Expert: Mary Gordon - 9/28/2009

Question
My mother is 81 and suffers from AD, as well as Hep C, Type 2 diabites and is in a wheelchair. My question to you is about Urinary Tract infections. Obviously, it's hard for her to identify a problem or pain. She doesn't know how to identify a certain pain all the time, as she's not sure where it's coming from. There was an odor from her urine 2 1/2 weeks ago. I suggested that they take a sample of her urine to be checked, which they never did. She is now in the hospital from a bad UTI (5 days). Could the infection have started 2 1/2 weeks ago? Just curious. Thanks

Answer
Hi Allison, yes, absolutely, she could have been sick for a couple of weeks - and missing them in the early stages can lead to a more serious and entrenched infection, or even kidney involvement.  

Having said that...it's not uncommon for the elderly in long term care facilities to have a diagnosis of a UTI either delayed or missed entirely. There are lots of reasons for that including the person having very muted symptoms or no symptoms at all. Add to that verbal difficulties where they can't tell you how they feel or answer questions and it can be a challenge to detect a UTI. Quite often in a person with dementia, all you will notice is a change in behavior - an increase in confusion or sleepiness. People with dementia often don't seem to feel physical sensations like a healthy person - for example, I do recall times when my mother in law should have been hungry, thirsty or in pain, and she seemed pretty much oblivious. Perhaps they feel the sensation and have no idea what it means.

At highest risk for UTIs include those with catheters, diabetics, people who are immobile, incontinent, on pain killers or anti-fever drugs,people who have a compromised immune system - and the cognitively impaired. I suspect your mom falls into a couple of those categories.

Reasons for staff missing the diagnosis include lack of laboratory facilities at the site, the lack of an on-site physician or family nurse practitioner, understaffing, staff turnover resulting in inexperienced staff being responsible for initial observations (i.e. they don't know what to look for, or they just don't know your mom), nurses with little time to assess residents. The condition of the residents themselves is like the final straw. The signs may be subtle or nonexistent on the physical side, or they may just not be themselves, or seem more out of it than usual. You have to be paying attention to see it.

You might want to have a discussion with the care staff. We used to have a chat every couple of months. I do think it's a concern that you raised the possibility and they didn't act on your perception. You know your mom, and if the alarm bells were going off in your gut, they should have taken that more seriously.

Mary G.