Geriatric UTI and Hallucinations/Psychosis

Mental1 · Jul 17, 2010

Yes I have seen delirium many times in the elderly. UTI's are I believe the number one cause for delirium in the elderly. Dehyratation and altered glucose and decreased electrolytes can also cause delirium. I don't understand why the assisted living would turn him away simply because of a UTI caused delirium since a simple course of antibiotics should treat that and the psychosis should disappear. Fight for him to stay in his nice place!!!

NocturneRN · Jul 17, 2010

I just want to say, I'm only a nursing student and this is NOT a medical question. It is regarding my grandfather. I guess my question is, have any of you experienced delusional patients because of a UTI?? Is that a common side effect for geriatrics that you've noticed? For the past 8 months he's been in assisted living and was doing quite well until recently. He gets bad when he doesn't eat or drink enough. It started one weekend when he didn't make it to dinner, and if he misses one meal, he goes downhill fast. Anyway, he also contracted another UTI. Thats when he started hallucinating. Since he was weak from not eating/drinking, he would hallucinate then get up and fall. He's been admitted to the hospital now and is being treated accordingly, but he is not getting better mentally and its been about a week being treated for the UTI. I don't think the assisted living will take him back, so he will be nursing home bound unfortunately. A few other nurses commented that for some reason, when geriatric patients get UTI's, they tend to get crazy like this. Of course when he is like this he is very difficult to handle. He's always trying to get up and do things he can't, etc. I feel terrible for the nurses honestly. And my mother is beside herself because the nursing home will be the 4th place he's been, and at times, he remembers his modular and asks her if he can go back, and asks her "I don't have to go somewhere else now do I?" None of the nursing homes here are comparable to the wonderful assisted living that took him (the assisted living was GORGEOUS), so its going to be really depressing. The man is 95 and just keeps on going. We would love for him to be able to go home, but his social security income will not cover in home care unfortunately and he needs it 24/7 now. My mom is feeling extremely guilty. Her brother sends his wife and she could care less. And her sister lives 1000 miles away and does nothing but call and harass the nurses/physicians and tell them they are lying about his condition.

Mental status changes certainly can be a sign of UTI. It's so common, in fact, that, when we get a geriatric patient in the ER with this problem, one of the first things we do is collect a urine specimen. And, yes, elderly patients (UTI or no UTI) can get confused and disoriented in the hospital, especially at night. (From my days of floor nursing, I recall that confused elderly women would say, "I have to call my daughter RIGHT NOW" ---at 2:30 am--- "because she's going to be wondering where I am." Confused elderly men would get up in the middle of the night----some of them forgetting that they hadn't been ambulatory for months or years----arguing, "I have to go start the car!" And no amount of reassurance or explanations will convince them otherwise.

Sometimes the confusion and restlessness clears up as quickly as it started: one evening the patient will be climbing out of bed and cursing the staff for putting him/her back in, and the next morning s/he'll be his/her old self. It's hard to say what causes it----fluid imbalance? Infection? Adverse reactions of medications? Being in an unfamiliar environment? or all four?----but it's quite common. Most nurses who have spent time caring for geriatric patients have similar stories.

Unfortunately, there are no easy answers, regarding future long term arrangements for your grandfather. All you can do is choose whichever option seems best, and visit him as often as possible to make sure he doesn't feel that he's been forgotten. Maybe some of the long term care nurses here will have some good suggestions to offer.

CrazierThanYou · Jul 17, 2010

We have a woman at our ALF who we believe has Alzheimer's but hasn't been officially diagnosed. Lately, her behavior has gone from pleasantly demented to evil and bizarre. I have repeatedly mentioned a UTI but does anyone listen? Nope.

But yes, to answer your question, that type of behavior is very common.

CT Pixie, BSN, RN · Jul 17, 2010

Delirium and major/minor changes in behavior is a huge red flag sign of UTI in the elderly. Lately I've had several pts who had been acting oddly for a few days. Lots of falls, some becoming violent when they had never been before. All of them had a UTI.

Most times a few doses of the antibiotic will clear up the delirium and behavioral changes. Once in a while I'll get a pt who's changes don't clear up for a few days after the entire antibiotic treatment.

What you are describing is very typical of the elderly UTI patient. And their signs and symptoms are atypical of what the younger population has. While "we" usually will run a temp, the elderly tend not to.

