Urinary Tract Infection Induced Delirium in Elderly Patients: A Systematic Review

Abstract

Urinary tract infection (UTI) is common in older adults, mainly due to several age-related risk factors. Symptoms of UTI are atypical in the elderly population, like hypotension, tachycardia, urinary incontinence, poor appetite, drowsiness, frequent falls, and delirium. UTI manifests more commonly and specifically for this age group as delirium or confusion in the absence of a fever. This systematic review aims to highlight the relationship between UTI and delirium in the elderly population by understanding the pathologies individually and collectively. A systematic review is conducted by searching PubMed with regular keywords and major Medical Subject Heading (MeSH) keywords, Science Direct, and Google Scholar. The inclusion criteria consisted of studies based on male and female human populations above the age of 65 in the English language, available in full text published between 2017 and 2022. However, the exclusion criteria were animal studies, clinical trials, literature published before 2017, and papers published in any other language except English. A total of 106 articles were identified, and nine final studies were selected after a quality assessment, following which a valid relationship between delirium and UTI was identified in this systematic review.

Determinants of delirium in elderly in-patients in a general ward setting in a teaching hospital: A case control study

“…[ 22 ] The present study showed a significant association between urinary tract infection and delirium on univariate analysis which is similar to a review done by Paul et al . In a cohort study[ 23 ] among mechanically ventilated patients, Lorazepam was an independent risk factor for delirium and this is corroborated in the present study. We found that the use of anticholinergics and not an increase in the number of medications was associated with delirium, as has been demonstrated by other investigators.…”

The Role of Neutrophil-to-Lymphocyte Ratio (NLR) in Urosepsis-Associated Delirium

“…Delirium is a common atypical clinical presentation of UTI in the older population. Delirium can be precipitated by UTI, or UTI can occur due to impaired maintenance of personal hygiene as a result of delirium, leading to unfavourable outcomes [ 21 ].…”

The Association of Infection with Delirium in the Post-Operative Period after Elective CABG Surgery

“…In their study published in 2017, Kuswardhani et al noted that in elderly individuals, delirium may be triggered by a number of factors, including infection such as UTIs, pneumonia and sepsis [20]. In their 2022 systematic review, Dutta et al noted that infection (particularly UTIs and pneumonia) is the most common triggering factor of delirium [21]. UTIs are the most researched type of infection, and their association with delirium has been most extensively investigated [22].…”