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

Susan J. Midthun


Urol Nurs. 2004;24(3) 

In This Article

Conclusions and Nursing Implications

Though it may appear there is little consensus regarding UTIs in the elderly, there are some areas in which most clinicians would agree. First, overuse of antibiotics is problematic in the area of UTIs in the elderly. Nursing implications include using methods other than these medications to alleviate symptoms such as incontinence, odor, and in some cases, frequency, urgency, and dysuria. Second, most health care professionals would advocate cautious interpretation of culture results. Because bacteriuria is common and transient in older individuals, a bacteriuric elderly resident may not have a UTI even in the presence of UTI symptoms. Ruling out other problems is particularly important with regard to symptoms, such as fever, that are common to other conditions. This will avoid a misdiagnosis causing unnecessary treatment and delaying appropriate interventions. Third, UTIs are the most common nosocomial infection in the LTCF and, by virtue of the definition, the origin of all UTIs is bacteriuria. Though little research exists in this area, management of bacteriuria by nursing methods may decrease the incidence of UTIs in the LTCF. Fourth, there is general agreement that there is much we do not yet understand about UTIs in the elderly. Nurses who work with the elderly on a daily basis are an excellent resource for insight and anecdotal data regarding UTIs in the aged population; especially the frail, cognitively impaired elderly of whom there are scarce data available. The nurse is also in a strategic position to conduct or participate in clinical research with this group of individuals.

Finally, many clinicians with knowledge of LTCF conditions would concur that institutionalized elderly are at risk for a delayed or missed diagnosis of a UTI. The lack of laboratory facilities, the lack of an on-site physician or family nurse practitioner, understaffing, staff turnover resulting in inexperienced staff being responsible for initial observations, nurses with little time to assess residents and, as mentioned, the condition of the residents themselves makes timely evaluations in the LTCF difficult at best. A proactive approach for nurses may be best, identifying those individuals who are bacteriuric and establishing an asymptomatic baseline from which acute changes could be monitored. The nurse could further identify individuals who are at risk for UTIs, such as the incontinent, catheterized, or immobile LTCF resident. The elderly who are in danger of absent or muted symptoms could be identified as well. These would include:

  • Those with catheters.

  • The incontinent.

  • Those receiving antipyretics or analgesics.

  • The immunocompromised.

  • The cognitively impaired.

Though there are many variables that challenge the assessment of a UTI in the elderly, one thing seems clear. The nurse can play a key role in improving this condition in the LTCF. Implementing nursing strategies to manage bacteriuria may demonstrate a decrease in the incidence of UTIs. Thoughtful evaluation of bacteriuria in the presence of symptoms, especially those common to other conditions, may decrease the use of inappropriate medications. Recognizing the crucial role of the nurse in identifying the subtle or atypical symptoms of a UTI may assist in timely evaluations. In conclusion, using the most recent knowledge to guide clinical assessment and intervention skills, the LTCF nurse and nurses who care for the elderly can influence positive outcomes in this challenging population.


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