Two recent cases in my geriatric case management practice highlight an important issue in elder care: urinary tract infections (UTIs) often present differently in older adults and can be easily missed.
In both cases, routine blood work revealed elevated white blood cell counts. One physician did not address the abnormal finding, while another physician contacted me to ask whether the client had recently experienced an infection. Although neither client had obvious symptoms, I was concerned about the possibility of a urinary tract infection.
My concern was based on experience. Older adults, particularly those with catheters or a history of recurrent infections, frequently develop UTIs without the classic symptoms seen in younger individuals. In my years of practice, I have seen seemingly minor infections progress rapidly to hospitalization and even sepsis because the warning signs were subtle or overlooked.
The first client had a catheter and a history of recurrent UTIs and sepsis. I requested a urinalysis, which revealed bacterial growth. Initially, the physician chose not to prescribe antibiotics because the client appeared asymptomatic. Recognizing that older adults often present atypically, I contacted the home health agency and requested a catheter change. During the visit, the home health nurse noted bladder spasms and leakage around the catheter—important clinical findings that had not previously been identified. After I communicated these findings to the physician, antibiotics were prescribed and treatment began before the infection could progress.
In the second case, I requested a urinalysis after noting an elevated white blood cell count, increased weakness, and a recent fall. The physician declined the request and directed the caregiver to take the client to the emergency department. After spending eight hours in a crowded emergency room environment, where the client was exposed to numerous illnesses and experienced significant fatigue, the diagnosis was confirmed: a urinary tract infection. The treatment required was a course of antibiotics.
These cases illustrate an important reality of geriatric care: older adults frequently do not present with the textbook symptoms that healthcare providers expect. Instead of burning, urgency, or fever, they may exhibit weakness, falls, confusion, fatigue, functional decline, or subtle changes in condition. Without someone familiar with these atypical presentations, infections can be missed until they become serious.
As a geriatric nurse case manager, my role extends beyond coordinating care. I monitor patterns, recognize subtle changes, advocate for appropriate diagnostic testing, communicate critical information among providers, and help prevent avoidable hospitalizations. By understanding the unique ways illnesses present in older adults, I am often able to identify problems earlier, reduce unnecessary emergency department visits, and ensure that clients receive timely and appropriate treatment.
In elder care, recognizing what is not obvious can make all the difference.
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