Physiologic changes with aging in the urinary tract
Decreased bladder capacity and increased urine production (especially at night)
Decreased voided volume
Decreased estrogen w/menopause leads to thinning of vaginal & urethral mucosa
Decreased lower urinary tract sensory threshold
Problems of urinary storage & emptying
Increase incidence of overflow incontinence from urethral obstruction or stricture
Decreased estrogen levels leads to pH changes in vagina, favoring colonization of E. coli, ↑risk of UTI
Prostatic enlargement can lead to urinary obstruction, increased residual urine & infection

Age-related Risk Factors for UTI
Advanced Age
Fecal incontinence/impaction
Incomplete bladder emptying or neurogenic bladder
Vaginal atrophy/estrogen deficiency
Pelvic prolapse/cystocele
Insufficient fluid intake/dehydration
Indwelling foley catheter or urinary catheterization or instrumentation procedures
Diabetes or immunosuppression
Benign prostatic hypertrophy
Bladder or prostate cancer
Urinary tract obstruction
Spinal cord injury

UTI’s in elderly men are always considered complicated
UTI’s in women are complicated when:
Hx of recurrent UTI
Secondary to structural abnormalities
Catheters
Stones
Urinary retention
Abscess formation or urosepsis
Primary diagnostic and treatment focus in research studies have been related to the elderly female population

UTI in Women
Escherichia coli—gram (-) etiologic agent in ~ 80% of all UTI’s
Research indicates primary source of microbial invasion is retrograde colonization by intestinal pathogens
Other factors influencing colonization: vaginal pH, urethral length, capacity of bacteria to adhere to urothelium..
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