Urinary Tract Infections in Older Persons- myassignmenthelp.com

Question: Discuss about theUrinary Tract Infections in Older Persons. Answer: Urinary Tract Infections in Older Persons Urinary tract infections (UTI) occur when bacteria attack the urinary tract via the urethra and they begin multiplying in the bladder. Urinary tract infections commonly affect women affecting the bladder and the urethra (Bardsley, 2017). This is because in women, the urethra is usually shorter therefore, shortening the distance traveled by bacteria to reach the bladder. There are several other risk factors that contribute to the development of urinary tract infections. These according to Beveridge et al (2011) include sexual activity; women who are sexually active have increased chances of having UTIs, some types of birth controls; the use of diaphragms and spermicidal agents puts a woman at a higher risk, menopause; circulating estrogen declines after menopause which results in changes in the urinary tract thus putting the women at a higher risk of being infected. There are different types of urinary tract infections in accordance with the particular parts that get affected. One of them is acute pyelonephritis that affects the kidney. The symptoms include pain on the upper back and on the side, nausea and vomiting. Another type of Urinary Tract Infection is cystitis that affects the bladder (Bardsley, 2017). The symptoms include pelvic pressure, blood in urine, frequent painful urination and lower abdomen discomfort. Finally, there is urethritis which affects the urethra. Its symptoms are burning sensation during urination and discharge. When urinary tract infections are not treated early enough, various complications may arise like recurrent infections, urethral narrowing where there is recurrent urethritis especially in men, permanent kidney damage, delivery of premature infants or of low birth weight in pregnant women and sepsis (Beveridge et al, 2011). Urinary tract infections in older persons may present hard to find out because they do not show the common signs and symptoms. This can be attributed to their slower immune system. Some of the non-classical symptoms of urinary tract infections in older adults include incontinence, agitation, falls, decreased mobility, urinary retention, lethargy and decreased appetite (Bardsley, 2017). Other severe symptoms could be vomiting, flushed skin, back pain, fever and nausea when the infection spreads into the kidney. There are certain conditions and factors that put the older persons at risk of UTIs. Conditions common in older persons like diabetes, Parkinsons disease and Alzheimers disease may lead to neurogenic bladder which increases the risk of urinary tract infections (Beveridge et al, 2011). Dementia, use of a catheter, history of UTIs, bowel incontinence, prolapsed bladder and bladder incontinence are also risk factors for UTIs in older persons. Confusion and Behavior Change As one gets older, changes take place in the immune system causing it to respond to the infection differently. Older persons may have increased signs of agitation, withdrawal and confusion (Ninan, 2013). Behavior changes can be caused by Urinary Tract Infections in persons with Alzheimers disease. These distressing changes in behavior are known as delirium and can range from restlessness and agitation to hallucinations. Delirium is a mental dysfunction that manifests with neuropsychiatric abnormalities than can occur within hours or days (Davidson et al, 2013). It is marked by decreased awareness and attention. Some symptoms include disorientation, illusions, clouded consciousness, hallucinations, dysphasia, tremor and motor abnormalities. Delirium that presents with increased motor movement is referred to as hyperactive delirium while the one that presents with low motor movement referred to as hypoactive delirium (Huh, 2016). Older persons more often experience hypoactive delirium. Sometimes Urinary Tract Infections also can increase the progression of dementia. Dementia is referred to as severe reduced mental ability thus interfering with ones daily life (Nicolle, 2013). Some of the symptoms may include difficulty in thinking and language, problem solving, memory loss and reduced ability to do everyday activities. It is progressive as damage of the brain cells continue. Safety and Communication Implications Delirium can increase the risk dementia and cognitive decline in older persons. Possible complications arise from these two conditions that affect the normal behavior of the older persons ((Huh, 2016). They may lose the ability to function or take care of themselves. They also lose the ability to interact well in their environment. Acquiring infections from the hospital is likely to occur as the patient stays longer in the hospital or in the nursing homes. The medications used may also present some side effects when treating the disorder (Bardsley, 2017). Since their perception is affected, they may become agitated, fearful, have combative behavior and could start wandering. Confusion and behavior change brought about by Urinary Tract Infections makes the patient vulnerable. Their safety is compromised due to impaired judgment and confusion (Ninan, 2013). When left alone, they