Understanding and Managing Urinary Tract Infections in the Elderly

Rebekah Kuschmider
Rebekah Kuschmider
February 24, 2024
min read
Medically reviewed by:
Trager Hintze, PharmD
Understanding and Managing Urinary Tract Infections in the Elderly

Urinary tract infections are among the most common infections in the United States, with over 8 million people seeing a doctor for UTI symptoms each year [1]. Anyone can get a urinary tract infection, but the risk increases as you age. It’s important for older adults and caretakers for the elderly to identify the signs of UTI to get proper testing and treatment for this common infection.

Understanding UTIs in the Elderly

A urinary tract infection (UTI) refers to a bacterial infection in any of the structures of the urinary tract, including:

  • Urethra
  • Ureters
  • Bladder
  • Kidneys

UTIs are more common in women than men, and age increases the risk of contracting a UTI. A study found that more than 10% of women aged over 65 and nearly 20% of those over 85 reported having a UTI [2].

Why Older Adults Are at Increased Risk for UTI

Various factors contribute to the increased risk of UTIs in older adults. Physical changes, functional disabilities, and underlying health conditions can all contribute to UTI risk.


For women, the risk of UTIs is higher if they had a history of UTIs in the past. Hormonal changes after menopause can also increase UTI risk. Low estrogen can lead to dryness, irritation, and loss of muscle strength in the urethra. These changes can cause harmful bacteria to proliferate in the urinary tract [3].

Bladder control issues

Issues related to bladder control and bladder emptying can also lead to a higher risk of UTIs. In men, prostate inflammation can cause incomplete bladder emptying and urine retention. Physical changes such as a prolapsed bladder or neurologic damage that inhibits bladder control can also increase UTI risk [4].

Health conditions and use of catheters

Bladder and bowel control issues in older adults are often related to underlying health conditions such as stroke, dementia, diabetes, or Parkinson’s disease. While the conditions themselves don’t cause UTIs, they can cause physical and neurological changes that increase UTI risk. In addition, individuals with significant health issues may need catheters to assist with urinary function. Catheterization is linked with increased UTI risk [2].

Mobility and hygiene issues

Older adults with limited mobility may be unable to use the bathroom as frequently as necessary. Holding urine too long can allow bacteria to flourish, causing infections. Some older adults may use incontinence briefs to address either incontinence or the inability to get to the bathroom quickly. Bacteria can transfer from the incontinence briefs to the urinary tract if they aren’t changed often or the individual’s skin isn’t cleaned thoroughly after removing the briefs [5].

Recognizing UTI Symptoms in the Elderly

Managing UTIs is relatively uncomplicated for older adults who are healthy, mobile, and able to communicate clearly. They can use home urine testing tools or visit a healthcare provider to confirm the diagnosis and move forward with appropriate treatment.

For older adults with more complex health issues who rely on caregivers to monitor their health, detecting UTIs can be more complicated. These individuals may not be able to articulate the presence of typical UTI symptoms, such as pain with urination or pelvic discomfort. Caregivers may instead notice other symptoms associated with UTIs in the elderly, such as [6]:

  • New or unusual incontinence
  • Urinary retention
  • Fever
  • Nausea
  • Fatigue

Older adults may also show behavioral changes when they have a UTI, such as:

  • Agitation
  • Lethargy
  • Confusion or disorientation
  • Decreased mobility or falling
  • Decreased appetite

The Importance of UTI Early Detection

Recognizing and diagnosing urinary tract infections in older adults is important. When left untreated, UTIs can progress to the kidneys and lead to a serious condition called urosepsis. Sepsis occurs when an infection overwhelms the immune system, and the body begins attacking organs and other tissues. Urosepsis is a medical emergency and requires immediate care. Without proper treatment, urosepsis can lead to organ damage, septic shock, or death [7].

If you or someone you are caring for is showing symptoms of a UTI, it’s important to do some tests to confirm whether or not they have the infection. You can start with a dipstick UTI test at home, then consult a healthcare provider about the next steps if the UTI over-the-counter test is positive.

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Diagnosing and Treating UTIs

Dipstick-style tests can be used to quickly and easily detect bacteria in a urine sample. These UTI test strips show results in a few minutes and don’t require bloodwork or other complicated testing. Dipstick tests, such as the Diagnox UTI test, are available for home use. Easy-to-use home UTI tests allow you to check for a possible UTI in the privacy and comfort of your home. Home testing is often easier for older adults and their caregivers.

A doctor may order a urine culture if a dipstick test shows a possible UTI. A urine culture identifies the type of bacteria present to determine which antibiotics are appropriate for treating the infection. If your doctor prescribes antibiotics, you should take the full course of treatment to make sure the infection is completely cured. Not taking all the prescribed doses can cause the infection to return and be more resistant to treatment [8].

In addition to antibiotics, the doctor may recommend options to manage symptoms of UTI. Over-the-counter pain relievers like ibuprofen or acetaminophen can reduce pain and bring down a fever. Medications like phenazopyridine can prevent pain during urination. Some supplements, such as cranberry or d-mannose powder, can also relieve symptoms.

