The risk of UTIs increases in older women—here’s why

When you think of urinary tract infections (UTIs), you may think of them occurring primarily among younger people. But UTIs in older women are common, too. In fact, they’re one of the most frequently diagnosed infections in older adults, particularly among those who live in long-term care facilities but also among those who live at home.

UTIs in older adults may also be more problematic than in younger people. For example, early symptoms of UTIs can be less noticeable or harder to recognize among older adults, says Cary Fishburne, MD, a urogynecologist at East Cooper Center for Pelvic Medicine in Goose Creek, South Carolina. This may lead to infection being diagnosed later, when it’s more likely to cause complications.

Here’s what you need to know about UTIs in older adults, how to recognize symptoms, and how to prevent them.

UTIs in older women

As a woman gets older and goes through menopause, lower levels of the hormone estrogen change the pH balance of the vagina. This makes it less acidic, which in turn makes it easier for harmful bacteria to grow, explains Dr. Fishburne. Estrogen also helps boost levels of healthy bacteria that normally live in the vagina and bladder. These bacteria crowd out populations of infection-causing bacteria. With the lower levels of estrogen that come after menopause, there are fewer healthy bacteria to help prevent infections.

The tissues of the urethra and bladder also thin and dry out, leaving them weaker and more prone to irritation. This makes them more likely to become infected. (The urethra is the thin tube that carries urine from the bladder out of the body.)

Both men and women can have medical conditions that make it harder for them to empty their bladders effectively, Fishburne adds. These include enlarged prostate for men, uterine prolapse for women, and other conditions such as multiple sclerosis or uncontrolled type 2 diabetes.

UTI symptoms in older women can be different

In younger adults, symptoms of a UTI can be fairly dramatic. Common signs include pain and burning during urination as well as a frequent, often urgent, need to pee. But UTI symptoms in older women are often less obvious, says Fishburne.

It’s not always easy to separate the signs of an infection from other underlying conditions such as overactive bladder, which are more common in the older population. These often vague and overlapping symptoms may include incontinence (loss of bladder control) and the need to go to the bathroom more frequently (also known as urge incontinence).

Among older adults, UTIs may cause symptoms not seen in younger people, such as confusion or agitation. That doesn’t mean your loved one certainly has a UTI if they are showing signs of delirium, Fishburne says. But if they appear confused or agitated, along with lower back pain, blood in their urine, or tenderness in their abdomen, they should see a healthcare provider (HCP) immediately.

An older adult with a UTI may also have a fever greater than 100 degrees Fahrenheit, but this does not occur in every situation. A fever is more likely to be a sign that the upper urinary tract or the kidneys are involved in the infection. Any of these symptoms should prompt a call to your HCP. At-home test kits aren’t always accurate and may often be unnecessary.

Older adults are more at risk for complications

A UTI is no more serious in an older adult than it is in a younger one, says Fishburne. Regardless of age, an HCP may likely suggest an antibiotic for anyone diagnosed with a UTI. But if an infection is left untreated, it can spread to the kidneys, putting older people at risk of other complications.

“Since they have a less robust immune system, their bodies are less able to fight infection, which can lead to it spreading to the bloodstream,” Fishburne explains. This can cause sepsis, a life-threatening condition where the body goes into overdrive trying to fight infection, triggering inflammation that can lead to deadly organ failure. Sepsis caused specifically by a UTI is known as urosepsis.

Past research has highlighted the importance of prompt treatments for UTIs in older adults. Data shows that the rates of bloodstream infection and mortality are significantly higher when antibiotics are delayed or not prescribed, compared with when they were prescribed immediately.

Older adults don’t need to be routinely screened for UTIs

Older adults often provide urine samples during their annual wellness exams. These don’t need to be screened for a UTI if a person doesn’t have symptoms such as fever, urinary pain, and/or urinary frequency, says Fishburne.

Many older adults have bacteria in their urine with no signs of a UTI at all. This is called asymptomatic bacteriuria, and it isn’t harmful to a person’s health. If there’s no infection, an antibiotic won’t provide any benefit and it may cause other adverse effects, such as nausea, vomiting, diarrhea, or vaginal yeast infections. There is also the possibility that unnecessary use of antibiotics can encourage the growth of drug-resistant bacteria.

There are ways to help prevent UTIs in older women

About 10 percent of women over the age of 65—and nearly 30 percent of women over age 85—will experience a UTI. Here are some strategies for preventing an infection.

Hydrate

Most experts recommend increasing daily water intake to help lower the risk of UTIs. Peeing frequently can help flush bacteria out of the body.

Practice good hygiene

Improper wiping following a bowel movement or having soiled undergarments may promote the growth of bacteria. Always wipe front to back and wash hands thoroughly after using the bathroom. Older adults should also be reminded to wear loose, breathable clothes and ensure that adult diapers, if worn, are changed frequently. If you are sexually active, urinating immediately after sex may help lower the risk of UTIs.

Ask about estrogen

Postmenopausal women can try using vaginal estrogen, either as a cream (brands include Premarin or Estrace), an insert (Vagifem), or a flexible ring (Estring) that’s placed into the vagina every three months. It’s estimated that vaginal estrogen may lower the risk of UTIs by as much as 75 percent over time. Ask your HCP if estrogen might be right for you.

Consider certain additions to your diet

Probiotics are live microorganisms found in many foods. Foods with probiotics can help encourage the growth of healthy bacteria, which may crowd out the unhealthy bacteria that may lead to UTIs. Probiotics can be found in a variety of foods, including yogurt (look for brands that say “active cultures” on the label) and fermented foods like kimchi and pickles.

Prebiotics are certain fiber-rich foods that support the growth of probiotics. Examples include bananas, asparagus, and onions. Evidence is limited for a direct link between probiotics and prebiotics and a reduced risk of UTIs, but these foods are generally healthy and contribute to a well-balanced diet.

The American Urological Association recommends cranberry as a preventive treatment. That said, a 2023 review published in The Senior Care Pharmacist noted that while there was no harm in taking over-the-counter cranberry products, little evidence exists for cranberry being clinically effective.

If none of these steps works for preventing UTIs, an HCP may also consider prescribing a single low dose of antibiotics as a preventive measure after having sex. This is known as antibiotic prophylaxis.

Talk to your healthcare provider

Anyone with repeated UTIs should always consult their HCP to figure out the proper treatment and to rule out other medical issues that could be contributing to the problem, says Fishburne. These include conditions like uterine prolapse (when the uterus drops down into the vagina), a bladder obstruction (a blockage at the base of the bladder), or kidney stones (small, hard deposits that form in the kidneys).

Although UTIs are common, they should not have to be frequent. An HCP can help figure out the best prevention techniques and treatment options for you.