Diagnosis

Good practice point
Where incontinence is a feature, causes other than UTI should be considered, for example prolapse, voiding dysfunction or functional impairment.

Evidence – See section 4.1.1 in full guideline.

Recommendation
Be aware that women aged 65 years and over, especially those in long-term care facilities, may not display the usual symptoms and signs of UTI that are seen in younger women.

Recommendation
Be aware that functional deterioration and/or changes to performance of activities of daily living may be indicators of infection in frail older people.

Good practice point
A holistic assessment is needed in the frail elderly to rule out other causes with both classical and non-classical signs of UTI. Signs and symptoms which may lead to functional decline include dehydration, constipation, electrolyte abnormality, polypharmacy, pain and urinary retention.

Good practice point
Consider sepsis, non-urinary infections and other causes of delirium in an unwell older adult with abnormal vital signs (for example, fever, tachycardia, hypotension, respiratory rate and saturations).

Evidence – See section 4.1.2 in full guideline.

Recommendation
Use of dipsticks for diagnosis of UTI in women aged 65 years and above in long-term care facilities or in frail elderly people requiring assisted living services is not recommended.

Good practice point
In women aged 65 years and over with symptoms suggestive of UTI a positive test for nitrite in the urine is a marker for bacteriuria, and this should be assessed in the context of the background incidence of asymptomatic bacteriuria.

Good practice point
Send a urine specimen for culture to confirm the pathogen and antibiotic susceptibility in women aged 65 years and above prior to starting antibiotics for a UTI.

Evidence – See section 4.1.3 in full guideline.