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Demential and UTI effects

Discussion in 'ARCHIVE FORUM: Support discussions' started by willemm, Oct 1, 2006.

  1. willemm

    willemm Registered User

    Sep 20, 2006
    41
    My wife has had dementia for 3 years now, which has varied in its behaviour from periods of calm when she is able to respond briefly in conversation, to periods of extreme agitation, shouting or screaming, with head tilted to one side, jaw dropped and eyes staring. I keep a daily diary and am able to look back to remind me of how things were, often thinking that today has been the worst ever, only to find that it had happened before, several times before.
    A new influence on her behaviour has taken place in the last few months, a disposition to UTIs (Uterine Transmitted Infections), which are not always accompanied by high temperature, but often flushes the face and forehead. When a UTI is present, her behaviour is always much worse, she is more easily aggravated by small things, like noise, or close movements causing her to shout even more, but her speech becomes affected too. She also goes off her food and drink.
    I dealt with this when I was caring for her at home by calling in a GP, who would invariably prescribe antibiotics, but 3 weeks ago she had to go into a care home (residential) as I could no longer cope.
    Does anyone else have any experience of dementia and UTIs? Any UTI by its nature takes a while to get seen to, then to get a test and a result, before any antibiotics are likely to be prescribed, meaning that several days can go by before any remedy can be applied.
    I don't think that Residential Homes have sufficient experience to recognise when a UTI may be present in someone whose behaviour is already difficult to understand.
    Does anyone have any suggestions as to how this problem can be best addressed?
     
  2. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,417
    #2 jenniferpa, Oct 1, 2006
    Last edited: Oct 1, 2006
    You know, this is only my personal experience, but I have found care workers to be very much on the ball when it comes to UTI's. In fact, if anything, they're only to eager to place the blame for a change in mental state on a UTI, even when there are no other symptoms. It's very well known that in the elderly, a UTI can cause an increase in confusion. You could check with the home that they have dipsticks to do the testing - this cuts down on the time to treatment considerably. The results from these are not100% but they are fast and cheap.

    Jennifer

    Oh, something else. I don't know if they do this in the UK, but when I was younger I was getting one UTI after another and my urologist put me on a low dose daily antibiotic for 6 months - this really resolved the problem. This may, of course, not be appropriate for a dementia patient, but you might want to raise the possibility with the GP.
     
  3. Norman

    Norman Registered User

    Oct 9, 2003
    4,348
    Birmingham Hades
    Hi Willemm
    urinary tract infections do cause changes in AD sufferers and this is well known..
    I agree with Jenifer, in my experience most health care assistants are quick to act when there is a change in an AD patient.
    Norman
     
  4. willemm

    willemm Registered User

    Sep 20, 2006
    41
    Thanks for your responses, they are most helpful especially as my wife is quite new to the home she has now been placed with. I suppose it remains to be seen if and how soon the care staff respond to what I have come to recocognise more readily when my wife was in my care.
    I have heard of long-term antibiotic use which I will discuss with her GP, but I have also heard of high strength cranberry capsules taken daily as being a good defence against bladder infections and UTIs in particular. Again I will appreciate hearing from anyone who can bear this out from own experience (or advise against if there are reasons to).
     
  5. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,417
    Cranberry capsules - I don't know what the downsides might be, but if they are effective, I think as much as anything it's because taking something like that makes you aware of how much (or little) water you're drinking. They are supposed to acidify the urine to make it more inhospitable for bacteria to grow. Personally, they didn't work well, or at least not as well as the antibiotics. I think for a dementia sufferer, there are many more things going on that contribute to a UTI - not emptying the bladder fully, not being aware that the bladder needs to be emptied, transfer of bacteria when "wiping" plus some I'm sure I haven't thought of. One thing to consider, if she is getting them very frequently (i.e. more than once a month) is that she may have a low grade kidney infection that is never really being cleared up by the antibiotics. From what you say, was the doctor prescribing without testing? Because, if so, there's a good chance that the bacteria in question are now resistant to the normally prescribed antibiotics. Having been there and done that, I ended up on Cipro once which means I would have been safe from Anthrax! I'm in the US, so I pay for my prescriptions, so I can tell you that it isn't the cheapest option, nor should it be prescribed willy-nilly. However, it may be necessary to push the GP to bring out the "big-guns".

    Jennifer
     
  6. willemm

    willemm Registered User

    Sep 20, 2006
    41
    Thanks for that Jennifer. You are right, there are a number of possibile causes. I may be biased, but several times when in respite, and now in care I found they were using large incontinence pads which I never used, by wiping (and washing) as and when needed. The recent spate of UTI bouts seems to coincide with the use of these devices which I realise have their uses for busy & limited care staff, but I am sure they increase the likelihood of cross-infection, especially if not replaced often enough (and area cleansed properly beforehand).
    Different GPs seem to have their own preferences for antibiotics. One prescribed an anti-bacterial type that was ineffective, so after a week, I got a different prescription. During last UTI a specimen was provided to own GP (still at home then and already on antibiotics provided by out-of-hours GP). I will ask what the results of this specimen provided, depending on what they (the lab) were looking for I suppose. It's complicated trying to deal with someone else's health problem, and moreso when they are unable to convey much themselves.
     
