UTI in the Elderly

If you think diagnosing a UTI in the elderly is simple, you're doing it wrong! We order urinalysis for elderly patients with all sorts of vague symptoms, even when these symptoms are unlikely to have anything to do with urinary tract infections. Urinalysis is much less reliable in elderly patients and residents of long-term care facilities. It is essential for every acute care physician to be aware of that. In this video, you will learn how to tell the difference between actual urinary tract infections and conditions that can mimic them both in terms of symptoms and findings in urinalysis. I highly recommend you read the articles I included in the description. Every physician who has ever ordered a urinalysis should read this.

DISCLAIMER: Please, always keep in mind that my videos are intended for educational purposes only. The content of my videos is NOT medical advice. I do not practice medicine over the internet. If you are a patient and have any questions about your health, please talk to your doctor.

CHAPTERS:
00:00 The basics of urinalysis in UTIs (urine test strips, biochemistry, microscopy)
01:43 The dangers of misunderstanding the role of urinalysis
03:45 Clinical presentation of urinary tract infections in elderly patients
05:04 Asymptomatic bacteriuria and pyuria (leukocyturia)
06:07 Urine sample contamination
06:45 UTI vs. asymptomatic bacteriuria: how to tell the difference

REFERENCES & RECOMMENDED READING:
1. Pallin DJ, Ronan C, Montazeri K, Wai K, Gold A, Parmar S, et al. Urinalysis in acute care of adults: pitfalls in testing and interpreting results. Open Forum Infect Dis. 2014 Mar;1(1):ofu019.
2. Rowe TA, Juthani-Mehta M. Urinary tract infection in older adults. Aging health. 2013 Oct;9(5).
3. Johnson JR, Drekonja DM. Bacteriuria/Pyuria of Clinically Undetermined Significance (BPCUS): Common, but Currently Nameless. The American Journal of Medicine. 2017 May 1;130(5):e201–4.
4. McMurdo ME, Gillespie ND. Urinary tract infection in old age: over-diagnosed and over-treated. Age Ageing. 2000 Jul;29(4):297–8.
5. Nicolle LE. Catheter associated urinary tract infections. Antimicrob Resist Infect Control. 2014;3:23.

[clinicaltips]

I want to remind everyone that my videos are for educational purposes only. Of course, everyone is welcome to watch, but the information I present is most useful for junior doctors, nurses, and students. As I stated in the description of every video and on my channel homepage, none of this is medical advice for patients. I don't practice medicine over the internet. If you are a patient and have any questions about your health, please get in touch with your doctor.

[nunyabznz]

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).

[jds]

The doctor refused to do an urinalysis because my mother didn't have any symptoms. The problem i had is after a period of time the symptoms go away but the infection remains. After much persistence, he ordered the urinalysis and she did have a UTI. He treated her with antibiotics but I wanted to make sure the UTI was gone so i asked for a culture. He refused again because she exhibited no symptoms even though i reminded him she never had symptoms the first time. My mother is 83 with mild dementia and has a history of not being able to empty her bladder.

[ithacacomments]

My mother passed away because the nursing home where she was a resident missed UTI, dehydration, and CHF....until she was extremely ill and went to the ER.

[borderlord]

My mother died at home less than 48 hours after being given the all clear in A+E of a hospital here in London.

She had been on Macrobid for a UTI for 4 days, vomiting twice and then suddenly feeling unwell after I walked her a few steps to bed..struggling to breath, high heart rate.

I called the ambulance.

The A+E Dr diagnosed dehydration, put her on a drip and said I could then take her home.
I said I was worried about Sepsis...he said her blood test was clear.

We went home after a long night.
My mother slept most of the day.
The next day the same scenario happened.She was sick when walking a few steps to bed...this time she did not recoverby the time the ambulance arrived it was too late.

I am certain this would not have happened if the Dr had kept her in and done a urinalysis, then admistered intravenous anti biotics.
The oral Macrobid had been administered too late by my mother's GP to clear the bacteria.

Her GP studying the A+E's discharge summary said she was surprised they didnt take a urine sample and that my mother's White blood cell count was raised.
The A+E Dr said her blood test was clear.

Absolutely devastating.

[jayakist]

I dpnt find a single doctor talking about this in india bro this has made a chaos in my dads life

[Swimchik]

I thought a UTI always is confirmed with a culture?

[Ichsenottogivein]

You could at least answer the questions that the viewers ask you.