Home Health Glenn Ellis Ellis: Urine Tests and Antibiotics in the Elderly

Ellis: Urine Tests and Antibiotics in the Elderly

By Glenn Ellis

Regardless of how healthy you may be otherwise, the most common infection that affects seniors and the elderly are in the urinary tract.

This can range from urinary incontinence; bladder infection; to even increasing the risk of kidney problems.

Now, before you get carried away, please keep in mind that we are talking about issues associated with aging…in other words, it only happens if you live long enough. Sure, people can have urinary issues at any point in life, but, again, we’re talking about aging and the elderly.

In fact, the urinary tract isn’t the only thing that comes along with aging. As you grow older, you will have other changes including: the bones, muscles, and joints; the male reproductive system; the female reproductive system; and in most of your organs, tissues, and cells.

Specifically, I’d like to address new findings that look at the problem with urine tests that result in elderly patients being prescribed an antibiotic. It seems that we are now finding out, that in most cases, this is not only of little to no benefit, it can actually cause problems.

It’s no secret that we have a serious problem with the overprescribing of antibiotics in this country. In some situations, when a person goes to the doctor, and before the test results are back, they are already prescribed and taking an antibiotic. The problem has gotten so out of hand that the Centers for Disease Control and Prevention (CDC) says that more than 70 percent of the bacteria responsible for the two million infections you can get while in a U.S. hospital are resistant to at least one commonly used antibiotic. It gets worse; 20 percent to 50 percent of antibiotics prescribed in hospitals are found (after the fact) to be unnecessary or inappropriate.

With the overuse or overprescribing of antibiotics, we can not only increase our resistance to antibiotics when you really need them, but can increase the severity of the condition you first complained about; how long you’ll be sick, increasing your risk of complications, and most importantly, prevent a situation that may have resolved itself on its own without an antibiotic.

Which leads me to the original point of this column.

The latest research on the topic has found that seniors and the elderly asked to provide a urine sample are routinely prescribed an antibiotic. In the past, when a urine specimen tested positive – even when no symptoms of infection were present – doctors were taught that treatment with antibiotics was the right approach.  We know now that is wrong.

As first reported in the New York Times, a task force concluded last month that for virtually everyone except pregnant women, screening for and treating asymptomatic bacteriuria (a urinary tract infection with no symptoms) provides no benefit and has potential harms.

What we are learning now is that many urine samples will reveal results showing the presence of bacteria, but this does not mean there is an infection. This practice happens all too often in the elderly, especially those in nursing homes.

It doesn’t help when most of us, like most doctors, expect to use an antibiotic on the slightest hint that there could be an infection of any kind; whether it’s a cold, sinus infection, rash, and yes, a urinary tract infection.

Urinary tract infections happen when germs get into the urethra and travel up into the bladder and kidneys. When you have a UTI, the lining of the bladder and urethra become red and irritated just as your throat does when you have a cold. The irritation can cause pain in your lower abdomen pelvic area and even lower back, and will usually make you feel like urinating more often.

Burning or pain when urinating is the most common symptom. You may even feel a strong urge or need to urinate but only get a few drops. This is because the bladder is so irritated that it makes you feel like you have to urinate, even when you don’t have much urine in your bladder. At times, you may lose control and leak urine. You may also find that your urine smells bad and is cloudy.

Further complicating things is the fact that somewhere between 40 percent-60 percent of all women will experience at least one urinary tract infection during their lifetime. Add to that, is the connection between urinary tract infections and dementia.

Often, a senior of elderly person may suddenly become confused, hallucinate, or have a drastic change in behavior. Mistakenly, this can be considered to be dementia or Alzheimer’s. Even though urinary tract infections can make dementia or Alzheimer’s worse, it is not necessarily the case.

In a younger person, the urinary tract infection would likely reveal itself with painful symptoms. In older people, it shows up as confusion, agitation or withdrawal.

So, as you can see, there is a plethora of reasons why the medical profession, as well as patients and families can find themselves on an antibiotic to treat a “urinary tract infection.”

The takeaway is to know that we have reached a point in routine healthcare where we have to ask questions; even when it comes to being asked by a doctor to “pee in a cup”.

Not the least of them being that it could be harmful to your health… .

Glenn Ellis, is Research Bioethics Fellow at Harvard Medical School and author of Which Doctor?, and Information is the Best Medicine. Listen to Glenn, on radio in Birmingham or V94.9, Sundays at 7:50pm, or visit: www.glennellis.com.