How to Spot a UTI in an Elderly Parent (When a UTI Doesn't Look Like a UTI)
HEALTH
One Almost Deadly Summer
In the summer of 2024, my mother and I traveled to California for my cousin's wedding. Days later, she was in the emergency room (ER), getting IV antibiotics for a UTI, followed by a hospital stay for sepsis, a life-threatening response to infection. The catchphrase "that escalated quickly" was very apropos.
Thankfully, she was cleared of the infection and left the hospital with a parting gift: a two-week course of IV antibiotics to complete at home. Guess who was taught to administer them?
Despite the learning curve, administering IV meds was better than having to plan a funeral. And I'm not being dramatic. Here's why.
Why You Need to Act Fast If You Suspect a UTI
Your body can only fight so many battles at once. One more skirmish, even a small one, can be the tipping point. Like many other things in life, it's a resource issue.
Given my mom's advanced age, severe aortic stenosis (a narrowing of the heart's aortic valve), frailty and dementia, the few days of trying to figure out what was wrong created a close call.
Paramedics to the Rescue
So, let's talk about how I eventually figured out my mom might have a UTI, with the help of the paramedics.
UTIs are commonly associated with symptoms such as painful urination and frequent urination. Changes in urine odor can also raise concerns. But these symptoms are typically experienced privately. If your loved one still goes to the bathroom independently, you're relying on them to recognize a change, understand that it's worth mentioning and communicate it to you.
My mother still goes to the bathroom independently and she didn't complain about a smell or any pain.
However, her behavior was off.
She was very fatigued. I mean, when she naps, she naps hard, but she was napping super hard for a couple of days. Her blood pressure was also much lower than normal.
I called 911 because I was concerned this might be a heart-related issue tied to her aortic valve. However, the paramedics didn't identify an obvious heart emergency at the time and brought up the possibility of a UTI. They told me to keep an eye out. So I went into helicopter caregiver mode, and once I caught a whiff of her urine, I knew ... and off we went to urgent care and the ER immediately after. In hindsight, we should have gone straight to the ER, all things considered.
We can take quite a bit for granted in our youth, or approximate youth. My mother's doctor explained that some people may not experience or recognize the burning sensation associated with UTIs as they age. And even if that symptom is pronounced, your loved one still must recognize it as something to communicate to you in a timely fashion.
For someone with dementia, that can be especially challenging.
UTI Symptoms in the Elderly
Meanwhile, the clock keeps ticking, and an undetected UTI can continue to fester. The good news is that, as in my mom's case, there are other potential symptoms and warning signs of a UTI in an elderly person. These can include low blood pressure, drowsiness, tachycardia (a faster-than-normal heart rate), new urinary incontinence, poor appetite and frequent falls. Some older adults with infections also experience delirium or confusion, sometimes without a fever.¹
But I do want to point out that despite my mother's dementia, she did not become noticeably more confused when she developed the infection that led to sepsis. She did have some of the other symptoms listed, though. And I also have to say that I've found that as my mother continues to age, the same symptoms can point to any number of conditions, sometimes more than one at the same time. Oy.
My Take on the UTI Situation
I now take note of behavior that makes me go "huh ..." or "hmmm, that was weird ..." Kind of like how a laptop behaves before it crashes: the buttons aren't responsive, funny messages pop up, and it just isn't working the way it normally does.
That doesn't mean the problem is necessarily a UTI, but it can mean something may be wrong, and it's worth investigating ASAP. Because if it is a UTI, as we've established, things can escalate quickly.
I group concerning behavior into two categories:
Atypical (or peculiar) behavior: If you notice behavior that is out of character or a deviation from typical behavior, it could be a symptom of a UTI in an elderly person. Maybe your loved one suddenly seems disoriented, unusually weak or unable to do something they normally manage. For example, I have heard of people fainting and even disrobing in public.
Exaggerated behavior: An existing behavior becomes noticeably more pronounced. My mother typically walks slowly, but she started walking even slower than her typical slow pace.
