A urinary tract infection is common and usually treatable. In older people, especially those with dementia, it can present atypically and escalate quickly. A sudden change in behaviour is a medical symptom, not a behavioural one.
Signs that are easy to miss
- New or worsening confusion, agitation or drowsiness.
- Falls or unsteadiness that started recently.
- Not eating or drinking.
- Incontinence that is new or worse.
- Low-grade fever, or a lower temperature than normal.
- Smelly or cloudy urine, or pain on passing urine.
- Pain in the back or side.
Not every confusion is a UTI, and not every UTI causes confusion. But a sudden change in an older person should be assessed.
What to do
Call the GP. A urine test is usually needed before antibiotics. Do not use leftover antibiotics from a previous infection.
Encourage fluids, unless the person has a fluid restriction. Keep the person comfortable and monitor their temperature and urine output.
When to call 000
High fever with shaking, severe pain, vomiting that will not stop, confusion with a very low blood pressure, or a person who is difficult to rouse. Sepsis is a medical emergency.
Prevention
- Drink enough fluid, unless restricted.
- Do not delay toileting. Prompt help if mobility is limited.
- Keep the genital area clean and dry.
- Treat constipation, which increases risk.
- For some people, the GP may recommend other measures.
A change in behaviour is a change in health
If a person with dementia suddenly becomes more confused, do not assume it is "just the dementia". Look for pain, constipation, dehydration, infection and a new medicine. Call the GP.
After the infection
Confusion can take days or weeks to settle after treatment. If it does not return to baseline, ask for a review. Do not accept a permanent decline without a cause being investigated.
Common questions
Is confusion always a sign of a UTI?
No. But a sudden change should be assessed. Other causes include dehydration, constipation, pain and new medicines.
Can I treat it with cranberry juice?
It is not a treatment for an active infection. Ask the GP.
Do I need a urine test?
Usually yes. A test helps confirm the infection and guide treatment.
When is it an emergency?
High fever with shaking, severe pain, vomiting, or a person who is difficult to rouse. Call 000.
How can I prevent another one?
Fluids, prompt toileting, hygiene and treating constipation. Ask the GP for advice specific to the person.
Sources and further reading
This guide is general information, not medical, legal or financial advice. If you are worried about your health, call your GP. In an emergency, call 000.