UTIs and Delirium

by | 04/06/2025

Risk

  • A person who has a UTI may experience a new, or an increase in confusion (delirium) fatigue, lethargy and impaired balance, which increases their risk of falling.

Reason

  • UTI’s are often caused by dehydration.
  • Older people are at more at risk of getting a UTI due to a number of factors:
    • Not drinking enough fluids.
    • The presence of a urinary catheter (a tube in your bladder used to drain urine).
    • Having a weakened immune system, for example people with diabetes or people having chemotherapy.
    • Not keeping the genital area clean and dry.

Intervention

  • Recognising the early signs and symptoms of a UTI, and the actions to prevent their occurrence, may reduce the negative effects of a UTI. These include:
    • Pain or a burning sensation when urinating (dysuria).
    • Discomfort in the lower abdomen, or pain in the back just under the ribs.
    • Frequent urges to urinate, needing to urinate suddenly or more urgently than usual.
    • Needing to urinate more often than usual than usual in the night (nocturia).
    • Odorous urine.
    • Cloudy urine.
    • Blood or sediment in the urine.
    • A high temperature, or feeling hot and shivery.
    • A very low temperature below 36° C.
    • Increased confusion.
    • Other signs of infection
  • Be aware of the signs of Urosepsis.
  • Ensure that the person is adequately hydrated, having at least 6 to 8 glasses of water throughout the day. Do not restrict fluids because of the fear of needing to go to the toilet at night.
  • Change incontinence pads or underwear immediately after voiding from the bowels.
  • Encourage individuals to:
    • Make sure that they wipe from front to back when going to the toilet.
    • Clean genital area daily using unperfumed soap avoid wearing tight or synthetic underwear.
    • Not to hold their urine if they feel the need to void.
    • Not to rush when urinating and to try to fully empty their bladder.
    • Not to have lots of sugary food or drinks, as they may encourage bacteria to grow.
    • Not to drink lots of alcoholic drinks, as they may irritate your bladder.
    • Not to take broad-spectrum antibiotics to treat the UTI.
  • Be empowered to question the prescription of unnecessary broad-spectrum antibiotics for UTI’s.
  • Use the ‘To dip or not to dip’ pathway to ensure early and accurate diagnosis of a UTI.
  • Remember prevention is key to reducing UTI’s.

Considerations

  • It is important that the individual’s capacity to make decisions around this specific area is considered and documented.
  • Individuals who have capacity regarding these decisions can make choices about what strategies they would like to implement to prevent or treat a UTI. You need to document their ability to make this decision, as well as what they chose every time is it relevant.
  • You may need to inform them of the benefits and risks, if they are not aware, or you may need to remind them if they have difficulty remembering things.
  • If the individual is assessed as not having capacity regarding these decisions, this needs to be documented appropriately and interventions need to be implemented and documented as part of a Best Interests Decision, using appropriate paperwork.