And y’all, turns out my thought process might have a smidge of credibility. Nursing homes use a checklist called the Revised McGeer Criteria to track infections, and it treats sudden changes in thinking or function as possible UTI signs for people with catheters.² While my mom didn’t have a catheter, it's a similar line of thinking.
Pro Tip: Know your loved one's baseline behavior. If you notice a sudden or significant change, contact a healthcare professional. If it's not a UTI, it could be something else that warrants medical intervention.
When Is a UTI in the Elderly an Emergency?
This is my perspective as a caregiver, again, not medical advice. After what happened to my mom, I look at all suspected UTIs as "emergencies" in the sense that they deserve prompt attention. Depending on her symptoms and the day of the week, that might mean a same-day doctor's appointment, urgent care or a trip to the ER. I've learned the hard way that things can escalate quickly, so I'd rather err on the side of caution.
I also take my mother's overall health into consideration. At the time of this specific incident, her health was very compromised. She had been very fatigued for three days, and it was now a Saturday when doctors' offices were closed. It was time for the ER, where I knew she could get IV antibiotics or be hospitalized if needed. I would rather take on the cost of an ER visit than wait for a doctor's appointment. But that's just me.
That said, more recently, after my mother's aortic valve replacement, I once again caught a whiff of foul-smelling urine. While that isn't always a sign of a UTI, I got it checked out. This time, it was on a weekday, so I was able to quickly get her into the doctor's office for diagnosis. By the way, that was the only symptom. Turns out, she did have a UTI, so oral antibiotics were prescribed right away. She got on the meds and got through the whole week without missing a beat. So, for me, it really depends on several factors, including what I call my "spidey sense," aka my Spirit-led gut.
On a more official note and for your consideration, the CDC lists several warning signs of sepsis, including confusion or disorientation, fever or feeling unusually cold, a high heart rate or weak pulse, shortness of breath, clammy skin and extreme pain or discomfort.³
Hey UTI, Mind Staying in Your Own Lane? Thank You Kindly.
In a frail or compromised elderly person, such as one with a heart condition or dementia, or both, the whole body can jump in ... imagine a flashing "red alert" sign and a siren going off — the heart, the brain, the kidneys ... an assortment of vital organs can become involved when an infection leads to sepsis.
In my mother's case, her heart is where I noticed the most "malfunction." And it makes sense, because at that time, my mom had an extremely narrow aortic valve. With blood flow compromised, I image in creates a cess pool for infections to thrive. She was not only hospitalized for a UTI, she also had to hospitalized for RSV as well. But that's another story...
So, keep your loved one's health conditions in mind. Changes involving an already compromised area of their health could signal that something is wrong, including an infection.
After a couple of close calls, including this one, I realized I had to prioritize immediate care for my mom when symptoms were serious, even for what might seem like a minor issue — UTI, respiratory illness, etc. Depending on the condition of your loved one, anything can quickly snowball into a hospitalization or worse.
Unfortunately, health issues don't always fit neatly into your schedule, and they don't take weekends, birthdays and holidays off (quite inconsiderate, if I do say so). I have spent more than one birthday weekend hovering in or around a hospital. Thank God I continue to be blessed with more birthdays.
What Causes a UTI in the Elderly
UTIs occur when bacteria enter and infect the urinary tract. Bacteria that normally live in the gastrointestinal tract are a common cause.⁴
Several factors can increase the risk of UTIs in older adults, including difficulty emptying the bladder, urinary incontinence, catheter use, certain health conditions and changes associated with menopause. For people with dementia or mobility limitations, managing personal hygiene can also become more challenging.
One of my mom's doctors mentioned that he sees poor hygiene as the most likely primary cause of UTIs in elderly patients. But hygiene isn't the only factor involved in UTI risk, and even excellent hygiene cannot prevent every infection.
UTI Prevention in the Elderly
This topic is very much TMI and yet also very critical. Keeping bacteria from entering the urinary tract is one part of UTI prevention, so cleanliness down there is important, and so is proper wiping.
One should wipe from front to back, not back to front. Wiping from back to front can drag fecal matter from the anus toward the urethra.