  7. willemm

    willemm Registered User

    Sep 20, 2006
    41
    Hi again Jennifer
    I was a bit confused by your mention of Cipro, but today, while doing a recap on my wife's recent history of UTIs, I came across a prescription she had been given called Ciprofloxacine, which unfortunately did little to ease her condition, and about 10 days later another GP prescribed Cefalexin saying that it (Cipro...) was a milder medication.
    Looking up Ciprofloxacine I found that it is an anti bacterial medication rather than antibiotic. They work in similar ways it seems, both being for urinary tract infections, but for whatever reason, Cipro did little for my wife's infection. I guess its down to us all being different..................
     
  8. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,417
    Hi Willem

    Ummm..
    an antibiotic IS an anti-bacterial medication - that's what antibiotics are. Cipro in particular is used against gram negative infections.

    Do they actually test your wife's urine to see what strains of bacteria are present? It sounds as if they are using a scattershot approach which might be what is leading to these repeated UTI's. I am absolutely not an expert, but from my own research, cefelaxin is more appropriately used in situations where gram positive bacteria are present, such as staph and strep, and can in fact increase the concentration of drug resistent gram negative bacteria. Gram negative bacteria are things like E. Coli and salmonella - in fact those bacteria that you would expect to be the problem if cross-contamination with faeces was a contributing cause.

    Anyway, to boil it all down, if they don't test the urine, they're only going to hit on the right antibiotic by chance, and she's going to get "bounce-back" infections.

    Unfortunately, as women, in particular, age the poor design of our urinary tract can cause real problems. Not a great example of "intelligent design" if you ask me.

    Jennifer
     
  9. BeckyJan

    BeckyJan Registered User

    Nov 28, 2005
    18,972
    Derbyshire
    Sorry to change tack on this thread but my query is in the same area and you all seem to be so knowledgable on the subject.
    My husband has been wearing pads for several months - more as a precaution when out and because his mobility is so poor. He is also on medication to help prevent his weeing too much in the night (enlarged prostrate I think!).

    However today, he came back from day hospital at 4.45 having weed him self on the journey home (not just a dribble!!). Then on changing he continued to wee! - ok all was put right, cleaned up changed etc. Then this was repeated again at 5.20 pm. Another change etc. Then again at 5.50 pm.

    I will def. ring the Incontinence Nurse tomorrow and handle that side of things BUT - do you think this frequency of urination is 'normal' or is it a dementia thing because of 'not emptying bladder'. Seems a naive question but just want to be armed with info before seeing a Nurse. Thanks Beckyjan
     
  10. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,417
    I'm sorry Becky Jan, but I'm afraid the male urinary system is a closed book to me. One thing I would consider is the possiblity of a UTI (yes, I know, I seem to have them on the brain). It's just that with a UTi you can have the urge to piddle all the time. Of course it could just be that they filled him up with fluids at the day hospital. On the other hand, I don't think increased frequency should ever be ignored, particularly if he's on a medication to reduce frequency, so don't be fobbed off!

    Jennifer
     
  11. Norman

    Norman Registered User

    Oct 9, 2003
    4,348
    Birmingham Hades
    Hi Beckjan
    has he been checked for prostate problems?
    It may be that several things UTI,not emptying his bladder, are all contributing to the problem.
    It may be just prostate.
    Norman
     
  12. willemm

    willemm Registered User

    Sep 20, 2006
    41
    It seems to me from comments and observations made by others that UTIs are far more complex than is generally known, or as well understood by the medical profession as they should be. It is mostly accepted that they aggravate an already complex situation by interfering with the brain and its control over the rest of the body. If each attack requires a full lab report on a uirine or blood specimen to verify just what each individual is suffering from in specific terms in order to prescribe the appropriate antibiotic or antibacterial treatment, this could be a time consuming process.
    Most hard pressed visiting GPs use a simple chemical strip test which is either positive (infection) or negative (no infection) and if positive they prescribe a general purpose antibiotic or antibacterial treatment (my BMA Encyclopaedia lists them in separate categories, but I am not a medical person).
    If then a course of 7 days is ineffective, by the time a GP is seen and a different treatment obtained quite a while has passed, leaving the patient (and carer) in considerable discomfort (understatement) and worse, the possibility of the infection becoming more resistant. In these medically advanced times, why can't urine or blood tests become more quickly dealt with to obtain the appropriate treatment rather than that of the "scattergun" approach?
     
  13. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,417
    I suppose the answer to that is money. I believe the statistics are that 80% of uti's are treatable with the most commonly prescribed antibiotics, which is why there is the approach that there is. Also, and I know this is going to sound sexist, but most of the people that set up these protocols are male, while most of the UTI sufferers are female. A UTI doesn't sound life threatening, but no one who hasn't experienced them can really understand how they can impact on your life. Honestly, I don't even like talking about them, because it brings the sensations back. Having said that, I've had great treatment from male doctors for UTI's and not so great treament from female ones. so it doesn't necessarily follow.

    Have you considered trying to find a private specialist? I know they do exists in the U.K. since that was what I ended up doing when I was still living there. Otherwise, I think you're just going to have to keep pushing and pushing: maybe then the appropriate tests will be run, if only to shut you up.

    Jennifer
     

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