UTIs Are More Common in Older Adults. Here’s How to Spot One

Written by Tracy Norfleet, MD, MBA, FACP, ABOM | Reviewed by Patricia Pinto-Garcia, MD, MPH Published on March 20, 2023

Key takeaways:

• You’re more likely to develop a urinary tract infection (UTI) as you get older. UTIs are common in older adults who are over the age of 65.
• UTIs typically cause pain and burning while peeing. But, in older adults, the symptoms of a UTI may also include confusion, agitation, and frequent falls.
• Older adults can develop serious health complications from a UTI. Starting antibiotic treatment as soon as possible can prevent these complications.

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Urinary tract infections (UTIs) affect the bladder and kidneys. UTIs are one of the most common reasons people seek medical care. And the risk of developing a UTI goes up as you get older. 

UTIs in older adults can quickly lead to more serious infections. So older adults with UTIs should seek care and start antibiotic treatment as soon as possible to avoid these complications. 

But spotting a UTI can be tougher than you think. Older adults may not experience common UTI symptoms like pain and burning with urination. Instead, they may experience seemingly unrelated symptoms, like confusion, agitation, and delirium. 

Why are UTIs more common in older adults?

The risk of developing a UTI changes over the course of a person’s life. As people get older, they’re more likely to develop a UTI. And UTIs are the second most common reason for hospitalization in adults over the age of 65.  

UTIs are more common in older adults for many reasons, including:

• Medication side effects: Older adults are more likely to take daily medications. Some of these medications can cause urine retention, which is when urine sits in the bladder longer than usual. When urine sits in the bladder longer, there is more time for bacteria to grow and cause a UTI. 
• Enlarged prostates: Older males are more likely to develop enlarged prostates. An enlarged prostate can lead to urine retention and increase the risk of a UTI. 
• Lower estrogen: After menopause, estrogen levels drop. This causes changes in the vagina that make it easier for bacteria to get into the bladder and cause a UTI.
• Weaker immune systems: As people get older, their immune systems take longer to respond to potential health threats, which increases the risk of developing an infection. Older adults are also more likely to have weakened immune systems, either from medical conditions or as a side effect of treatment for medical conditions. 
• Exposure to bacteria: Older adults are more likely to receive care at a hospital or long-term care facility. So they’re also more likely to get exposed to bacteria that can lead to infections. 
• Memory changes: As the brain ages, older adults may experience memory lapses and hold their urine in longer than usual. This gives bacteria time to grow in the bladder and cause an infection. Adults who develop dementia are even more likely to forget to go to the bathroom and are at the highest risk for developing a UTI. 
• Trouble getting to the bathroom: Older adults who have trouble getting to the bathroom are more likely to hold in their urine and develop an infection. Some older adults have trouble getting to or using the bathroom, while others have trouble asking for help.

How are UTI symptoms different in older adults?

Older adults may develop unexpected symptoms when they have a UTI. This can make it harder to spot a UTI and get treatment. These symptoms include:

• Confusion
• Fatigue
• Agitation
• Speech or language changes
• Frequent falls
• Dizziness
• Decreased Appetite

Older adults can also develop more common UTI symptoms like: 

• Burning and pain while urinating (peeing)
• Feeling the need to urinate more often
• Having an urgent need to urinate
• Blood in the urine
• Cloudy, discolored, or bad-smelling urine
• Fever
• Back pain

Older adults who have trouble communicating may not be able to let someone know they are feeling these symptoms. So their UTIs may get overlooked at first. 

Adults who have trouble getting to the bathroom may develop incontinence. Sometimes, “accidents” get chalked up to normal aging. But they can actually be a sign of a UTI. So, if an older loved one develops sudden behavior changes or incontinence, make sure they see a healthcare provider right away. 

How do you treat UTIs in older adults?

Older adults who develop a UTI need treatment with antibiotics. 

While younger adults can take a “wait and see” approach, older adults should start taking antibiotics right away. That’s because older adults are at higher risk for developing serious complications from a UTI, like sepsis. 

The best antibiotic for a UTI depends on which bacteria is causing the infection. But, while the exact antibiotic may be different from one case to the next, the length of treatment is usually the same. In most cases, older adults need to take antibiotics for 7 to 14 days to cure a UTI.

Older adults can take over-the-counter treatments for UTIs to help with symptom relief. But these treatments won’t cure a UTI or prevent complications. So it’s important to take them in addition to and not instead of antibiotic treatment. 

When should an older adult seek care for a UTI?

If you’re over 65 years old and you think you might have a UTI, see your healthcare provider right away. Even if you only have mild symptoms, like burning with urination, it’s important to start treatment early to prevent complications.

If you’ve noticed that an older loved one isn’t acting like themselves, take them to see a healthcare provider. Keep in mind that older adults may not develop a fever when they have an infection. But symptoms like confusion, irritability, and trouble sleeping may provide clues that they have a UTI.

The bottom line

Older adults are more likely to develop urinary tract infections (UTIs) than younger adults. Older adults can experience symptoms like pain and burning with urination when they have a UTI. But they can also develop unexpected symptoms, like incontinence, confusion, agitation, and behavior changes. 

Older adults have a higher chance of developing serious complications from a UTI, like sepsis. So they need treatment with antibiotics as soon as possible to prevent these complications.

If you think you might have a UTI, see a healthcare provider. Or, if a loved one isn’t acting like themselves, make sure they get checked for a UTI.