UTI Delirium in Nursing Home Residents

UTI Delirium in Nursing Home Residents

UTI delirium affects millions of older adults every single year. For many elderly patients, UTI induced delirium represents the beginning of the end of their lives. A urinary tract infection is generally not a big deal for young, healthy adults with strong immune systems. But for an older adult, a urinary tract infection can be life-threatening. Without prompt diagnosis and treatment, urinary tract infections can quickly turn into sepsis and death. This is especially the case for older adults in nursing homes who often experience daily abuse and neglect. UTI delirium is a problem in and of itself. Older adults who have pre-existing mental disorders – such as dementia and Alzheimer’s disease – often never fully recover from UTI delirium.

There have been dozens of studies and systematic reviews conducted over the last few decades that aim to explain the connection between UTI induced delirium in older adults. Unfortunately, many of these studies have insufficient evidence and/or unclear results. More recently though, doctors and researchers from Cedars-Sinai have determined a probable cause of UTI delirium among older adults, and that is the protein called interleukin-6 (IL-6). Below, our legal team explains UTI basics and the connection to IL-6.

If your elderly loved one has suffered multiple infections in their nursing home which have led to sepsis or death, you may have grounds to file an elder abuse lawsuit. Call the Chicago nursing home abuse and neglect lawyers at 312-321-1111 today.

What is a UTI?

A urinary tract infection (UTI) is basically a bladder infection. Urinary tract infections happen when harmful bacteria travels up the urethra and into the bladder. When urinary tract infections go untreated for days or weeks, the infection can spread even further up into the ureters and kidneys. At this point, the patient may develop a kidney infection, which can be life-threatening.

Escherichia coli (e-coli) is the most common type of bacteria that causes urinary tract infections. E-coli naturally exists in the lower intestine of both people and animals. Occasionally, e-coli can travel from the lower intestine to the urethra, causing an infection. Women and people with weakened immune systems are more likely to have frequent infections.

The typical protocol for diagnosing a urinary tract infection (UTI) is to analyze symptoms and perform a urine culture to determine which type of bacteria is causing the infection. Once a doctor diagnoses a patient with a urinary tract infection, they will prescribe the correct type of antibiotics to treat the specific bacteria, and send the patient home.

How Common Are Urinary Tract Infections in the U.S.?

Urinary tract infections lead to millions of urgent care visits every year. In fact, a study reporting the epidemiology of UTIs states that this type of infection accounted for 10.5 million doctor’s office visits and 2 million ER visits in 2007. Most UTI sufferers are women, because the female urethra is much shorter than a male urethra. Therefore, harmful bacteria have less distance to travel in the urinary system in order to cause an infection.

Postmenopausal have a much higher risk of suffering from a urinary tract infection (UTI) than younger women due to the gradual weakening of the immune system and lower estrogen levels. Both of these biological changes naturally occur with age.

Why Are Elderly People More at Risk for UTIs?

UTI risk factors among older adults include:

  • A weak immune system
  • An underlying disease such as bladder/kidney stones, functional abnormalities of the urinary system, obesity, diabetes, etc.
  • Catheter and/or diaper use
  • Nursing home abuse and neglect (sexual abuse, allowing elderly people to sit in dirty diapers, failing to help the elderly patients bathe regularly, etc.)
  • Malnutrition and dehydration
  • An estrogen deficiency among elderly women

UTIs account for more than one-third of all nursing home infections according to a 2014 study. According to another study, UTIs are the second most commonly diagnosed infection among elderly patients. Respiratory infections are the number one most commonly diagnosed infection.

UTI Symptoms

Typical urinary tract infection (UTI) symptoms include:

  • Painful urination
  • Urinary urgency
  • Bloody and/or cloudy urine
  • Pelvic pain
  • Fever and chills
  • Foul smelling urine
  • Incontinence
  • Lower back pain, nausea, and vomiting if the UTI has turned into a kidney infection

This is what doctors call a symptomatic UTI. Some people – more commonly older adults – suffer from asymptomatic bacteriuria, which is basically a urinary tract infection with no symptoms. In fact, the CDC claims that the prevalence of asymptomatic bacteriuria is between 25% and 50% among elderly patients in nursing homes. Lack of UTI symptoms can be incredibly dangerous, especially for hospitalized older adults. They have a much higher chance of going untreated for days or weeks and then going into one of the three stages of sepsis.

