We are trying to help care for a loved one who lives far away. Local siblings reported that she was extremely confused on Father's Day. They thought the caregiver looked awful too. They wonder if it might be time to look for residential care. Some of them do not see her very often (every three months or so) so I wonder if maybe the decline over the past few months has surprised them. However, if this is a rapid change should we ask to have her urine cultured? She was just at her annual physical but my husband confirmed this morning that a urine analysis was not done. She may have just been having a bad day, too. There was a lot of company. When is it appropriate to ask the doctor to do a urine culture? How long can a urinary tract infection go untreated before it causes symptoms other than confusion? What other symptoms should we ask her caretaker to look for? Will she eventually run a fever or something?
Shakingdustoff's point about overuse of antibiotics was helpful and I appreciate the time she took to post.
Here are three websites that tell you about UTIs, causes, symptoms and treatment. I think that you might find them very informative. Let me know if you have any other questions.
www.womenshealth.gov/a-z-topics/urinary-tract-infections
www.medlineplus.gov/ency/article/000521.htm
www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447
A woman I know was normally very social and active; she loved playing cards, doing puzzles, and bowling (with plastic pins and balls in the facility dining room). She could walk without any assistance. When she would get an UTI, she became a different person. She became withdrawn, would not participate in her usual activities, could not even speak properly, nor could she walk by herself, sometimes she had to be pushed in a wheel chair. Fever?-Nope. Complain of burning with urination?--Nope. Just the behavior changes. Once she received the antibiotics and the UTI was gone, she became her old self again.
Here another example of how infections can affect the elderly:
Another woman I knew was very steady on her feet and was able to walk without assistance. She had a tendency to get mild pneumonia about once or twice a year--easily treatable with antibiotics. How did we know that she had pneumonia? She didn't have any breathing problems. SHE WOULD FALL. We knew that if she fell that we needed to have her see the doctor for a chest x-ray to see if she had pneumonia again...and she did every time.
Do these examples help you any?
This morning was the first time we contacted her doctor since she was diagnosed and we don't want to be the kind of family that tells him how to do his job. But if behavior changes are the only observable symptom, maybe she needs periodic testing. Her husband did express at the last doctor visit that he was concerned about her extreme fatigue. I was disappointed that a urine analysis wasn't part of the semiannual exam.
What I would not want is for her to get antibiotics 'just to see' or just to mollify us ! Increased confusion is most likely just part of the disease progression, I would guess. As long as she's not in pain, I suppose we should just wait and see? Maybe they will do a culture for us. What is the harm?
If the change in your loved one has been rapid and you are seeing increased confusion and disorientation along with your love one not act like themselves, then I think that it is time to have their urine checked for a UTI. Ask the doctor for a UA and a Urine culture. It takes about 3 days for the culture to process enough so that the bacteria can be identified and the proper antibiotic prescribed. Your loved one's doctor might prescribe an antibiotic when the UA sample is taken and then change the antibiotic if a different one will work better on whatever is causing your loved one's UTI. After the antibiotic is completed, ask the doctor if he/she will do a follow-up urine sample to check if the UTI has been treated completely or whether another prescription of antibiotics will be needed to completely clear up the UTI. If a regular urine sample is difficult to obtain from your loved one, LO may need to have a "straight-catheterization" done to obtain urine for the Urine Culture.
Let us know what happens with your loved one and if they have an UTI or not.
I just can't see what conceivable harm it would do to run a culture. Is it difficult to get a clean specimen off her or something? Who would be able to help with that?
There has been quite a lot of debate about the treatment of low grade uti's in elderly patients; it's not always the best idea just to chuck some antibiotics at it and cross your fingers, as has been usual practice in recent years. But to my mind, that's still no reason not to *investigate*.
He is very reluctant to have the home care providers touch her (although he is letting them help her bathe) and he is also reluctant to have her to leave the house without him.
The social worker thinks there are two reasons for his reluctance to accept help. He's trying to control what he can control, since he can't control her illness. And he is reluctant to admit that she needs help because that is admitting she has a terminal disease. I stated before that in my opinion she would outlive him if he doesn't accept more help and I was not kidding. His family has extreme longevity but his father and grandfather were well cared for; they did not provide care to anyone. Women do the caregiving in his family of origin. Another problem is that he says no to all offers of help unless the helpers are willing to do exactly as he wants. He offers no flexibility or acknowledgement that people can only offer what they have to offer. He wants to dictate the terms. It's a very sad situation. But it could be a lot better if he were more cooperative. But...you play the hand you are dealt I suppose.
I appreciate this doctor's decision to hold off on medicating her. When they discussed her daytime sleepiness, he didn't jump to prescribe a sleeping pill. He prescribed more daytime activity and suggested a routine at bedtime to help her know it was time to go to sleep. I am happy with the professionals she has on her care team.
Just because YOU had a bad experience with a nursing home does NOT mean that Marcia's loved one is going to have the same experience. Marcia stated that "I am happy with the professionals she has on her care team. " Then that should be enough for you. If you had read the previous postings, then you would know that Marcia is very knowledgably about UTIs and if she has a specific question, she knows what to ask.
This is 4th or 5th time that you have repeated this story and you are beginning to sound like a broken record that can't be fixed. I am sorry that your Mom had such a bad experience, but please quit offering such unfounded and weird advice.
Caring for a dementia patient is NOT a job for one person. Certainly not for one ELDERLY person. Does FIL have help coming in on a regular basis?
Getting a dementia patient to drink more water and follow a bed time routine can be fraught with a LOT of pitfalls. Does the doctor she sees have a lot of experience with dementia patients?
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