Urinary Tract Infections (UTI’s) are fairly common in even the general, otherwise-healthy population.



Symptoms of a urinary tract infection can vary. Someone may experience a lot of symptoms and someone else may not know that they even had one.


Symptoms can include:
  • Burning and Pain with Urination
  • Feeling the Urge to Urinate Frequently
  • Only Urinating Small Amounts
  • Blood Tinged, Dark, Cloudy, or Strong-Smelling Urine
  • Pelvic Pain
  • Back Pain
  • Fever
  • Nausea
  • Vomiting
  • Confusion


In the hospice population and elderly population, especially those with dementia and Alzheimer’s disease, symptoms of a UTI are not always so pronounced, or the person may not be able to express themselves verbally.


Many in this population are also incontinent of their bladder and may not be able to perform adequate self care, relying on others to assist and clean them often to avoid UTI’s and skin breakdown.
The UTI may go untreated due to health care workers and caregivers not picking up on the clues if the person is unable to verbally tell them.

Behavioral symptoms may appear within the first few days of infection. They may experience frequent bathroom trips, incontinence, odorous urine, agitation, confusion, restlessness, or hallucinations.

A urinary tract infection can quickly progress and lead to decline in status. Due to the diagnosis of dementia or Alzheimer’s, these patients’ symptoms may be thought to be related to the disease itself rather than an infection.


Terminally Ill Patients Are More Susceptible to Infections.

Risk Factors Include:
  • In females, having a shorter urethra or in menopause
  • Bed-bound, mostly bed bound, sedentary life style
  • Unable to verbalize needs
  • Dementia or other diseases that affect cognitive abilities
  • Urinary and/or fecal incontinence
  • Enlarged prostates
  • Urinary catheters
  • Constipation
  • Certain medications that decrease urine flow
  • Certain diseases or conditions that could restrict or obstruct urine flow
  • Suppressed immune system
When a terminally ill patient has a suspected UTI, the hospice can provide antibiotics, when appropriate and agreed upon, due to the fact that the goal of hospice is to alleviate distressing symptoms to promote comfort at end of life.


Failure to treat the symptoms can result in discomfort, renal failure, or sepsis, however the family and hospice team will need to take into consideration their current condition, their ability to swallow or have IV access, their or their family’s wishes for treatment, and potential side effects of antibiotics.


Prevention and Natural Treatments:

  • Hydrate! Drinking water can help to flush out bacteria.
  • Cranberry Juice! Some studies show that cranberry juice can make it harder for bacteria to grow on the urinary tract walls.
  • Go! Don’t hold it! Holding your urine gives the bacteria time to duplicate and grow.
  • Probiotics! Probiotics help your body replenish your good bacteria, especially when on antibiotics.
  • Garlic! Some studies show garlic extract can help reduce the number of bad bacteria.
  • Avoid bladder irritating foods! Citrus or very acidic foods, artificial sweeteners, caffeine, and alcohol can irritate your bladder.
  • Females- Wipe from front to back! Bacteria can be brought from the backside to the front, leading to the most common Urinary Tract Infections.
  • Wear loose, breathable clothing and undergarments, specifically cotton.


Even with the best of care, UTI’s can happen. Prompt identification and treatment of them is crucial to prevent further complications and discomfort.


Hospice will not withhold treatment of UTI’s just because they are at end of life, however in some instances the treatment may not be beneficial or warranted depending on the patient’s current condition and desires.

Talk to your medical provider if you are concerned your loved one may be experiencing a urinary tract infection.