can wander and get lost or have an accident. They are unable to take care of themselves like properly maintain their hygiene. This makes them vulnerable to other infections and diseases like water-borne diseases (Nicolle, 2016). Some become dysfunctional and cannot cook or look for proper food and can lead to malnutrition. The patients may also compromise the safety of the people close to them or their family members especially in an attempt to restrain the patient and he/she becomes violent. Communication is also implicated. When confusion and behavior change arises, communication becomes a challenge especially with the family members when they are not aware of the presentation of the illness and how to communicate during such conditions (Nicolle, 2016). The patient will not be aware of his/her condition and as a result cannot explain what is going on with him/her. During diagnosis, communication may also pose as a challenge and hindrance. Delirium always compromises the ability of the patient to communicate their symptoms (Huh, 2016). Difficulty in communication results from cognitive changes that affect the patients perception and attention or consciousness which are the main symptoms of delirium. This therefore, requires specialist intervention in order to understand the condition of the patient. Diagnosis of UTIs in Older Persons Diagnosis of UTIs can easily be done through urinalysis and a urine culture can be done to determine the causative bacteria in order to prescribe the best antibiotic. Ultrasound examination, X-rays, and CAT scan can also be used in diagnosis (Nicolle, 2016). Symptoms of confusion can pose a challenge in diagnosis of older persons. Confusion and behavior change is a sign enough to diagnose Urinary Tract Infections as they are symptoms that may develop in older persons with the infections. Further diagnosis can be done by a psychiatrist in order to manage the mental disorders like delirium and dementia that may arise in older persons upon infections of the urinary tract (Nicolle, 2013). Mental status assessment and neurological examinations will be necessary in the diagnosis of the mental disorders. Treatment and Management of UTIs in older Persons Antibiotics are the recommended treatment of UTIs in both old and young people. Some of these antibiotics include amoxicillin, ciprofloxacin and levofloxacin. They are prescribed according to the severity of the infection (Huh, 2016). When UTIs lead to confusion and behavior changes in older persons, it is important to manage these mental disorders. This includes pharmacological management supportive therapy. The patient may be required to stay in hospital for close monitoring. They should be allowed to sleep between 10 p.m. and 6 a.m. undisturbed so that they maintain a normal sleep cycle (Nicolle, 2016). Techniques like reorientation or memory cues like family photos maybe are helpful. Keeping the patient a stable, well- lit and quiet environment reduces the risk of delirium by 53%. It is encouraged that the patient gets support from the family and familiar nurses (Davidson et al, 2013). Focus on the usefulness of interventions like daily interventions, physical or occupational the rapy and avoidance of sensorial deprivation significantly reduces the development of delirium in older persons. Care givers should avoid physical restraints as these patients may become violent and pull out intravenous fluids or climb out of the bed reducing compliance to medication. To manage the behavioral changes, there should be psychiatric consultations (Beveridge et al, 2011). Preventing all the UTIs is impossible but measures can be taken to reduce the chances of being infected. It is recommended that one drinks plenty of water; at least 8 glasses of water a day, avoiding bladder irritants, urinating as soon as the urge comes; approximately every two to three hours and keeping proper hygiene of the genitalia (Osamwonyi Foley, 2017). Older adults who are unable to take care of themselves and could be immobile are advised to stay in nursing home with proper care to help prevent UTIs. Conclusion In conclusion, older persons are vulnerable and prone to various infections and conditions that put them at a higher risk of being infected with Urinary Tract Infections. This is due to changes in their immune system which responds slowly. Mental disorders of confusion and behavior change arising from UTIs can be reversed as they are not permanent. This is through treating the underlying cause which is the urinary tract infections and also supportive therapy to manage the developed delirium and possibly dementia. UTIs cannot be prevented but chances of contracting it can be reduced greatly. References Bardsley, A. (2017). Diagnosis, prevention, and treatment of urinary tract infections in older people.Nursing Older People,29(2), 32-38. Beveridge, L., Beveridge, L., Davey, P., Phillips, G. (2011). Optimal management of urinary tract infections in older people.Clinical Interventions In Aging, 173. Davidson, E., Zimmermann, B., Jungfer, E., Chrubasik-Hausmann, S. (2013). Prevention of Urinary Tract Infections with Vaccinium Products.Phytotherapy Research,28(3), 465-470. Huh, J. (2016). 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