Bladder Infections: To Treat or Not to Treat in Older Adults?
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- เผยแพร่เมื่อ 22 พ.ค. 2024
- Bladder Infections: To Treat or Not to Treat in Older Adults?
“Asymptomatic bacteriuria in long-term care is more common than actual Urinary Tract Infections. About 35 to 40% of men and about 50% of women in long-term care have it-that's even higher for women with urinary incontinence.”
-Jamie Smith, MSN, FNP
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When someone is aged and frail, the risk of a bladder infection is higher, raising the chances of delirium, hospital admission, or even death.
In this episode of This Is Getting Old: Moving Towards An Age-Friendly World, Jamie Smith, a Family Nurse Practitioner in geriatrics and nursing home care, describes bladder infections and things you and healthcare professionals should know about helping the older adults decide whether or not to treat with antibiotics.
Part One of 'Bladder Infections: To Treat or Not to Treat in Older Adults?'.
What Is A Bladder Infection?
A Urinary Tract Infection (UTI) a bacterial infection within the bladder. It's an acute illness that affects the genitourinary system and is commonly known as a “bladder infection” - and means you have an infection of your genitourinary system, so your bladder, kidneys, ureters or urethra with a “positive urine” with a urine sample.
The typical symptoms include: burning sensation with urination, abnormal urgency and frequency in urination. In addition, you may have severe pubic pain or “gross hematuria” (where your pee turns different colors like pinkish or reddish).
Asymptomatic Bacteriuria (ASB), also known as a colonized state. ASB is where you have a positive urine sample, but lack the typical genitourinary symptoms that go along with a UTI. The presence of bacteria in ASB is in quantitative counts of ≥ 100,000 colony-forming units/milliliter (CFU/mL) or ≥ 100 CFU/mL in a catheterized specimen. Thus, in the absence of urinary tract symptoms, asymptomatic bacteriuria is determined by white blood cells in the urine.
"It's critical to differentiate between UTI and colonized state because when you give antibiotics to older adults, that increases their risk of antibiotic resistance, drug to drug interaction, and increased health care cost." - Jamie Smith, MSN, FNP.
To Treat or Not To Treat?
Telling the difference between a UTI and ASB is tricky in older adults, especially those in long-term care facilities because localized genitourinary symptoms are far less pervasive in them. Consequently, there have been differences in treatment protocols from place to place regarding a bladder infection.
✔️ Differences in Protocols For Treatment at ER/ Hospital vs Long-term care settings
Whenever a family member requests a patient to go out because they're confused about whether it's a UTI or ASB, one of the first things the ER does is check a Complete Blood Count (CBC) and a Basic Metabolic Panel (BMP). Even if the urine has trace amounts of bacteria, let's say the patient is confused that they can't tell if there are any genitourinary symptoms, the ER will typically go ahead and prescribe an antibiotic.
✔️ Protocols for Treatment at Skilled Nursing Facilities or at Home
Bladder infection treatments are different in long term care facilities or at home because the staff or family members can tell if the older adult is having symptoms. If the older adult is not having any symptoms associated with the urinary tract, that's classified as colonized. We don't treat colonized states because we look at Loeb's or McGreer's Criteria, and if they don't qualify, we don't treat them because of the risk of harm by giving them an antibiotic.
Risks of Harm in Older Adults
It's imperative to differentiate between UTI and ASB (colonized state). Because when you give antibiotics to older adults, that increases their risk of Clostridium difficile (C. diff), antibiotic resistance, a drug to drug interaction, and increased health care cost.
Part Two of 'Bladder Infections: To Treat or Not to Treat in Older Adults?'
Role of Cognition in Treating Asymptomatic Bacteriuria
Remember that treating ASB is not always straightforward. Long term care patients sometimes will have a cognitive impairment, and they can't always tell you if the symptoms are there.
There are several tools that you can use. The AMDA Watchlist, for instance, is a urinary tract infection flip manual. This one-pager watchlist can be used by staff or family members, and it helps care providers figure out if it's a UTI or colonized state.
Read the full article at www.MelissaBPhD.com/podcast-blog
I wish she were my doctor!! I just realized at 68, since I had to find a new doctor when mine suddenly retired, that I’d like a woman doc❣️🙏
The written summary is excellent.
I had recurring UTI symptoms but no bacteria was ever found in the culture. After watching many masterclasses online I decided to do a parasite cleanse. After 30 days on a capsule which has mimosa pudica as well as the usual antiparasitic herbs I noticed that I had urinated out some small odd curved items (sharp on one end) that looked out of place. They were big enough to see and not microscopic. That was 2 years ago and I have not had any urgency, pain, or uncontrollable releases. I was even afraid my pelvic floor was damaged from giving birth to a baby over 11 lbs. There are very healthy parasite cleanse protocols out there that are quite inexpensive (less than the copay for dr visit).
As a former nurse, UTI in elderly dont present with dysuria, elevated temp or elevated pulse. They have decreased appetite, lower energy and increased agitation. AND, abx use doesnt increase resistance or C-diff. That is total BS.
Jamie's approach delays treatment. This is not only incompetence, but it is cruel.
Do you think it’s ever ok to let a uti run it’s course in an elderly person, or should they seek help immediately
@@nikkinik17 use the supplements: d-mannose, cranberry, echinacea, and vitamin c
Yes, agree with you. When Drs put you through hell in delaying abiotic treatment because it's not showing up in a cup or you do not match all their criteria is delayed treatment which led me to ER in severe kidney infection which has now damaged my insides permanently and now chronic cystitis. They did that to my sister which led to uretur aggressive cancer and she lost her kidney. Over covid years one of the Charlies Angels gals died from sepsis from delayed treatment of uti. Doctors should apply that "benefits outweigh risk factor" in immediate treatment similar to what they told us about the vaccine and know that drs are graded on too many tests and abiotics they prescribe and receive bonuses for doing so.
@@nikkinik17 A UTI running its course means the patient dies.
I'm sorry, but this guest was not easy to understand. Some of the verbiage was unfamiliar, and at times she simply spoke too fast. I'm sure she is extremely knowledgeable, but not a great communicator.
Hardly understood any of this
Oh wow someone just deleted my question… whoever runs this channel doesn’t wanna be challenged
I see your question. Didn't. See an answer though.
sorry to tell, I did not learn any thing .she talked fast.
I really Appreciate your Good work Dr Ogoh on TH-cam, Thanks for curing my #uti sickness . No more pains and sleepless nightmares, thanks #drogoh ✌
That person’s sound terrible
Meeting you Dr Igho on TH-cam channel is like meeting GOD himself, because what you did in my life is what no other doctor can't do, Thank you for curing my infection with your herbs, you are a life saver may God bless you