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   and dementia   
   Urinary tract infections (UTIs) and dementia   
      
      
      
      
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   Urinary tract infections (UTIs) are a type of infection that are common among   
   older people. Women are more commonly affected by them than men. If a person   
   with a memory impairment or dementia has a urinary tract infection, this can   
   cause sudden and    
   severe confusion known as 'delirium'. This factsheet explains the different   
   types of UTIs, their symptoms and treatments, and gives tips on how they may   
   be prevented.   
      
   What is a urinary tract infection?   
   A urinary tract infection is usually caused by bacteria entering the urinary   
   tract via the urethra - the tube that allows the passage of urine from the   
   bladder to outside the body. The bacteria can then move upwards through the   
   urinary tract, infecting    
   the bladder (a condition known as cystitis) and sometimes the kidneys (a   
   condition known as pyelonephritis).   
      
   Around half of women will need treatment for at least one UTI during their   
   lifetime. If treated with the right antibiotics, UTIs normally cause no   
   further problems and the infection soon passes. Though complications are   
   uncommon, they can be serious and    
   include kidney damage and blood poisoning, which can be fatal.   
      
   Urinary tract infections and dementia   
   UTIs can cause sudden confusion (also known as delirium) in older people and   
   people with dementia. If the person has a sudden and unexplained change in   
   their behaviour, such as increased confusion, agitation, or withdrawal, this   
   may be because of a UTI.   
      
   The person may not be able to communicate how they feel, therefore it is   
   helpful to be familiar with the symptoms of UTIs and seek medical help to   
   ensure they get the correct treatment.   
      
   It is also important to be aware that any infection could speed up the   
   progression of dementia and so all infections should be identified and treated   
   quickly.   
      
   The urinary tract   
   Diagram shows the urinary tract in men and women   
      
   A diagram of the urinary tractSource: The Bladder and Bowel Foundation   
      
   The urinary tract is made up of two kidneys and their ureters (tubes linking   
   the kidneys with the bladder), the bladder and the urethra. The kidneys are   
   bean-shaped organs that filter waste products from the blood and convert them   
   into urine. The ureters    
   are hollow tubes that transport urine from the kidneys to the bladder. The   
   bladder is a muscular sac that has two functions: to store urine and to pass   
   urine from the body. The urethra is the tube from the bladder that allows the   
   passing of urine. It is    
   much shorter in women than in men.   
      
   What can cause a urinary tract infection?   
   Urine is normally sterile (does not contain bacteria), although in older   
   people it is common to have bacteria in the urine (known as bacteriuria). This   
   is because the flow of their urine is weaker and they are less likely to empty   
   their bladder fully.    
   Using a catheter (a tube placed into the bladder that empties urine into a   
   bag) almost always results in bacteria being present in the urine. This does   
   not usually need treating unless the person starts to show symptoms of a UTI   
   (see 'Types of UTI and    
   how they are treated' below), when prompt treatment with antibiotics is   
   important.   
      
   It is more common for women to get UTIs because the urethral opening is close   
   to the vagina and anus. Poor hygiene and wiping 'back to front' (rather than   
   front to back) after going to the toilet can enable bacteria from the bowel   
   and vagina to enter the    
   urethral opening to the bladder more easily. Sexual intercourse (and to a   
   lesser extent other sexual activity) can also lead to UTIs in some people,   
   though the risk is much greater for women.   
      
   As dementia progresses, it may be harder to maintain personal hygiene (eg   
   washing regularly, changing clothes). This may increase the risk of developing   
   a UTI.   
      
   Abnormal changes in the structure of the urinary tract can lead to bladder   
   emptying problems that may contribute to a UTI. These include an enlarged   
   prostate in men or a prolapse in women (where the uterus, bladder or bowel   
   descends from the normal    
   position due to a weakness of the supporting structures).   
      
   Urinary catheters are a common cause of UTIs and must be avoided whenever   
   possible. Urinary tract infections are the most common hospital-acquired   
   infection in the UK. They account for a quarter of all hospital-acquired   
   infections, and the majority of    
   these are associated with catheters. Therefore, catheters should only be used   
   for incontinence when all other options have been explored (see also   
   'Catheter-related UTIs' below).   
      
   Individuals with a weak immune system, for example people with diabetes or   
   those being treated for cancer with chemotherapy, are at greater risk of   
   getting a urinary tract infection.   
      
   Obtaining samples of urine to test for a UTI   
   If a urine sample is required, either to do a routine dip test or to be sent   
   to the laboratory for testing, this should preferably be taken in the morning   
   - the first time urine is passed that day. Obtaining urine samples from a   
   person with dementia can    
   be difficult, and the relative or carer closest to them will probably be the   
   best person to assist with this.   
      
   If the person is incontinent and wears incontinence pads, a urine collection   
   pack can be used to draw a sample of urine from the pad. These are usually   
   made up of two urine collection pads, a 5ml syringe and a urine specimen   
   container. Contact your GP or    
   local NHS continence service for advice on how to obtain these. The Bladder   
   and Bowel Foundation and PromoCon can both help you to find your local   
   continence service (see 'Other useful organisations').   
      
   Types of UTI and how they are treated   
   Lower urinary tract infection   
      
   This is when only the urethra and/or bladder is infected. A diagnosis of lower   
   urinary tract infection can be made using a simple urine dip test.   
      
   The symptoms of a lower urinary tract infection include at least one of the   
   following:   
      
   pain, or a burning sensation when passing urine (called dysuria)   
   the need to pass urine immediately (called urgency)   
   the feeling of not being able to urinate fully   
   cloudy, bloody or bad-smelling urine   
   lower abdominal pain   
   urinary incontinence - the involuntary leakage of urine   
   mild fever (a high temperature between 37-38°C or 98.6-101.0°F)   
      
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