Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-11T02:24:38.873Z Has data issue: false hasContentIssue false
  • English
  • Français

Urinary tract infection in very old women is associated with delirium

Published online by Cambridge University Press:  18 August 2010

Irene Eriksson ,
Yngve Gustafson ,
Lisbeth Fagerström  and
Birgitta Olofsson
Irene Eriksson*
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden School of Life Sciences, University of Skövde, Skövde, Sweden
Yngve Gustafson
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Lisbeth Fagerström
Affiliation:
School of Life Sciences, University of Skövde, Skövde, Sweden Department of Health and Life Sciences, University of Buskerud, Kongsberg, Norway
Birgitta Olofsson
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden Department of Nursing, Umeå University, Umeå, Sweden
*
Correspondence should be addressed to: I. Eriksson, School of Life Sciences, University of Skövde, SE-541 28 Skövde, Sweden. Phone: +46 500 44 84 75; Fax: +46 500 44 84 99. Email: irene.eriksson@his.se.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: The aim of the study was to investigate whether urinary tract infection (UTI) in a representative sample of 85-, 90- and ≥95-year-old women is associated with delirium.

Methods: In 504 out of 643 women (78.4%) it was possible to evaluate UTI and delirium. Assessments such as the Organic Brain Syndrome (OBS) Scale, the Geriatric Depression Scale-15 (GDS-15) and the Mini-mental State Examination (MMSE) were performed during home visits. Delirium, dementia and depression were diagnosed according to the DSM-IV criteria. A diagnosed, symptomatic UTI with or without ongoing treatment, documented in medical records or detected in association with the assessments, was registered.

Results: Eighty-seven of 504 women (17.2%), were diagnosed as having a UTI with or without ongoing treatment when they were assessed, and almost half of them (44.8%) were diagnosed to be delirious or having had episodes of delirium during the past month. One hundred and thirty-seven of the 504 women (27.2%) were delirious or had had episodes of delirium during the past month and 39 (28.5%) of them were diagnosed to have a UTI. In a multivariate logistic regression model, delirium was significantly associated with Alzheimer's disease (OR = 5.8), multi-infarct dementia (OR = 5.4), depression (OR = 3.1), heart failure (OR = 2.3) and urinary tract infection (OR = 1.9).

Conclusions: A large proportion of very old women with UTI suffered from delirium which might indicate that UTI is a common cause of delirium. There should be more focus on detecting, preventing and treating UTI to avoid unnecessary suffering among old women.

