The Prevalence of Urinary Tract Infections in Institutionalized vs. Noninstitutionalized Elderly Persons

Jung-Sik Huh

doi:10.14777/uti.2016.11.02.56

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Huh: The Prevalence of Urinary Tract Infections in Institutionalized vs. Noninstitutionalized Elderly Persons

Review

Urogenit Tract Infect 2016;11(2):56-61.

Published online: 19 January 2016

DOI: https://doi.org/10.14777/uti.2016.11.02.56

The Prevalence of Urinary Tract Infections in Institutionalized vs. Noninstitutionalized Elderly Persons

Jung-Sik Huh

Department of Urology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea

Correspondence to: Jung-Sik Huh http://orcid.org/0000-0003-2767-4390 Department of Urology, Jeju National University Hospital, 15 Aran 13-gil, Jeju 63241, Korea Tel: +82-64-717-1760, Fax: +82-64-757-8276 E-mail: urohjs@jejunu.ac.kr

Received 21 July 2016 Revised 10 August 2016 Accepted 13 August 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This review involves the prevalence of urinary tract infections (UTIs) in elderly persons in Korea. The global average life expectancy has been increasing due to recent advances in medical technology, economic development, and availability of hygienic environment. UTIs and asymptomatic bacteriuria are common diseases in both genders of all ages, but have been particularly increasing in elderly populations. The common causes of this increase are overactive bladder, benign prostatic hyperplasia, and neurogenic bladder. Institutionalized patients are susceptible to bacterial infections due to urinary incontinence, fecal contamination, and poor perineal hygiene. UTIs are the second most common infection, constituting 25% of all infection occurrences in elderly populations living at home. Several studies involving elderly persons living in the community have reported that the prevalence of UTIs is 0.07/person-year in postmenopausal women, 0.12/person-year in elderly persons with diabetes mellitus, and 0.05/person-year in men. The incidence of UTIs in elderly individuals increases with age, particularly in institutionalized elderly patients compared with those at home. However, no study has compared the prevalence of UTIs between institutionalized and noninstitutionalized elderly persons in Korea. Such comparison and evaluation may help to prevent UTIs in elderly Korean people.

Keywords: Prevalence, Urinary tract infections, Elderly, Institutionalized

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Table 1.

Characteristics and physiologic changes of elderly persons [4-6]

Characteristic	Function
General characteristics	Lack of physical activity
	Nutritional deficiencies
	Comorbid disease
Comobid diseases	Chronic diseases-neurological diseases, peripheral vascular and cerebrovascular disease, chronic pulmonary condition
	Diabetes mellitus
	Invasive devices
	Functional impairment
Specific immunity	Decrease T lymphocytes
	Decreased antibody production
	Decrease interleukin-2
Skin	Decrease epidermal thinning
	Decrease elasticity
Respiratory tract	Decrease cough reflex
	Decrease mucociliary transport
Gastrointestinal tract	Decrease gastric acidity
	Decrease motility
Urinary tract	Increase perineal-vaginal colonization
	Increase prostate size
	Decrease urine osmolality

Table 2.

Risk factors for bacteriuria in general [14,15]

Sexual activity: nonpregnant women ages 18-40

Use of diaphragm with spermicide

Older age

Female sex

Diabetes mellitus

Neurogenic bladder

Hemodialysis

Urinary retention

Urinary catheter use

Indwelling

Intermittent

External (condom)

Table 3.

Prevalence of asymptomatic bacteriuria in selected populations

Reference	Age (y)	Population	Prevalence (%)
Nicolle et al. [1]	≥65	General	1.5-43
Juthani-Mehta [23]	＞65	General	20 (women)
Woodford and George [25]	＞75	General	10 (men) 7-10 (men)
Zhanel et al. [26]	＞65	Community-dwelling Long-term care	3.6-19.0 (men) 25-50 (women) 15-40 (men)

Table 4.

Prevalence of urinary tract infections in selected populations

Reference	Age (y)	Population	Prevalence
Laupland et al. [17]		General	17.5/1,000 populations
Nicolle et al. [6]		Long-term care residents	17-55% (women) 15-31% (men)
Jackson et al. [33]		Long-term care	0.1-2.4 cases/1,000 resident days
Caljouw et al. [36]	55-75	Community-dwelling	7/100 patients years (women)
Griebling [34]	86-90	Community-dwelling	12.8/100 patient years (women)
Griebling [34]	75-84	Community-dwelling	2.8-6.7/1,000 population (men)
Monane et al. [35]	＞85	Community-dwelling	4.3-7.8/1,000 population (men)
	＞65	General	10% (women)

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