Criteria for Urinary Tract Infection in the Elderly: Variables That Challenge Nursing Assessment

Susan J. Midthun


Urol Nurs. 2004;24(3) 

In This Article

Abstract and Introduction


Urinary tract infections (UTIs) are common in the elderly, yet there is much disagreement in the literature regarding many aspects of this condition. To assist the nurse in developing optimum care strategies, UTI criteria in the elderly are discussed. Using the most recent knowledge to guide clinical assessment and intervention skills, the long-term care facility nurse and nurses who care for the elderly can influence positive outcomes in this challenging population.


Urinary tract infections (UTIs) are the most common type of nosocomial infection found in long-term care facilities (LTCFs) (Warren, Palumbo, Fitterman, & Speedie, 1991). Yet, there is much to be understood about UTIs in the elderly (generally considered to be those over 64 years old). Just as children are medically not small adults, the elderly are not necessarily older adults. They are unique in many ways. Urinary tract infection requiring antibiotic treatment is defined in the general population as the presence of significant amounts of a single micro organism in the urine (Winsinger, 1996). In the elderly, researchers have found that significant bacteriuria, even with accompanying pyuria, is not sufficient as an indicator for a UTI or antibiotic therapy (Nicolle, 2000). Further, symptoms of a UTI in the general population are not always applicable to the elderly. However, at present, there is no consensus on the definition and management of an elderly UTI. To give optimal care, the LTCF nurse, who plays a key role in initiating assessment and determining treatment, should be aware of both the uniqueness of UTIs and the contentious nature of their diagnosis in this population (Beier, 1999; Nicolle, 2000; Smith, 1998). The three criteria that, at present, are considered diagnostic for a UTI in the institutionalized elderly are: bacteriuria, pyuria, and symptoms (Garner, Jarvis, Emori, Horanm, & Hughes, 1988; Jackson et al., 1992; Loeb et al., 2001; McGeer et al., 1991). See Table 1 for a composite of the proposed criteria for a UTI. It should be noted that these authors do not share consensus regarding diagnostic criteria. Other possible symptoms as well as nursing implications for managing UTI in the elderly population will also be discussed.


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