Keywords

urinary tract infectiondeliriumold women
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 3 , April 2011 , pp. 496 - 502
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
Bjorkelund, K. B., Larsson, S., Gustafson, L. and Andersson, E. (2006). The Organic Brain Syndrome (OBS) scale: a systematic review. International Journal of Geriatric Psychiatry, 21, 210–222.CrossRefGoogle ScholarPubMed
Conn, D. and Lieff, S. (2001). Diagnosing and managing delirium in the elderly. Canadian Family Physician, 47, 101–108.Google ScholarPubMed
de Rooij, S., van Munster, B., Korevaar, J. and Levi, M. (2007). Cytokines and acute phase response in delirium. Journal of Psychosomatic Research, 62, 521–525.CrossRefGoogle ScholarPubMed
Edlund, A., Lundstrom, M., Karlsson, S., Brannstrom, B., Bucht, G. and Gustafson, Y. (2006). Delirium in older patients admitted to general internal medicine. Journal of Geriatric Psychiatry and Neurology, 19, 83–90.CrossRefGoogle ScholarPubMed
Eriksson, I., Gustafson, Y., Fagerstrom, L. and Olofsson, B. (2010). Prevalence and factors associated with urinary tract infections (UTIs) in very old women. Archives of Gerontology and Geriatric, 50, 132–135.CrossRefGoogle ScholarPubMed
Eriksson, M., Samuelsson, E., Gustafson, Y., Aberg, T. and Engstrom, K. G. (2002). Delirium after coronary bypass surgery evaluated by the organic brain syndrome protocol. Scandinavian Cardiovascular Journal, 36, 250–255.Google Scholar
Fagerberg, I. and Jonhagen, M. (2002). Temporary confusion: a fearful experience. Journal of Psychiatric and Mental Health Nursing, 9, 339–346.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric and Research, 12, 189–198.Google Scholar
Foxman, B. (2002). Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. American Journal of Medicine, 113 (Suppl 1 A), 5 S–13 S.CrossRefGoogle ScholarPubMed
Gustafson, Y. et al. (1988). Acute confusional states in elderly patients treated for femoral neck fracture. Journal of the American Geriatrics Society, 36, 525–530.CrossRefGoogle ScholarPubMed
Gustafson, Y., Brannstrom, B., Norberg, A., Bucht, G. and Winblad, B. (1991). Underdiagnosis and poor documentation of acute confusional states in elderly hip fracture patients. Journal of the American Geriatrics Society, 39, 760–765.CrossRefGoogle ScholarPubMed
Harrington, R. and Hooton, T. (2000). Urinary tract infection risk factors and gender. Journal of Gender-Specific Medicine, 3, 27–34.Google ScholarPubMed
Jensen, E., Dehlin, O. and Gustafson, L. (1993). A comparison between three psychogeriatric rating scales. International Journal of Geriatric Psychiatry, 8, 215–229.Google Scholar
Johansson, C., Molander, U., Milsom, I. and Ekelund, P. (1996). Association between urinary incontinence and urinary tract infections, and fractures in postmenopausal women. Maturitas, 23, 265–271.CrossRefGoogle ScholarPubMed
Kamel, H. (2005). The frequency and factors linked to a urinary tract infection coding in patients undergoing hip fracture surgery. Journal of the American Medical Directors Association, 6, 316–320.CrossRefGoogle ScholarPubMed
Katz, S., Ford, A., Moskowitz, R., Jackson, B. and Jaffe, M. (1963). Studies of illness in the aged: the Index of ADL as a standardized measure of biological and psychological function. JAMA, 185, 914–919.CrossRefGoogle Scholar
Laurila, J., Laakkonen, M. L., Laurila, J. V., Timo, S. and Reijo, T. (2008). Predisposing and precipitating factors for delirium in a frail geriatric population. Journal of Psychosomatic Research, 65, 249–254.CrossRefGoogle Scholar
Lawton, M. (1975). The Philadelphia Geriatric Center Morale Scale: a revision. Journal of Gerontology, 30, 85–89.CrossRefGoogle ScholarPubMed
Lipowski, Z. (1989). Delirium in the elderly patient. New England Journal of Medicine, 320, 578–582.Google Scholar
Lundstrom, M., Edlund, A., Bucht, G., Karlsson, S. and Gustafson, Y. (2003). Dementia after delirium in patients with femoral neck fractures. Journal of American Geriatrics Society, 51, 1002–1006.CrossRefGoogle ScholarPubMed
Manepalli, J., Grossberg, G. and Mueller, C. (1990). Prevalence of delirium and urinary tract infection in a psychogeriatric unit. Journal of Geriatric Psychiatry and Neurology, 3, 198–202.CrossRefGoogle Scholar
McCusker, J., Cole, M., Abrahamowicz, M., Primeau, F. and Belzile, E. (2002). Delirium predicts 12-month mortality. Archives of Internal Medicine, 162, 457–463.Google Scholar
Montgomery, S. A. and Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389.CrossRefGoogle ScholarPubMed
Sheikh, J. and Yesavage, J. (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165–172.Google Scholar
Shortliffe, L. and McCue, J. (2002). Urinary tract infection at the age extremes: pediatrics and geriatrics. American Journal of Medicine, 113 (Suppl. 1 A), 55 S–66 S.Google Scholar
van Munster, B., Korevaar, J., Zwinderman, A., Levi, M., Wiersinga, W. and de Rooij, S. (2008). Time-course of cytokines during delirium in elderly patients with hip fractures. Journal of the American Geriatrics Society, 56, 1704–1709.CrossRefGoogle ScholarPubMed
Vellas, B. et al. (1999). The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition, 15, 116–122.CrossRefGoogle ScholarPubMed
von Heideken Wagert, P. et al. (2006). Health status in the oldest old: age and sex differences in the Umeå 85+ Study. Aging Clinical and Experimental Research, 18, 116–126.CrossRefGoogle ScholarPubMed
Young, J., Leentjens, A., George, J., Olofsson, B. and Gustafson, Y. (2008). Systematic approaches to the prevention and management of patients with delirium. Journal of Psychosomatic Research, 65, 267–272.Google Scholar