Influence of chronic disease on the presentation of urinary tract infections in the institutionalized elderly

UTIs are a common problem in institutionalized elderly. Due to a variety of reasons, UTIs may present atypically, making diagnosis difficult. Presenting signs and symptoms of UTIs were therefore studied in a 275-bed teaching skilled nursing home. Data from persons with diabetes mellitus and dementia were separately analyzed and compared to those without these two common chronic age-prevalent conditions. There were 144 UTIs in 65 persons (23.4%) over a 6-month period: mean, 2.2 per person (range 1-8). Forty-seven percent of infections presented with fever; 7.6%, GU symptoms; 11.8%, altered mental status; and 42.4%, miscellaneous presentations. Eight percent of UTIs presented with more than one symptom. Although persons with diabetes mellitus and dementia did not differ in their incidence of UTIs, fever and altered mental status were more commonly noted in persons with diabetes mellitus. Fever, however, was the only statistically significant finding (p<0.03). Interestingly, persons with dementia did not differ in their UTI symptomatology as compared to non-demented controls. UTIs are common in institutionalized elderly. Close to half present without any evidence of fever, and over 90% present without any GU symptoms. Any change in condition warrants a high index of suspicion for a UTI.