Harvard Health includes front-to-back wiping among its UTI prevention recommendations, and medical literature identifies bacteria from the gastrointestinal tract as a common cause of urinary infections.⁵
I have wet wipes on hand in the bathroom, but I have to chase after my mom to use them. I have also considered replacing the toilet seat in her bathroom with a bidet toilet seat. I will likely have to chase after her for that, too, but I think it will be worth it.
Have we exhausted the topic of poop for the moment? I hope so!
Add-ons: After my mother had a stroke (2022), she was getting UTIs frequently. This was before her health was as compromised, and one nurse told me that D-mannose can help keep bacteria from "sticking" to the urinary tract. Cranberry extract was another tip for preventing UTIs.
However, I haven't found anything "official" that backs that up. However, a 2024 randomized clinical trial published in JAMA Internal Medicine found that daily D-mannose did not significantly reduce recurrent UTIs compared with a placebo.⁶ Cranberry products may help prevent recurrent UTIs in some people, although the evidence varies by population.⁷Neither D-mannose nor cranberry products should be used in place of medical treatment for an active UTI.
If you're considering any supplements, including these, or even vitamins, always consult a doctor before taking them or giving them to anyone. The elderly can be frail, some supplements can interfere with medications ... and you don't want to go from bad to worse.
And while hygiene matters, it's not a guarantee against infection. There are other ways to develop a UTI such as sexual intercourse.
Frequently Asked Questions about UTIs in the Elderly
And How Is My Mom Today?
THANKS for asking. She's peachy keen and quickly reclaimed her role post-UTI as backseat driver and unabashed matchmaker.
She insists on trying to find me a husband everywhere I take her.
Eeevvvverywhere.
Know your loved one's normal. Sudden or exaggerated changes in behavior, energy or physical condition can mean something is wrong, even when the cause isn't obvious. Even if it's not a UTI, it could be something else.
Keep your head on a swivel. I know it's hard when you are juggling so many things, but being observant can help prevent a hospitalization or worse.
Act fast. Given that UTIs can escalate quickly, it's important to get a move on the situation.
Prevention. Hygiene, hydration when appropriate, bladder health and individual risk factors all deserve attention, particularly when UTIs recur.
Trust your observations, but don't diagnose from them. As a caregiver, you may be the first person to notice that something isn't right. That's valuable information to share with a healthcare professional. But don't be afraid to get a second opinion either. That's a story for another day...
1. Mody, L., & Juthani-Mehta, M. (2014). Urinary tract infections in older women: A clinical review. JAMA, 311(8), 844–854.
2. Stone, N. D., Ashraf, M. S., Calder, J., et al. (2012). Surveillance definitions of infections in long-term care facilities: Revisiting the McGeer criteria. Infection Control & Hospital Epidemiology, 33(10), 965–977.
3. Centers for Disease Control and Prevention (CDC). About sepsis.
4. Urinary tract infections in the elderly: A review of disease characteristics and current treatment options. (2020). Drugs in Context.
5. Fisher, J. (2025, May 1). UTI in older women: Why postmenopausal women are susceptible to urinary tract infection, and what to do about it. Harvard Health Publishing.
6. Hayward, G., Mort, S., Hay, A. D., et al. (2024). D-mannose for prevention of recurrent urinary tract infection among women: A randomized clinical trial. JAMA Internal Medicine, 184(6), 619–628.
7. Williams, G., Hahn, D., Stephens, J. H., et al. (2023). Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews, Issue 4, CD001321.
8. Infectious Diseases Society of America (IDSA). (2019). Clinical practice guideline for the management of asymptomatic bacteriuria.
About the Author
3+ years ago, my mother's stroke turned me into a full-time caregiver, dealing with some elder-specific and some mom-specific conditions, including vascular dementia, Alzheimer's, congestive heart failure, and aortic stenosis. My caregiving journey didn't start there, though. In high school, I would skip class to take my dad to his doctor's appointments. In different ways, my parents have both been unwell throughout my life. I've put this site together to share a little knowledge, sprinkled with a few laughs. I hope it's helpful, and at least, I hope you know that you are not alone.
Widad's Daughter,
Patty Fadhouli
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