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

Susan J. Midthun


Urol Nurs. 2004;24(3) 

In This Article

Other Possible Symptoms of a UTI

Other than the decline in mental and functional status mentioned previously, there are several other symptoms that have been associated with UTIs in the elderly (see Table 7 ) (Bahnson, 1986; Baldassarre & Kaye, 1991; Black, Hawks, & Keene, 2001; Esposito, et al., 1980; Fontanarosa et al., 1992; Gleckman et al., 1982; Richardson, 1993; Richard son & Hricz, 1995; Rudman et al., 1988; Windsor, 1983). These include signs of urosepsis as evidenced not only by an altered mental status and fever, but by increased pulse and respiratory rate, and/or hypotension as well (Bahnson, 1986; Gleckman, 1992; Rudman et al., 1988). Other respiratory symptoms, such as rales or respiratory distress, may be the primary indicators (Balas sarre & Kaye, 1991; Gleckman et al., 1982). Gastrointestinal symptoms such as nausea, vomiting, and abdominal tenderness also are signs of an elderly person's UTI (Black et al., 2001; Gleckman, 1992; Richardson, 1993). These and the "decline" symptoms are not specifically urinary symptoms and are, therefore, described as nonspecific or atypical symptoms of a UTI. Clinicians are not in agreement regarding the implications of these symptoms. Some studies considered them to be indicators of a UTI (Beier, 1999; Barnett & Stephens, 1997; McCue, 2000; Yoshikawa, 1984b; Yoshi kawa & Norman, 1995). Other authors found them unreliable markers of this infection (Bentley et al., 2001; McMurdo & Gillespie, 2000; Nicolle, 1993, 1999, 2000; Orr et al., 1996; Walker, McGeer, Simor, Arm strong-Evans, & Loeb, 2000). Nevertheless, several physicians have questioned the appropriateness of not treating bacteriuria in the presence of a change in the patient's condition. They found patients improved following antibiotic treatment in these instances despite a lack of typical UTI symptoms (Hamilton-Miller, 1999; Miller, 2001).


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