Hi everyone, "newby nurse" just have a quick question. After being a nurse for 4 months now at LTC, I have noticed that patients who are exhibiting "changes in mental status" almost always test positive for UTIs. My question is why does this happen to older patients? They become confused and some even hallucinate. What is the chemistry behind this? Why does this particular infection affect older patients in this way?

Thank you in advance for any information you can provide!

Dehydration, toxins building up, fever..... tosses normal state of affairs off in the bloodstream if bad enough; if a "simple" UTI, it can be the anxiety of urgency/pain/burning.... a lot depends on how far from baseline someone is. But yeah- when someone was a bit goofy out of the blue, the first thing done was get an order for a UA, C&S. Dollars to donuts, they had funk in the UA.

http://www.amda.com/publications/caring/october2002/utis.cfm

http://en.allexperts.com/q/Geriatric-Medicine-2002/2009/9/Mental-status-changes.htm

http://search.yahoo.com/search;_ylt=Ate0MlwmDyJqeb9LaKvwVtGbvZx4?p=cause+of+mental+status+changes+in+elderly+with+UTI&toggle=1&cop=mss&ei=UTF-8&fr=yfp-t-701

5.4 Million links... hopefully one will be useful ... maybe narrow it down a bit more w/info pertinent to specific situations?

...Great links xT........Any infection in the elderly can cause altered mental status. They are considered immunocompromised.. so they may not spike high fever or have a significant increase in the wbc. Thats why even 2 degrees higher is significant on elderly pts. Left shift granulocytes can be helpful in identifying infection.

Often infections are something you want to rule out when elderly presents with AMS. UTI being the common one for elderly, its checked by running a urinalysis and subsquent urine culture. The ability to respond to irregularities is weakend in the elderly and that makes small changes difficult with the system to deal with the stress...the proverbial straw that breaks the camels back.

As for pathophysiology, few things to think about:

1) weakened immune system (to begin with) is put to the test with the infection which adds stress to the body.

2) Having fever.. results in diaphoresis.. could result in dehydration. they're usually dehydrated to begin with.

3) Metabolic changes

4) decreased O2 delivery to the brain during infection

etc.

http://katrenawells.suite101.com/uti-may-be-cause-of-sudden-confusion-in-elderly-a129617

They are particularly sensitive to changes that young folks can normally handle. They are really sensitive to changes in O2 which could be the reason for change in mental status we see in most infections

All the above replies are 100% right, I just wanted to add that you tend to see UTI's more frequently in the elderly (specifically LTC setting) because more of these patients are incontinent. When someone sits in waste for any period of time, it opens the door wide open to UTI. Also, many patients have catheters, and you can find TONS of material for CAUTI (Catheter-Acquired UTI) and contributing factors.

Its worth reiterating that any infection can effect mental status, you tend to see more UTI in LTC for the reason mentioned above.

Thank you everyone for your responses. All this information has helped me to understand how UTIs affect older adults. The majority are also women which makes sense because of anatomy. I just wasn't understanding the CMS and now I do. Thank you so much! Also I did not realize that older adults are considered immunocompromised...

Thank you to those of you who supplied the links...very helpful and educational!

UTI is also my first suspicion when an elderly person falls for no obvious reason. A urine dip is always part of my fall investigation reports.

UTI is also my first suspicion when an elderly person falls for no obvious reason. A urine dip is always part of my fall investigation reports.

Yup, me, too. Falls and AMS will usually have me clamoring for UA orders