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Bladder Infections: To Treat or Not to Treat in Older Adults?

“Asymptomatic bacteriuria in long-term care is more common than actual Urinary Tract Infections. About 35 to 40% of men and about 50% of women in long-term care have it—that’s even higher for women with urinary incontinence.”

-Jamie Smith, MSN, FNP
_______________________________________________________________________

When someone is aged and frail, the risk of a bladder infection is higher, raising the chances of delirium, hospital admission, or even death.

In this episode of This Is Getting Old: Moving Towards An Age-Friendly World, Jamie Smith, a Family Nurse Practitioner in geriatrics and nursing home care, describes bladder infections and things you and healthcare professionals should know about helping the older adults decide whether or not to treat with antibiotics.

Part One of ‘Bladder Infections: To Treat or Not to Treat in Older Adults?’.

What Is A Bladder Infection?

A Urinary Tract Infection (UTI) a bacterial infection within the bladder. It’s an acute illness that affects the genitourinary system and is commonly known as a “bladder infection” – and means you have an infection of your genitourinary system, so your bladder, kidneys, ureters or urethra with a “positive urine” with a urine sample.

The typical symptoms include: burning sensation with urination, abnormal urgency and frequency in urination. In addition, you may have severe pubic pain or “gross hematuria” (where your pee turns different colors like pinkish or reddish).

Asymptomatic Bacteriuria (ASB), also known as a colonized state. ASB is where you have a positive urine sample, but lack the typical genitourinary symptoms that go along with a UTI. The presence of bacteria in ASB is in quantitative counts of ≥ 100,000 colony-forming units/milliliter (CFU/mL) or ≥ 100 CFU/mL in a catheterized specimen. Thus, in the absence of urinary tract symptoms, asymptomatic bacteriuria is determined by white blood cells in the urine.

“It’s critical to differentiate between UTI and colonized state because when you give antibiotics to older adults, that increases their risk of antibiotic resistance, drug to drug interaction, and increased health care cost.” – Jamie Smith, MSN, FNP.

To Treat or Not To Treat?

Telling the difference between a UTI and ASB is tricky in older adults, especially those in long-term care facilities because localized genitourinary symptoms are far less pervasive in them. Consequently, there have been differences in treatment protocols from place to place regarding a bladder infection.

✔️ Differences in Protocols For Treatment at ER/ Hospital vs Long-term care settings
Whenever a family member requests a patient to go out because they’re confused about whether it’s a UTI or ASB, one of the first things the ER does is check a Complete Blood Count (CBC) and a Basic Metabolic Panel (BMP). Even if the urine has trace amounts of bacteria, let’s say the patient is confused that they can’t tell if there are any genitourinary symptoms, the ER will typically go ahead and prescribe an antibiotic.

✔️ Protocols for Treatment at Skilled Nursing Facilities or at Home

Bladder infection treatments are different in long term care facilities or at home because the staff or family members can tell if the older adult is having symptoms. If the older adult is not having any symptoms associated with the urinary tract, that’s classified as colonized. We don’t treat colonized states because we look at Loeb’s or McGreer’s Criteria, and if they don’t qualify, we don’t treat them because of the risk of harm by giving them an antibiotic.

Risks of Harm in Older Adults

It’s imperative to differentiate between UTI and ASB (colonized state). Because when you give antibiotics to older adults, that increases their risk of Clostridium difficile (C. diff), antibiotic resistance, a drug to drug interaction, and increased health care cost.

Part Two of ‘Bladder Infections: To Treat or Not to Treat in Older Adults?’

Role of Cognition in Treating Asymptomatic Bacteriuria

Remember that treating ASB is not always straightforward. Long term care patients sometimes will have a cognitive impairment, and they can’t always tell you if the symptoms are there.

There are several tools that you can use. The AMDA Watchlist, for instance, is a urinary tract infection flip manual. This one-pager watchlist can be used by staff or family members, and it helps care providers figure out if it’s a UTI or colonized state.

Read the full article at www.MelissaBPhD.com/podcast-blog

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How does arthritis affect your joints? How does joint replacement work? What is recovery like after a joint replacement? Antonia Chen, M.D., M.B.A, Orthopaedic Surgeon and Director of Research, Arthroplasty Services at Brigham and Women’s Hospital, and Associate Professor of Orthopaedic Surgery at Harvard Medical School discusses the most common joint replacements and the best things people can do to help them return to the activities of daily life after surgery.

