I recently had a conversation with a retired Occupational Therapist friend who spent years in rehab facilities and nursing homes. She shared something that took me by surprise: while I’ve always thought limited mobility and cognitive decline were the main reasons so many people over 80 end up in nursing homes, I realized I’d missed a critical underlying cause.
The Hidden Culprit? UTIs (Urinary Tract Infections)
UTIs often present very differently in older adults which is why they’re often missed. Unlike younger people who experience pain or fever, older adults may not show these classic symptoms. Instead, a UTI can quietly progress, leading to confusion, falls, and even sepsis in severe cases.
When a UTI goes undetected, it can trigger an inflammatory response that impacts brain function. This can cause sudden confusion, memory problems, and difficulty focusing—symptoms that look a lot like dementia.
The Link Between UTIs and Falls
The cognitive disorientation caused by a UTI increases the risk of falls, which can lead to hospitalizations, broken bones, and further complications.
If an older client of mine complains of balance issues or falls, one of the first things I suggest is a urine culture to check for a hidden UTI. It’s surprising how often this simple test is overlooked, even by neurologists!
Who’s Affected?
While I used to think UTIs were mostly a women’s issue, my friend again corrected me—men are affected too. Around 20-30% of women over 80 experience UTIs annually, while only 10-15% of men in the same age group, especially those in long-term care.
For men, UTIs are often related to prostate enlargement, bladder issues, catheter use, and even sexual intercourse.
Women, on the other hand, face UTIs mainly due to decreased estrogen levels with the onset of menopause. Low estrogen levels cause changes in the genitourinary system which includes the vaginal tissue, urethra, bladder, pelvic floor and ligaments. And of course, increased use of catheters, adult diapers, or other medical devices contributes as well, which could be minimized by hormonal treatment.
Prevention and Treatment
For postmenopausal women, the use of vaginal estrogen therapy is a key preventive measure!!! And I’m hoping all women will explore this therapy, even if they are wary of systemic HRT.
Even if you’ve had cancer, many doctors are on board with this therapy it as it stays localized to the genitourinary tract and doesn’t raise overall estrogen levels.
Side Note: Systemic HRT, if at appropriate doses, will also prevent issues of the genitourinary system, reducing UTI’s AND preventing osteoporosis which is another common cause for falls mainly in women as they age.
Treating UTIs promptly with antibiotics can reverse cognitive issues in most cases, though some older adults may face lingering effects if they have underlying conditions.