Urinary tract infections (UTIs) are one of the most common infections in people over 65. UTIs cause millions of patients to visit a healthcare provider each year.
The challenge is that the symptoms you may have experienced from a UTI when you were younger, like painful burning, may not be what you experience as you get older. And, if left untreated, a UTI can turn into a serious infection in the blood called sepsis.
That’s why it’s important to know what to look for.
We spoke with Jungwuk Han, MD, an internal medicine specialist with Banner Health. He helps us understand how aging changes UTI risk and ways to prevent an infection.
Why UTIs become more common as you age
A UTI happens when bacteria, often Escherichia coli (E. coli), infect parts of the urinary tract including the urethra, bladder and kidneys. There are several reasons why UTIs become more common as you age.
“As we get older, our body’s natural defenses change,” Dr. Han said. “We experience changes in hormones, the immune system and the urinary tract.”
Hormone changes
For women, dropping estrogen levels after menopause can lead to changes in the vaginal area. This can disrupt healthy bacteria, making it easier for harmful bacteria to grow.
Men may also experience changes in the prostate that affect urine flow, which can increase UTI risk.
Weakened immune system
“Your immune system helps protect you from germs,” Dr. Han said. “As you age, it doesn’t work as quickly or strongly.”
This makes it easier for bacteria like E. coli to settle in your urinary tract and cause infection.
Changes in the urinary tract
“The lining of your bladder, urethra and surrounding areas can become thinner and less flexible over time,” Dr. Han said. “This change can make it easier for bacteria to attach and harder for your body to flush them out.”
Some adults may also have more difficulty emptying their bladder due to weak bladder muscles, enlarged prostate or nerve problems. Urine that stays in the bladder can give bacteria a chance to multiply.
Risk factors that raise your UTI risk
These things can raise your risk of UTIs:
- Chronic health conditions: Conditions such as diabetes, kidney problems or nerve disorders can make UTIs more common. High blood sugar, for example, can feed bacteria and make infections more likely.
- Use of catheters: Sometimes, older adults need a catheter to help them urinate (pee). While catheters can be helpful, they also increase the risk of introducing bacteria into the urinary tract.
- Cognitive conditions: Memory problems like Alzheimer’s disease or dementia can make it hard for people to take care of themselves and stay clean.
- Dehydration: Not drinking enough water means your body produces less urine, which makes it harder to flush bacteria from the bladder.
- Constipation: When stool (poop) builds up in the intestines, it can press on the bladder and urinary tract, making it harder to fully empty your bladder. This trapped urine can let bacteria grow.
- Medications: Some medicines, such as those that affect urine flow or weaken your immune system, can increase the risk.
- Mobility issues: Difficulty getting to the bathroom or cleaning thoroughly can raise risk.
Recognizing symptoms in older adults
In children or younger adults, UTIs usually cause symptoms such as burning, an urgent or frequent need to pee and cloudy or strong-smelling urine. An infection in older adults, however, can look a bit different.
“Older adults may not show classic UTI signs,” Dr. Han said. “The single best sign of a UTI in an older adult is often a sudden change in behavior or personality changes.”
Also watch for:
- Sudden mental fog or confusion
- Mood swings or irritability
- Fever, chills or shaking (rigors)
- Balance problems or falls
- New or worsening incontinence
- Extreme fatigue or decreased energy
- Loss of appetite
What is asymptomatic bacteriuria?
Sometimes, lab results show bacteria in your urine even when you feel completely fine. This is called asymptomatic bacteriuria, a condition where bacteria are present without causing any signs of illness.
It’s common in older adults, especially older women. About 6% to 16% of women over 65, nearly 20% of women over 80 and up to half of women living in long-term care facilities may have this condition.
“We usually don’t treat asymptomatic bacteriuria,” Dr. Han said. “Studies show that giving antibiotics when you don’t have symptoms doesn’t help prevent future infections or improve well-being. Plus, unnecessary use can cause side effects or antibiotic resistance.”
Diagnosing UTIs
UTI symptoms can be easy to miss or look like other problems. Your provider may order lab tests to find out what’s going on:
- Urinalysis: Checks for white blood cells and bacteria in your urine.
- Urine culture: Finds out what bacteria (usually E. coli) are causing the problem and helps guide treatment.
- Medical history and exam: Looks at past health issues, whether you use a catheter and how your bladder is working.
Treating UTIs in older adults
Most UTIs with symptoms need antibiotics. Using the wrong antibiotics or stopping them early can lead to bacteria becoming resistant. Your health care provider will choose the right antibiotic for your infection.
“In most simple UTIs, we start with antibiotics like nitrofurantoin or trimethoprim-sulfamethoxazole,” Dr. Han said. “These medicines target the bacteria that usually cause UTIs, especially E. coli, which causes most uncomplicated cases. They work well in the urine and help prevent broader antibiotic resistance.”
For more serious infections, like complicated UTIs or those that could cause sepsis, you might need to go to the hospital and get antibiotics through an IV.
Always finish your antibiotics, even if you feel better. Stopping early can let the infection come back or make future treatments less effective. Drink plenty of water to help flush out bacteria and call your provider if your symptoms get worse.
Preventing UTIs
You can reduce your risk of UTIs with everyday habits:
- Drink plenty of water: Water helps flush bacteria out of your bladder.
- Practice good hygiene: Wipe from front to back, keep the area clean and avoid harsh soaps.
- Urinate often: Don't hold in your pee. Make sure to empty your bladder fully.
- Wear breathable clothes: Cotton underwear and loose pants help keep you dry and comfortable.
- Control health problems: Keep things like blood sugar levels in check.
- Use hormone treatments, if needed: Special creams, tablets or rings containing estrogen can help strengthen tissue and balance bacteria. These can reduce infections by half.
- Prevent constipation: Eat fiber, drink water and stay active to keep your bowels regular.
- Consider supplements: Cranberry extracts and D-mannose may help prevent UTIs.
- Ask about preventive options: Older adults may need low-dose antibiotics or other strategies to reduce the frequency of UTIs.
“If you have two infections in six months or three in a year, talk with your provider about ways to help prevent them,” Dr. Han said.
When to seek help
If you have mild burning, urgency or cloudy urine, start by contacting your health care provider. They can confirm whether it’s a UTI and prescribe antibiotics if needed.
You should also see your provider if you notice:
- Any symptoms that could point to an infection, even if they are minor
- Unusual behavior or personality changes
- Repeated infections, which may mean you need a prevention plan
- Any health changes if you’re at higher risk
Get immediate medical help if you notice:
- Sudden confusion or changes in mental state
- High fever, chills or shaking
- Severe pain
- Major weakness or extreme tiredness
- Nausea, vomiting or loss of appetite
- New trouble with bladder control or getting around
- Unexplained falls or balance problems
- Difficulty breathing
Takeaway
Urinary tract infections (UTIs) are common in older adults and can be hard to notice. As people age, their immune system, hormones and tissues change, making infections more likely and harder to spot.
If you or someone you care for shows signs of a UTI, talk to a Banner Health specialist. They can perform a urine test, provide safe treatment and help develop a plan to prevent future infections.
