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The management of urinary tract infections in older patients within an urgent care out-of-hours setting

25 March 2021
Volume 30 · Issue 6


This article critically analyses the prevalence, assessment and management of urinary tract infections (UTIs) in patients over the age of 65, in an urgent care out-of-hours service in order to enhance care. It is undertaken from the perspective of working as an Advanced Nurse Practitioner (ANP). A synopsis of UTI is presented, examining the epidemiology and aetiology. The process of assessment, diagnosis and management of UTI in older people is appraised based on current evidence. Difficulties associated with the recognition of UTI in elderly are evaluated. Finally, recommendations are made for the improvement of future practice as an ANP.

Urinary tract infections (UTIs) are among the most frequent bacterial infections seen within primary care (National Institute for Health and Care Excellence (NICE), 2020a). They are caused by the presence of multiplying microorganisms in the urinary tract with infection being determined by a combination of bacteria in the urine plus clinical features (NICE, 2015). It is estimated that more than 92 million people are affected worldwide and among older people, UTI is a substantial cause of mortality (NIHR Community Healthcare Medtech and In Vitro Diagnostics Cooperative, 2016). It is estimated that 1-3% of primary care attendances are due to UTI-related symptoms and they comprise the main reason for 13.7% of antibiotic prescribing (NIHR Community Healthcare Medtech and In Vitro Diagnostics Cooperative, 2016). The prevalence is approximately 20% in women aged over 65, compared with 11% in the overall population (Chu and Lowder, 2018). However, both genders are at risk of UTI in older age, with a male-to-female ratio of 1:2 (Cove-Smith and Almond, 2007). The risk increases substantially in patients over the age of 85 (Rowe and Juthani-Mehta, 2013).

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