In some cases, a dipstick test may show the presence of bacteria even though the individual has no UTI symptoms. This may be due to asymptomatic bacteriuria (ASB), a condition where elevated bacteria levels are present but do not lead to a UTI. No treatment is necessary for ASB. Using antibiotics for ASB can lead to drug resistance and make treating future infections more difficult [9].

Preventing UTIs in Elderly People

UTI prevention in elderly people is the best way to avoid the discomfort and complications the infection may cause. There are a few common sense steps older adults and their caregivers can take to prevent urinary tract infections [10]:


Drinking plenty of water or other non-caffeinated, non-alcoholic beverages keeps urine properly diluted and can lower the amount of bacteria in the bladder. Drinking six to eight glasses of water per day can help prevent UTIs.

Regular Bathroom Use

Going to the bathroom regularly and fully emptying the bladder prevents urine from sitting in your bladder for too long. Bacteria grow best in warm and wet environments. Removing fluid from the bladder inhibits bacterial growth. Most adults should empty their bladder four to eight times per day.

Personal Hygiene

Make sure you wipe front to back when cleaning yourself or an individual you’re caring for. Bacteria around the anus can cause UTIs, so wiping front to back pushes those bacteria away from the urinary opening. In addition, make sure the urinary region is kept clean and dry. Take showers instead of baths, and use gentle, unscented soap to clean the genital area.

Dietary Considerations

Certain dietary supplements or foods may help prevent UTIs.

  • D-mannose is a type of naturally occurring sugar that is available in powder form as a dietary supplement. It may be useful for treating and preventing UTIs by making it more difficult for bacteria to take hold.
  • Cranberry juice can increase hydration and may help with UTI symptoms. Cranberry is also a source of natural d-mannose and vitamin C, which can boost the immune system.  
  • Probiotic supplements or probiotic-rich foods like yogurt and kefir can be a source of beneficial microorganisms. Some research suggests that the good bacteria in probiotic supplements can balance out the harmful bacteria that cause UTIs.

Take Note of Unusual Behavior or Symptoms

Caregivers who assist older adults should be alert to changes in behavior or mood. Older individuals who cannot easily communicate verbally may show distress or discomfort in other ways. Unusual agitation, fatigue, unexplained fever, or changes in bathroom habits may indicate a UTI. Watching for unusual behavior is especially important if the individual is on a catheter or has an underlying condition that can increase UTI risk. Call a healthcare provider for guidance if you have concerns about a potential UTI.

Having a supply of at-home testing kits for UTI early detection can be helpful. Clinical-grade, reliable UTI tests, such as the Diagnox UTI Test, can help you quickly and comfortably ascertain if you or someone you’re caring for has a UTI. The results of a home test can be the starting point for a conversation with your healthcare provider about further testing and treatment.


UTIs can pose a significant health concern for older adults. Understanding the signs of UTIs in the elderly can help caregivers detect UTIs before they become a serious health threat. Preventive measures, using home tests to identify possible UTIs, and working with healthcare providers to address problems can protect the health of older individuals.


[1] Urology Care Foundation, "Understanding UTIs Across the Lifespan".

[2] L. Rodriguez-Mañas (2020), "Urinary tract infections in the elderly: a review of disease characteristics and current treatment options," Drugs in Context, 9, 2020-4-13.

[3] S. B. Cichowski, "UTIs After Menopause: Why They’re Common and What to Do About Them," The American College of Obstetricians and Gynecologists.

[4] T. A. Rowe & M. Juthani-Mehta (2013), "Urinary tract infection in older adults," Aging Health, 9(5), 10.2217/ahe.13.38.

[5] L. A. Beveridge, P. G. Davey, G. Phillips, & M.E. McMurdo (2011), "Optimal management of urinary tract infections in older people," Clinical Interventions in Aging, 6, 173–180.

[6] Cleveland Clinic, "Symptoms of Urinary Tract Infections in Older Adults."

[7] Cleveland Clinic, "Urosepsis."

[8] Y. Alpay, N. Aykin, P. Korkmaz, H.M. Gulduren & F.C. Caglan (2018), "Urinary tract infections in the geriatric patients," Pakistan Journal of Medical Sciences, 34(1), 67–72.

[9] D.N. Givler, A. Givler, "Asymptomatic Bacteriuria," [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.

[10] Centers for Disease Control and Prevention, "Urinary Tract Infection."

About the Author
Rebekah Kuschmider

Rebekah has been writing about culture, health, and politics since 2010. She has a masters degree in Arts Policy and Administration from The Ohio State University. Her work has been seen at WebMD, The Candidly, MedicineNet, YourTango, Ravishly, Babble, Scary Mommy, Salon, Role Reboot, The Good Men Project, SheSaid, Huffington Post, and Mamamia. She is a former cohost of the weekly podcast The More Perfect Union. Rebekah lives in Maryland with her husband, two kids, and a dog who sheds a lot.

About the Reviewer
This blog was
Medically reviewed by:
Trager Hintze, PharmD

Trager Hintze is a clinical assistant professor and emergency medicine clinical pharmacist located in College Station, Texas. He has a bachelor's degree in biology as well as a Doctor of Pharmacy degree. He balances teaching at Texas A&M University College of Pharmacy and practicing emergency medicine at St. Joseph Regional Health Hospital.

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