Urinary Tract Infections (UTIs) and People With Dementia

Symtoms to Look For

UTIs are infections that occur anywhere in the urinary tract system. They are most often caused by bacteria, but fungi and viruses can also cause them. A UTI can significantly impact the functioning of someone who has Alzheimer's disease or another kind of dementia.

Doctor holding an empty specimen cup
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  • Burning feeling while urinating
  • An increased need to urinate
  • Pain in lower abdomen, side or back
  • Blood in the urine
  • Urine that appears cloudy, dirty or has mucous strands
  • Urine with a foul odor
  • Fever
  • Delirium
  • Nausea and vomiting

Symptoms of a UTI in Dementia

When someone with dementia develops a UTI, it can be more difficult to identify the signs. Because of word-finding difficulty, the person might not be able to express an increase in discomfort or identify an increased need to urinate.

Often, people who have dementia and who develop a UTI will experience significant behavioral changes. Any infection can trigger delirium, and UTIs are a frequent cause of delirium in dementia. You might see the following symptoms of a UTI in someone with dementia:

  • Increased falls
  • Changes in behavior such as increased aggression, agitation or anger
  • Changes in appetite
  • Sleeps more or less than normal
  • An increase in confusion and disorientation 
  • An overall decline in functioning not explained by another condition that arises suddenly

Why Risks Are Higher With Dementia

  • Hygiene problems: People with dementia are prone to use improper wiping techniques after using the bathroom, such as wiping from back to front instead of front to back. This can increase the spread of bacteria.
  • Women: Approximately two-thirds of people with dementia are women. Women also have an increased risk of a UTI because of how their urinary systems are structured.
  • Incontinence: As dementia progresses, the ability to control bladder and bowel urges declines. Low-quality adult incontinence pads can add to the problem because they don’t absorb urine well, which then causes it to sit right against the skin and increases the risk of infection, as well as skin problems such as pressure sores. Soiled incontinence products should be changed as soon as possible.
  • Reduced physical mobility: Physical ability declines as dementia progresses, and limited movement increases the risk of a UTI.
  • Other conditions common in older adults: This includes a tendency to have a weaker immune system, a higher risk of diabetes, the potential for urinary retention, and prostate problems in men.

Should Catheters Be Used?

Catheters historically have been thought of as a way to respond to problems with incontinence, but their use is not recommended unless absolutely medically necessary. The insertion of a catheter can introduce more bacteria into the urinary system and this increases the risk significantly for UTIs. A UTI that develops in someone using a catheter is called a Cather Associated Urinary Tract Infection (CAUTI), and the medical community has worked hard to reduce these (often) preventable infections.

Catheters are appropriate for some conditions such as urinary retention, where someone is unable to completely empty their bladder, but they are not recommended without a specific medical condition that makes the necessary.


Most often, UTIs are treated with antibiotics. A sample of your urine is tested at a laboratory to identify which antibiotic is likely to be effective in treating it. Sometimes, healthcare providers will start you on one antibiotic and then change it to a different one after lab results are available.

"I Know My Mother Has a UTI. Why Are They Waiting to Treat It?"

One of the challenges in healthcare is managing the use of antibiotics. Historically, antibiotics have been overused, and this has resulted in an increase in infections that are resistant to typical antibiotics. In other words, the bacteria have grown stronger and the usual antibiotics aren't always effective.

It's not unusual for a urine test of an older person to test positive for a UTI even if a person has no symptoms. In these cases, an antibiotic is not always needed, and over-prescribing them can trigger the bacteria to strengthen and become resistant, thus requiring stronger and stronger antibiotics.

In order to test for a UTI, many organizations such as nursing homes follow the McGreer Guidelines which require at least three of the following symptoms (fever, pain, increased confusion, change in urine appearance or odor, urgency or frequency) to be present before they will test and eventually order an antibiotic. These limitations were developed with the goal of using antibiotics wisely.

Preventing UTIs

The following strategies can help decrease the chance that a person with dementia will develop a UTI:

Encouraging adequate fluids can help reduce the chance of UTIs.

The person with dementia may need some extra assistance with cleaning themselves and wiping properly after urinating or having a bowel movement. Additionally, after sex, women should be encouraged to urinate because of the increased risk of a UTI.

  • Don’t wait to urinate

Holding your urine too long can increase the risk of a UTI.

  • Encourage clothing that can breathe

Clothing that is too tight or underwear made from nylon as opposed to cotton can trap moisture and increase the risk.

Does Cranberry Juice Help?

Research has come up with different results on this question. Some studies have found a slight benefit of cranberry juice in reducing the risk of UTIs. Others have not found a difference when cranberry juice was ingested. You should check with your healthcare provider first before adding cranberry juice to your diet on a regular basis because it can interact with other medications such as Coumadin (warfarin).

Frequently Asked Questions

  • Can a UTI make dementia worse?

    Yes, a UTI can trigger behavioral changes and delirium in people with dementia. Any infection causes inflammation throughout the body. This often results in worsening dementia symptoms, including increased confusion and disorientation, changes in appetite and sleep, and an overall decline in functioning. 

  • What causes urinary tract infections in elderly females?

    Women are more prone to UTIs than men due to their urinary systems. Factors that contribute to UTIs in elderly females include incontinence, reduced mobility, chronic medical conditions (such as diabetes), and improper wiping techniques. 

  • Will confusion from a UTI go away?

    Yes. Confusion and delirium related to urinary tract infections in elderly people will go away once the infection starts to clear up with antibiotics. Depending on the extent of the infection, it could take anywhere from 24 hours to several weeks for the UTI—and subsequent confusion—to go away.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Urinary tract infection.

  2. Enshaeifar S, Zoha A, Skillman S, et al. Machine learning methods for detecting urinary tract infection and analysing daily living activities in people with dementiaPLoS One. 2019;14(1):e0209909. doi:10.1371/journal.pone.0209909

  3. Geerlings SE. Clinical presentations and epidemiology of urinary tract infections. Microbiol Spectr. 2016;4(5). doi:10.1128/microbiolspec.UTI-0002-2012

  4. Genao L, Buhr GT. Urinary tract infections in older adults residing in long-term care facilitiesAnn Longterm Care. 2012;20(4):33–38.

  5. Stone ND, Ashraf MS, Calder J, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteriaInfect Control Hosp Epidemiol. 2012;33(10):965–977.

  6. Foxman B, Cronenwett AE, Spino C, Berger MB, Morgan DM. Cranberry juice capsules and urinary tract infection after surgery: results of a randomized trialAm J Obstet Gynecol. 2015;213(2):194.e1–194.e1948. doi:10.1016/j.ajog.2015.04.003

  7. Gunnarsson AK, Gunningberg L, Larsson S, Jonsson KB. Cranberry juice concentrate does not significantly decrease the incidence of acquired bacteriuria in female hip fracture patients receiving urine catheter: a double-blind randomized trialClin Interv Aging. 2017;12:137–143. doi:10.2147/CIA.S113597

Additional Reading

By Esther Heerema, MSW
Esther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer's disease and other kinds of dementia.