UTI’s in the elderly and care homes are the commonest illnesses afflicting ageing patients. It is imperative with growing numbers that steps are taken to reduce and prevent UTI’s which are so costly and miserable.
Millard House is a Care Home in Bocking, Essex caring for 40 elderly people reaching the end of life. There are hundreds like it all round the country.
Millard House has enrolled three staff into the national Gold Standards Framework. Its aim is to train staff for a higher knowledge and job satisfaction in this branch of medicine. Caring for the elderly as they reach the end of life is a growing medical need.
End of life care . The end of life now takes a much longer time than previously when doctors assisted the terminally ill with a touch more morphine or had no knowledge of drugs and treatments to save lives. This arrival of a ‘stalled’ death is the reason why Dignity in Dying and Compassion in Dying have emerged as charitable institutions to fight worldwide for patient choice in how and when they want to die. (https://www.dignityindying.org.uk )
Common misery of UTI’s in Care Homes . Urinary Tract Infections are immensely common in the elderly and in Care Homes. I have a six page booklet of reasons why and how to take preventive action. Prevention of UTI’s is very simple once you understand where the infection is coming from.
UTI causes. Particularly in the elderly, causes of UTI’s become fewer than in previous years of life when sexual activity, clothing, jobs and other reasons abound.
UTI’s in the elderly and care homes revolve around two main causes;
1 Thin, atrophied perineal skin susceptible to germs travelling from the anal opening towards the urethral opening.
2 Absent or very ineffective hygiene due to joint stiffness, poor mobility and lack of care staff knowledge.
Bottle Washing to prevent UTI’s in the Elderly and Care Homes is seldom able to be achieved. Today’s elderly would have used wash cloths or flannels to clean after a bowel movement but many become unable to as they age. So what can be done instead?
Millard House is going to undertake a slight plumbing change in its bathrooms. Briefly demonstrating my intentions to care staff, their house plumber will attach a short-hosed, small-headed shower to the basin pipes which are already close to toilets. Water temperature will be fixed at 38 degrees for patients to simply shower themselves down from the front whilst still on the toilet. This simple device is in common use in hot and cold countries.
To soap the anal opening from behind and pick up microscopic bacteria is best accomplished with a soft muslin square which can be binned. The little shower is then turned on to rinse off the soapy perineal residue containing coliforms.
UTI’s in the elderly caused by Coliforms. As the commonest bacteria to cause UTI’s in all age groups it is the reason for falls, dementia, kidney failure, and deaths in the elderly. Coliforms are alright in the gut but not outside it where they go hunting for a new home to invade and infect. The nearest option for them to ‘swim’ to is the urethral opening. By washing them off at source, travel forwards is then prevented especially along the thin, cracked skin of the ageing perineum.
UTI’s in the elderly caused by atrophy. Atrophy is thinning skin and can only be treated with very small amounts of hormones replacing ones now lost. I’m on 1 low dose hormone tablet a week relieving joint stiffness. It’s very efficient. I take it for no other reason. My doctors know and I’ve been fully tested by the gynae dept for any signs that I should not try this.
UTI’s in the elderly and care home can be avoided
Prevention of UTI’s in the elderly is therefore twofold:
*mild hormone treatment.
* daily, efficient perineal hygiene.
Prevention is always better than ‘cure’!
Angela Kilmartin July 8th, 2018