Other UTI symptoms that aren’t discussed as often include UTI delirium, acute confusion, agitation, and/or psychosis. These severe symptoms generally only appear in older adults, especially those with pre-existing neurologic disorders such as dementia or Alzheimer’s disease.

UTI induced delirium in the elderly often represents the “the beginning of the end” of their lives. The urinary tract infection can lead to sepsis and then death, especially if the patient has a long history of infections and antibiotic use. But the delirium is another danger in and of itself, especially those with pre-existing cognitive issues. Delirium can lead to a sharp, irreversible, mental and cognitive decline. Once older adults begin experiencing frequent UTIs and delirium, the risk of death is much higher.

uti delirium

UTI Induced Delirium – What it is and Why it Happens

Firstly, the Mayo Clinic defines delirium as “a serious change in mental abilities. It results in confused thinking and a lack of awareness of someone’s surroundings.”

In the last few decades, there have been several clinical trials conducted with both laboratory mice and elderly hospitalized patients in order to better understand UTI delirium. One systematic review from 2014 states that many studies about UTI induced delirium have “significant methodological flaws that likely led to biased results. Therefore, it is difficult to ascertain the degree to which urinary tract infections cause delirium.”

UTI Delirium and Interleukin 6 (IL-6)

Meanwhile, a more recent study from 2021 claims that a crucial protein that helps regulate immune response – interleukin 6 (IL-6) – may play a huge role in UTI associated delirium.

Director of the Neurosciences Critical Care Unit and Neurocritical Care Research at Cedars-Sinai – Dr. Shouri Lahiri – and his colleagues observed laboratory mice in different types of mazes. Some mice had UTI’s and some didn’t.

The uninfected mice tended to show far fewer signs of anxiety and memory loss compared to the infected mice. Anxiety and memory loss are common symptoms of delirium. Investigators also noticed that the infected mice suffered a type of brain injury while the uninfected mice didn’t.

Dr. Lahiri theorized that the anxiety, memory loss, and brain dysfunction caused by the UTI could be explained by the presence of IL-6. Dr. Lahiri and his fellow investigators believe this based on evidence from a prior study which drew a connection between ventilator induced lung injury and delirium. As previously stated, IL-6 helps regulate the immune response. The investigators believe that both the lung injury and the UTI react with this IL-6 protein. Therefore, IL-6 could explain the connection between a urinary tract infection and delirium.

Dr. Lahiri states: “Occasionally, when the response of IL-6 is excessive, our research indicates that there can be brain injury. IL-6 induces changes within the neurons that our studies connected with delirium-like behavior. This is the first time this type of structural and functional change has been demonstrated. We’ve now shown two distinct models of this connection, one non-infectious and one infectious.”

Dr. Lahiri and the investigators then treated some of the infected mice with antibodies that blocked IL-6 and its negative effects. As a result, the mice’s anxiety and memory loss symptoms completely resolved. All structural and functional brain dysfunction resolved as well.

UTI Treatment

The only sure-fire UTI treatment out there right now is antibiotic treatment. When people have frequent UTIs, they have to undergo frequent antibiotic treatment. Taking antibiotics on a regular basis can lead to antibiotic resistance, which is incredibly dangerous, especially for an elderly person with a weakened immune system. Antibiotic resistance means that the harmful bacteria learn to survive the toxic conditions that a full round of antibiotics can create. So even when the patient completes the round of antibiotics, the infection comes back, often worse than before. Additionally, antibiotics often don’t treat or reverse UTI associated delirium.

So, Dr. Lahiri states that the next step is to design clinical trials with anti-IL-6 antibodies with elderly patients hospitalized with UTI’s. If all goes well, these patients could fully recover from UTI induced delirium and therefore live longer lives.

elderly uti confusion

Call a Chicago Nursing Home Abuse and Neglect Lawyer at Curcio Law Offices Today

If you believe that your elderly loved one has suffered a severe urinary tract infection (UTI) and UTI associated delirium due to nursing home abuse and neglect, you may have grounds to pursue legal action. The Chicago nursing home abuse and neglect lawyers at Curcio Law Offices have what it takes to pursue justice and compensation for your elderly loved one. Call 312-321-1111 to schedule a free consultation today.

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