Preparing for Joint Replacement Surgery: https://hipknee.aahks.org/preparing-for-joint-replacement-surgery-at-home-exercises/
Hip Conditioning Program: https://orthoinfo.aaos.org/en/recovery/hip-conditioning-program/
Knee Exercises: https://orthoinfo.aaos.org/en/staying-healthy/knee-exercises/”

Subscribe Link: https://www.youtube.com/channel/UCYrLjATd88gPwIKntCoR0WQ?sub_confirmation=1

0:00 – Intro
0:27 – Conditions That Affect Your Joints
0:35 – Example of Arthritis in Knee
0:59 – Example of Arthritis in Hip
1:29 – Ways to Treat Joint Pain
3:07 – Most Common Joint Replacement Procedures
4:14 – Recovery After Surgery

About Mass General Brigham:
Mass General Brigham combines the strength of two world-class academic medical centers, five nationally ranked specialty hospitals, 11 community hospitals, and dozens of health centers. Our doctors and researchers accelerate medical breakthroughs and drive innovations in patient care. They are leaders in medical education, serving as Harvard Medical School faculty and training the next generation of physicians. Mass General Brigham’s mission is to deliver the best, affordable health care to patients everywhere. Together, we transform the health of our communities and beyond.

#Arthritis #JointPain #MassGeneralBrigham #MGB

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Arthritis Symptoms, Joint Replacement, and Surgical Recovery Explained | Mass General Brigham

Seeking relief from chronic joint pain and rheumatoid arthritis, Barbara Young turned to Sarasota Memorial orthopedic surgeon Edward Stolarski, MD, who specializes in hip and knee replacement and reconstruction surgeries. Barbara shares her story and how choosing the right orthopedic specialist put an end to decades of pain.
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What Are Bladder Stones? Causes, Symptoms & Remedies
Click Here to Learn More about Treatment of Bladder Stones: https://age2b.com/treatment-bladder-stones-age
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Urinary Tract Infection (UTI) Signs & Symptoms (& Why They Occur)

Urinary tract infections (UTIs) are infections (mostly bacterial) of the urinary system. UTIs occur more frequently in young women compared to other groups. Due to irritation and inflammation from infective organisms, UTIs have characteristic signs and symptoms. In this lesson, we discuss those signs and symptoms in detail and discuss the reason why they occur.

If you found this lesson helpful, please like and subscribe for more lessons like this one.

JJ

**MEDICAL LEGAL DISCLAIMER**: JJ Medicine does not provide medical advice, and the information available on this channel does not offer a diagnosis or advice regarding treatment. Information presented in these lessons is for educational purposes ONLY, and information presented here is not to be used as an alternative to a healthcare professional’s diagnosis and treatment of any person/animal. Only a physician or other licensed healthcare professional are able to determine the requirement for medical assistance to be given to a patient. Please seek the advice of your physician or other licensed healthcare provider if you have any questions regarding a medical condition.

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Watch more Digestion & Stomach Problems videos: http://www.howcast.com/videos/224198-How-to-Recognize-Signs-of-a-Bladder-Infection

Stop a bladder or urinary tract infection in its tracks by learning what to look for and how to prevent it from getting worse.

Step 1: Check frequency of urination
Check your frequency of urination. A swollen, infected bladder will make you feel the urge to urinate more often.

Step 2: Pay attention to a burning sensation
Check for a burning sensation when urinating, a common symptom of a bladder infection.

Tip
Holding urine too long can encourage infection, so go when you have to go.

Step 3: Observe the color and smell of urine
Observe the color and smell of your urine. If your bladder is infected, urine may be dark yellow or greenish, with a foul odor.

Tip
If you take an over-the-counter drug for bladder infections and painful urination persists, see your doctor immediately.

Step 4: Check for pain in the stomach or pelvic area
Check for throbbing pain in your stomach or pelvic area, as this is indicative of an advanced infection.

Step 5: Watch for blood in the urine
Watch for blood in your urine and contact your physician immediately to prevent further damage to your urinary tract.

Step 6: Contact your physician
Contact your physician for an accurate diagnosis. No two people are alike when it comes to infection symptoms.

Did You Know?
Up to 30 percent of women will get a bladder infection in their lifetime.

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What are the signs and symptoms of bladder cancer? Dana-Farber’s Matthew Mossanen, MD talks about who is most at risk, bladder cancer’s symptoms, and how it is diagnosed. Learn more about the Genitourinary Cancer Treatment Center at Dana-Farber Cancer Institute here: https://www.dana-farber.org/genitourinary-cancer-treatment-center/.

Most people know little about bladder cancer, even though there are more than a half million people in the U.S. with the disease. Cheryl Lee, MD, a urologic oncologist at The Ohio State University Wexner Medical Center, explains that one of the earliest signs of bladder cancer is blood in the urine. Although this may also be an indication of other conditions, it is important to always follow up with your physician if you do have blood in your urine because early detection is your best chance for a cure. You should also try to eliminate the primary risks for bladder cancer: smoking and exposure to chemicals. Also important is eating a well-balanced diet, including plenty of fruits and vegetables, and drinking plenty of water. To learn more or to schedule an appointment, visit https://wexnermedical.osu.edu/urology or call (614) 293-8155

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What is rheumatoid arthritis? Rheumatoid arthritis is an autoimmune condition where the immune system attacks the joints.

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