Why do the elderly have AMS with UTI's?

JDCitizen · Mar 15, 2009

Good question....

Try this: https://allnurses.com/general-nursing-discussion/connection-between-eldery-177871.html

Elderly you have to lean back (Neuro workup is negative)

AMS before infection? How much of a change now.

AMS after the infection?

Fever?

Co-morbidities?

Electrolyte imbalance (dehydration)?

Sepsis?

Medications?

My first years in medical training (Emergency Medical Services) AMS elderly. Things to think (not in any particular order although ABCs always play a part:

1) Medication (esp insulin, narcotics, MH medications)

2) Stroke

3) Infection (pneumonia can = hypoxia, UTI can = sepsis, fever itself can cause all kinds of problems)

4) MI

allnurses Guide · Mar 15, 2009

It isn't the UTI as much as its the urosepsis. Sepsis puts people into warm shock, and you get poor perfusion of organs, including the brain.

clay07 · Mar 15, 2009

UTI caused by incontinece secondary to AMS. or AMS caused by infection/fever/metabolic changes for example increase in serum blood sugar caused by infection (depending on its severity)...

Not all elderly patients with UTI have AMS, maybe the patient had the AMS which led to incontinence and that inadvertently led to UTI...just using the cards I got. Need more info from patient's history :nurse: :typing

Did I answer your question?

nerdtonurse?, BSN, RN · Mar 15, 2009

Thanks! I was thinking about folks I'd had with liver failure, and how they get the super high ammonia levels with resultant AMS, and was trying to figure out if maybe there was something intrinsic to the mechanism of a UTI that would also cross the blood/brain barrier -- we don't routinely pull ammonia levels on UTIs, maybe we should? It just seems to me that I see more of an AMS in UTIs than I do in other sepsis -- oriented becomes disoriented, and disoriented go off the chain. I hadn't thought about the perfusion failure...

My mom swears that while other kids' first word is "mama" or "dada" mine was "WHY?"

arelle68 · Mar 15, 2009

My elderly pts on the Alzheimer's unit have an exacerbation of AMS with UTI. I think it has to do with pain and not sleeping. Not sleeping always makes things worse, and they don't sleep when they think they have to go the toilet all night long.

reisling · Mar 15, 2009

Sepsis. It can cause a metabolic encephalopathy

classicdame, MSN, EdD · Mar 16, 2009

one of the biggest reasons is dehydration. Brain cells, and other cells, all need water. Once we flush out the bladder and rehydrate the whole body, AMS can improve. I believe the elderly lose their ability to detect thirst and are border-lilne dehydrated anyway.

ERjodiRN · Mar 16, 2009

i agree with JBUDD. it's usually mild or full-on urosepsis that causes the mental changes. in addition to that, it's not just in the elderly. i had a guy who was 35 yrs old who we had to put in 4pt leather restraints because he was so insane. big dude, too. once things had cleared up we told him how he acted and he was absolutely floored, and terribly apologetic!

leslie :-D · Mar 16, 2009

uti's in the elderly, mostly are not detected until it has progressed to urosepsis.

they don't even become febrile until it has advanced to septic levels.

by that time, the infection is systemic, thus affecting the brain, as ruby noted.

pneumonia, wounds are mostly detected when the infection is still localized.

so it's not r/t an infectious process per se, but the severity of that infectious process.

leslie

nerdtonurse?, BSN, RN · Mar 18, 2009

Thanks everyone. The more I think about what you've said, the more it makes sense. Guess I was just looking for a zebra, and ignoring the horse standing on my foot....:)

JDCitizen · Mar 18, 2009

Actually it can be a simple as polyuria. Irritation of the bladder can equal excessive urination that can lead to dehydration as well as electrolyte imbalances... Sometimes it's not just the infection.