On May 6, 2012, I began this column "Navigating Health and Aging." Two articles per month times nearly four years and you can do the math — a lot of information. That's always been my goal, to be informative on important issues that affect all of us whether young or aging. It's been interesting to observe which topics create a response or in some cases, a stir you might say.

So far, the most correspondence has come after my article on depression and, most recently, poop. Yes my last column focused on bowel issues.

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So after writing what adds up to over 100 articles in the last 4 years, what have I heard most about? Poop. People have stopped me, commented to me and discussed it with me. I have found myself replying, "I have written a lot of other articles" almost defending myself that I have given lots of really interesting information over the years besides bowel functioning. Hearing "I never really have read your article, just skimmed, but I read all of that one" doesn't really make me feel all that great. I mean who wants to be thought of as the nurse who writes about bowels? (Seems that the word poop is also offensive to some.)

I have had this topic up my sleeve for a long time and since body functions seem to hit home for everyone I thought why not continue with elimination issues? However, joking aside, this is an issue that I want everyone to take very seriously.

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Urinary tract infections (UTIs) are a serious health threat. The American Urological Association reports that urinary tract infection (UTI) is a significant health problem in both community and hospital-based settings. It is estimated that 150 million UTIs occur yearly worldwide, accounting for $6 billion in health care expenses. In Medicare beneficiaries 65 years or older, UTIs account for 1.8 million office visits per year.

Urinary Tract infections can occur at any age. However, the aging are at particular risk. The aging may be more prone to infection due to weakening of the bladder, which causes poor emptying of urine leading to retention of urine or incontinence. Poor hygiene is often the culprit leading to infection.

Incontinence, leaking of urine or inability to hold urine at all, can also lead to infection. Infections start when bacteria present in the urinary tract multiply and cause symptoms. Urine that sits in the bladder for too long due to retention or holding it for too long, as well as urine that sits on the skin or in an absorptive undergarment such as a Depends can start the infection. Chronic health conditions can contribute to the development of a UTI. Those suffering from dementia are at very high risk of developing a UTI.

Symptoms of a UTI in the younger, healthier populations include: urinary urgency, frequency, burning, pain, back pain, lower abdominal or suprapubic pain, foul-smelling urine, low-grade fever and in some cases blood in the urine. These symptoms while being typical and easy to diagnose may not occur in the older population and even more so in those suffering from dementia. Sometimes, the only thing noted in UTIs affecting the aging is a change in behavior or cognition.

The aging population may have more subtle symptoms such as lethargy or sleepiness, decreased appetite, behavior changes with an abrupt onset over hours or days such as confusion, agitation, paranoia, irritability, falls and dementia-type behaviors which are really what is referred to as "delirium." Those with dementia may have a super-imposed delirium, which causes a worsening of symptoms of dementia.

It has been extremely frustrating to me to watch residents in long-term care facilities with the symptoms of a UTI, go ignored because they do not follow the Medicare guidelines for symptoms warranting testing. Some communities are quite efficient and aware of the change in behavior of a resident with sudden onset of vague or difficult behaviors and test for UTI. However some communities will not respond until the resident shows more definitive behaviors. Often it is late when symptoms or changes are identified and the severity of symptoms warrants hospitalization. Emergency room visits for UTI is high. I have seen patients whose family members have thought that their loved one has had a stroke due to slurred speech, falls or sudden delirium. Sepsis, an infection that progresses into the blood can be life-threatening.

The message in this is be proactive to avoid infection. Use good hygiene practices, wipe from front to back and dispose of toilet tissue — do not use the same tissue and wipe again! Use wipes or clean with a bottle of water (peri-bottle) after having a bowel movement if prone to infection, urinate frequently, do not hold it! Change pads or disposable undergarments frequently and whenever soiled immediately. Wear cotton underwear. Drink plenty of water. Hydrate! In some, cranberry juice or capsules may prevent infection but be aware that cranberry capsules and juice may cause a change in the INR of those taking Coumadin therefore speak with your physician first.

If you or a loved one notices symptoms whether typical or unusual changes in behavior seek medical attention. Advocate for intervention if symptoms are present and unique to you or a loved one when affected by a UTI if you have experienced one in the past.

Jill Rosner is a registered nurse, certified geriatric care manager and owner of Rosner Healthcare Navigation. She provides patient advocacy and care management services to clients with health and aging issues. Contact her at JillRosnerRN@aol.com.



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