How is UTI diagnosed in an elderly resident of a nursing home?
For some elderly individuals, ascertainment of clinical signs and symptoms may be difficult because of dementia, impaired communication, or coexisting chronic genitourinary symptoms. In the absence of an indwelling catheter, a clinical diagnosis of urinary infection in an elderly person should be made only if localizing genitourinary symptoms—such as frequency, urgency, hematuria, or costovertebral angle pain or tenderness—are present. Nonlocalizing or nonspecific signs or symptoms in elderly individuals, such as increased confusion or falls, should not be attributed to urinary infection. For the 30% to 50% of male or female nursing home residents with bacteriuria at any time, 90% will also have pyuria. The presence of pyuria, “foul-smelling urine,” or other urinalysis findings, such as bacteriuria or hematuria, are not indications for antimicrobial therapy in the absence of other localizing signs or symptoms.