Association found that drinking about 10 ounces of cranberry juice a day appears to help prevent recurrence in these older women, but overall the evidence on the effectiveness of cranberry juice is still unclear.
Most experts do recommend upping water intake. Urinating immediately after intercourse may help prevent UTIs in older women who are sexually active.
Good hygiene is also crucial to preventing repeated UTIs in older women. Improper wiping following a bowel movement or soiled undergarments may promote the growth of bacteria. Older adults should be reminded about genital hygiene and the importance of staying clean. They should also wear loose, breathable clothes and ensure that adult diapers, if worn, are changed frequently.
Postmenopausal women can try using vaginal estrogen, either as a cream (Premarin or Estrace), an insert (Vagifem) or an actual flexible ring (Estring) that’s placed into the vagina for three months. If none of these steps work, women may also consider a single low dose of antibiotics as a preventive after having sex.
Anyone with repeated UTIs should also always consult their HCP to figure out the proper treatment and rule out other medical issues that could be contributing to the problem, such as uterine prolapse (the uterus drops down into the vagina), a bladder obstruction (a blockage at the base of the bladder) or kidney stones (small, hard deposit that forms in the kidneys), adds Fishburne. Although UTIs are common, they should not have to be frequent. A healthcare provider can help figure out the prevention techniques and treatment options that are right for each person.