Scarlette Wings · Jul 17, 2010

first let me say that i am sorry for your situation. it is so hard to have to confront the issue of a nursing long term care facility for those we love. guilt is a constant companion. please know that many areas have support groups for the families dealing with such an emotional upheaval.

second, mental status changes were always the very first thing i noticed when i worked long term care and the minute i realized that something was not quite right with my patient i would test their urine. i cannot tell you how often the mental changes were the first clue and occured long before a fever or maliase. i think that is why so many elderly are septic by the time they come into a hospital.

the change in intake and fluids is also sadly the primary cause. you are right on track with that. i wish you the best of luck.

CapeCodMermaid, RN · Jul 17, 2010

Yes I have seen delirium many times in the elderly. UTI's are I believe the number one cause for delirium in the elderly. Dehyratation and altered glucose and decreased electrolytes can also cause delirium. I don't understand why the assisted living would turn him away simply because of a UTI caused delirium since a simple course of antibiotics should treat that and the psychosis should disappear. Fight for him to stay in his nice place!!!

Fight for him to stay in his nice place??? It won't do him any good if his health fails further because he can not remember to eat and drink properly. I'm sure there are plenty of ALs who keep residents who should really be in a skilled facility simply because they don't want to lose the money. Not all skilled facilities are horrible places. I've worked in several and most have been staffed by very warm, caring people.

It's not easy. Good luck.

njmomstudent · Jul 17, 2010

Thank you everyone. I did see him today and he is hallucinating badly. He talks to people that aren't there. He thought he was in his truck at one point and was trying to get a screwdriver he needed. Alot of it seems to be memories of events in the past he's living in, but he does see things that are not there, and does not recognize any of us. The AL will be evaluating him on monday, but he is a very high risk for the even if he improves. Since he keeps seeing things that aren't there he keeps trying to get up and he is a major fall risk. While I was there they had to put a foley in (which was HORRIBLE because he had no idea what they were doing or why and was just screaming that it hurt and to please stop the whole time). Then he tried to rip it out of course and is in restraints now.

Whats incredible is, the priest stopped in his room yesterday while my mom was there. He snapped out of his psychosis, looked at the priest, and said he was doing good for a 95 year old and refused to die until he was 120. My mother left that part out until a few minutes ago. I told her she needed to stop letting this wreck her so much in that case. THIS is what he wants, even in this wreck of a mental state, so she needs to accept it.

ktwlpn, LPN · Jul 17, 2010

We have a woman at our ALF who we believe has Alzheimer's but hasn't been officially diagnosed. Lately, her behavior has gone from pleasantly demented to evil and bizarre. I have repeatedly mentioned a UTI but does anyone listen? Nope.
But yes, to answer your question, that type of behavior is very common.

Try telling them that she cried when she urinated due to burning-you'll get your u/a then

LouisVRN, RN · Jul 17, 2010

This is incredibly incredibly common. We frequently have older patients who are confused, don't know where they are dont recognize their families, their families don't recognize them, they try to get out of the bed all the time, even though a majority are there with fractured hips from falls. Once the UTI is treated it is miraculous to see how different they are.

CrazierThanYou · Jul 17, 2010

Try telling them that she cried when she urinated due to burning-you'll get your u/a then

Good idea. Supposedly she had a u/a. But this facility is run by a group of habitual liars. She has a whole host of other issues. Lets just say, I would LOVE to be the one to take her to an MD visit.

Bobbm2 · Nov 26, 2010

I sympathise completely and I realise that this posting is a bit behind the original but I would like to let you know that this same scenario is happening to me at the moment.

My mother, who is 79, had a temperature of 103 so I decided to call the doctor. As soon as she arrived she immediately diagnosed a UTI. It took her just seconds as she recognised the symptoms from what I told her on the phone and what she witnessed on her arrival. My mother was seeing all sorts of things; children playing in her bedroom, dogs jumping about, water leaking from the toilet and massive amounts of flowers in the garden (it's November here in the UK and the garden is bare). She was on antibiotics for just 6 days and everything cleared up as soon as it started.

As you will know, during the periods that she was hallucinating it is very worrying to see a loved one confused and not lucid. However, with the right diagnosis it clears up very quickly.

It sounds like your relative has not been diagnosed properly.