Urinary tract infection

Also called UTI, Cystitis, Water infection

Common, usually simple, and in older people the single most over-diagnosed and under-recognised infection there is.

What it is

UTIs are worth an entry not because they are complicated but because two opposite mistakes are made constantly, and both cause harm.

Mistake one: in older people, any confusion gets blamed on a UTI, a urine dip comes back positive, antibiotics are given, and the real cause, which might be delirium from a chest infection, a medication or constipation, goes unfound.

Mistake two: a genuine infection in somebody who cannot describe symptoms gets missed until it becomes sepsis.

Both come from the same root: asymptomatic bacteriuria. Many older people have bacteria in their urine all the time without infection, so a positive dipstick in someone over 65 proves almost nothing. NICE advises against using dipsticks to diagnose UTI in this group.

Signs you might notice

In younger adults: burning on passing urine, needing to go frequently and urgently, lower abdominal pain, cloudy or smelly urine.

Blood in the urine.

In older people or people who cannot report symptoms: new confusion, new incontinence, falls, reduced appetite, being not themselves. These are real signals, and they mean look for a cause, not assume a UTI.

Fever, flank pain, vomiting or feeling very unwell suggests the kidneys are involved and needs urgent care.

How it can affect day-to-day life

Antibiotic resistance is the long-term consequence of over-treatment, and recurrent UTIs in older people are frequently a story of repeated unnecessary courses.

Recurrent genuine infections in women deserve investigation and preventive options rather than an endless cycle of three-day courses.

Catheters change the picture entirely: catheter-associated infections are common and serious, and every catheter should have a documented reason and a review date.

Supporting someone well

In an older person with new confusion, look for all the causes rather than dipping urine. Ask about chest, bowels, medication, pain and hydration first.

Keep fluid intake up. This is the most reliable prevention there is and the most commonly neglected in care settings, often because staff are managing continence.

Encourage regular, unhurried toileting and full bladder emptying.

For catheters, keep the bag below bladder level, keep the system closed, and question whether the catheter is still needed at every review.

Send a urine sample for culture rather than treating on a dipstick alone in anybody over 65.

Fiducia Together keeps fluid intake, continence and observations in one clinical record, which is what allows somebody to see that three infections in six months sit alongside consistently poor fluid intake.

Where to get help

A GP or pharmacist can treat a simple UTI. Many pharmacies now treat uncomplicated UTI in women directly under the Pharmacy First scheme.

Fever, back pain, vomiting, or confusion with a suspected infection needs same-day medical assessment.

Recurrent infections warrant referral rather than repeat prescriptions.