Urinary Tract Infections in Older Adults: Current Issues and New Therapeutic Options

Sophie Robichaud, MD, FRCP(C); Joseph M. Blondeau, MSc, PhD, RSM(CCM), SM(AAM), SM(ASCP), FCCP

Disclosures

Geriatrics and Aging. 2008;11(10):582-588. 

In This Article

The Older Adult Population

There is a great diversity among the older population (>65 years). A large proportion live independently in community settings (95%), others in LTC facilities (5%).[4] The epidemiology, risk factors, diagnosis, and management of UTI are affected by the different characteristics of these two populations. In the community setting, the rate of UTI accounts for 24% of all diagnosed infections, followed by respiratory tract infections.[5] The risk of infection has been mostly associated with incontinence in older women (33-50% are affected)[6] as well as the presence of cystoceles, previous surgery, increased residual urine volume, and bladder diverticuli.[7] For men, chronic urinary retention associated with prostatic hypertrophy, bacterial prostatitis, and incontinence are the principal risk factors for UTI.[3,4] Despite the fact that most of the older adults live in a community setting, the majority of studies have focused primarily on residents of LTC facilities. It is the most common infection reported in LTC facilities,[2,3,7,8] accounting for 25-30% of all bacterial infections.[8] In this particular setting, the use of chronic indwelling catheters (for 5-10% of the institutionalized population),[2,3] the presence of significant comorbidities, incontinence of both urine and bowel, and the risk of transmission of uropathogens from resident to resident[3,7,9] have been associated with both asymptomatic and symptomatic infections. Thus, the more impaired or frail the individual, the higher the risk for a symptomatic or asymptomatic UTI. It is of note that, as in the general population, women >65 years old experience symptomatic UTI more frequently than do men.[7,10]

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