Caring for Dementia

First, we must understand that a UTI is an infection; an intrusion of bacteria into the body. This initial acknowledgement sets the stage for further consideration into the processes associated with UTIs.

The transmission of bacteria from the urethra to the bladder is a key point in the process of a UTI. Unhindered bacteria in these areas can lead to complications such as kidney involvement, and in severe cases, infiltration into the bloodstream.

Contrary to the misconception that UTIs only cause discomfort, these infections have broader implications. Acknowledging the various symptoms highlights the need for vigilant medical attention, steering us away from complacency in what might initially seem like a routine infection. We must equip ourselves with the knowledge needed to make informed decisions and prioritize medical care.

Delirium

Whether the infection is localized in the bladder, impacting the kidneys, or circulating in the bloodstream, there’s a potential implication—a trigger for “delirium.” Recognizing the consequences of an untreated delirium emphasizes the urgency of timely detection and intervention.

“Delirium can often be traced to one or more contributing factors, such as a severe or chronic illness, changes in metabolic balance (such as low sodium), medication, infection, surgery, or alcohol or drug intoxication or withdrawal.”

Mayoclinic.org

Delirium encompasses a spectrum of behavioural changes, ranging from subtle to extreme, and its symptoms can escalate to a critical, potentially fatal level if left untreated. Recognized as a medical emergency, prompt intervention is required when symptoms of delirium manifest.

Individuals with dementia often present with a persistent state of confusion; when met with delirium, it can introduce a heightened vulnerability due to their pre-existing cognitive challenges. We must understand that the cognitive fragility associated with dementia exacerbates the impact of a UTI, potentially resulting in symptoms that demand urgent medical attention.

In essence, the combined effort of dementia and UTIs underscores the need for a further understanding of the potential complexities involved. This awareness is pivotal in creating a proactive approach to healthcare, emphasizing the critical importance of timely detection and prompt treatment. We must work to mitigate the risks associated with delirium in individuals facing dual challenges of dementia and urinary tract infections.

Symptoms of Delirium (Behaviour Changes)

• Seeing things that don’t exist (hallucinations)
• Restlessness, agitation or combative behaviour
• Calling out, moaning or making other sounds
• Being quiet and withdrawn — especially in older adults
• Slowed movement or lethargy
• Disturbed sleep habits
• Reversal of night-day sleep-wake cycle

List from http://www.mayoclinic.org

UTI’s and Behavioural Changes

Moving forward, it’s essential to recognize that a urinary tract infection (UTI) is an infection capable of triggering a delirium. This delirium, marked by changes in behaviour, emphasizes the importance of staying alert to sudden shifts in character or cognition. This increased awareness acts as a proactive approach in caring for, and promoting the well-being of individuals who may find themselves with a UTI, delirium, and dementia.

When we notice changes in behaviour during a urinary tract infection (UTI), it’s important to understand that these symptoms vary from person to person. For example, someone usually calm may become irritable, while a typically energetic person might become withdrawn. To address these changes effectively, it’s important to be familiar with the person’s usual behaviour. By recognizing their baseline, we can better identify and respond to the unique ways UTIs affect individual behaviours.

Urinary tract infections (UTIs) in individuals with dementia might not always exhibit noticeable symptoms. Subtle behavioural shifts, like withdrawal, slight irritability, or unexpressed pain, could be indicative. Alternatively, more pronounced changes may manifest as restlessness, agitation, and physically or verbally threatening behaviour. These acute shifts warrant further investigation, as they might be signs of a UTI-induced delirium. If you observe abrupt behavioural changes without an apparent cause, it’s advisable to consult a physician. Requesting a urine test for a UTI can provide clarity and aid in timely intervention.

Older adults and UTI’s

Certain demographics among older adults are at an increased risk of Urinary Tract Infections, a concern that warrants a closer examination. Notably, individuals with dementia that have difficulties with communication find themselves in a heightened risk category. This vulnerability intensifies when those with communication challenges also require physical assistance for toileting, showering, or changing their clothes. UTIs are prevalent among those requiring assistance and residing in long-term care homes, where the responsibilities of care faces obstacles, primarily stemming from staff shortages and time constraints. Individuals facing difficulties in communication and mobilization are at an elevated risk due to extended exposure to soiled or wet incontinence products.

In addition to cognitive challenges, individuals with physical impairments, such as people in wheelchairs or those requiring assistance to mobilize, form another high-risk group for UTIs. The reliance on assistance introduces delays in changing incontinence products, a common challenge in long-term care homes. Unfortunately, this delay has led to instances where residents who are cognitively able with physical challenges become incontinent due to the inability of staff to attend promptly.

Changing at Night

Caregivers frequently express concerns about managing incontinence, especially during the night, prompting the common question: “Should we change them at night?” Addressing this is complex, as it depends on individual circumstances, preferences and routines. However, we offer practical tips that have proven effective for many families.

One approach is implementing a continence routine, collaboratively decided among caregivers. This routine typically aligns with the periods when the individual is most prone to incontinence. For instance, caregivers might opt to change their loved one every 2-3 hours, strategically selecting times like post-meals or before bedtime.

Another successful strategy involves changing the individual halfway through the night. This entails selecting a specific time during the middle of the night, to ensure a fresh change. This approach has demonstrated efficacy in preventing urinary tract infections (UTIs) and maintaining optimal hygiene.

Some families prefer changing their loved one right before bedtime and immediately upon waking. The choice to forego nighttime changes might be appropriate for “light wetter’s”, individuals who have trouble sleeping, or individuals who exhibit aggressive responsive behaviours when awakened. In these cases, the disruption caused by nighttime changes may outweigh the benefits.

For those working with physically aggressive behaviours, caregivers may need to employ creative techniques to ensure cleanliness. It’s crucial to recognize that there’s no one-size-fits-all solution, given the diversity of routines and personalities. Despite the individual challenges each situation presents, caregivers must be mindful that extended exposure to a saturated product can foster bacterial growth, constituting a significant risk for urinary tract infections. It is important we utilize tailored approaches to incontinence management that prioritize both hygiene and individual needs.

If you observe symptoms indicative of a urinary tract infection (UTI) in your loved one or the individual under your care, it is imperative to engage their healthcare provider. Timely consultation with a doctor is critical to facilitate the process of diagnosis and treatment. UTIs demand quick attention and require antibiotic treatment prescribed by a qualified medical professional. Immediate medical intervention is paramount to effectively address and manage this infection.

Have you had success with preventing UTI’s? Are you finding it difficult to prevent UTI’s? What has worked for you? Let us know in the comments below!