Training Tuesday: Recognising a UTI in Someone With Dementia
Previous Weeks
Week Zero: The Language of Care (Words We Use and Words We Avoid)
Week one: How to Use a Slide Sheet (and How Not To)
Week two: How to Use a Hoist and Sling (and How Not To)
Week Three: How to Identify Pressure Sores (and What to Avoid)
week Four: Why Washing Your Hands Properly Actually Matters
Week Five: How to Use a Sara Stedy (With Video and What to Avoid)
Week Six: Dressing and Undressing Assistance
Week Seven: How to Find the right shoes from care work
Week Eight: How to Support Someone Through a Panic or Anxiety Episode
Week Nine: Basic First Aid for a Fall — What to Check Before Helping Someone Up
Week Ten: How to Write Good Notes and a Proper Handover
Week Eleven: What Urine Can Tell You
Before We Start
Carers and family members don't diagnose. What we can do is notice, record, and escalate quickly. That matters here more than almost anywhere, because a urinary tract infection in an older person, and particularly someone living with dementia, rarely announces itself the way it does in a younger adult.
Why It Gets Missed
In younger adults, a UTI usually means burning, frequency, and pain. In older adults, especially those with dementia, the first sign is often a sudden change in behaviour: new confusion, agitation, drowsiness, or a fall. Someone may not be able to tell you it hurts, or may not connect the discomfort to their bladder at all.
That means a UTI is easily written off as "the dementia getting worse". Treated promptly it often clears, and the person returns to their previous baseline. Missed, it can lead to delirium, hospital admission, or sepsis.
What to Look For
Changes from their normal, over hours or a day or two:
New or worse confusion, or a sudden "not themselves" feeling
Agitation, restlessness, or unusual drowsiness
Hallucinations or paranoid ideas that weren't there yesterday
A fall, or new unsteadiness
Reduced appetite or drinking
New incontinence, or needing the toilet much more often
Signs in the urine:
Cloudy, dark, or blood-tinged urine
A strong or unusual smell
Physical signs:
Fever, chills, or shivering
Pain low in the tummy, or in the back or side
A change in skin colour
Not every sign will be there. The most useful thing you can bring to a GP is a clear account of what has changed and when.
What to Do
Note what you saw and when. Time it started, what's different, what they've drunk, any temperature.
Encourage fluids gently if they can swallow safely.
Contact the GP or NHS 111 the same day. Don't wait for the pattern to "settle".
Tell the office and the family, so everyone has the same picture.
Don't rely on a home dipstick. NICE guidance advises against using urine dipstick tests to diagnose UTI in people aged 65 and over, because many older adults have harmless bacteria in their urine that produce a positive result without infection. Clinicians make the decision using symptoms and examination.
Red Flags: Call 999
Treat as an emergency if you see signs of sepsis:
Slurred speech or new severe confusion
Extreme shivering or muscle pain
Passing no urine for a day
Severe breathlessness
Skin that is mottled, blue, pale, or ashen
Someone saying they feel they might die
In these cases, do not wait. Call 999 and say you are worried about sepsis.
Reducing the Risk
Regular drinks through the day (a dark urine colour is an early warning, see our urine colour guide)
Prompt continence pad changes and thorough, gentle hygiene, wiping front to back
Regular toilet prompts rather than waiting for a request
Managing constipation, which can press on the bladder
Extra vigilance for anyone with a catheter
If You Want to Learn Properly
We cover this in every carer's induction at The Coach House. See our Dementia Care and Careers pages.
📞 01948 411222 ✉️ mail@nshomecare.co.uk
North Shropshire Homecare, The Coach House, 15/17 Green End, Whitchurch, SY13 1AD