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**Do you have elderly people at your home? Are they not able to hold their urination?
Are they on a catheter?**
**If your answer is yes, then they all are prone to urinary tract infection (UTI).**

**I am Anju Bobin, Senior Nurse and Training Manager at Epoch Elder Care. With my 16 years of experience, I am sharing with you some aspects and care management of UTI, which will be useful to you, as a caregiver.**  
 
Urinary Tract Infection (UTI) is a common abbreviation that all are aware of. This is common in young and old but older people have higher chances of getting UTI.
 
Experiencing pain and burning sensation and cloudy urine are all signs of a UTI. The infection can affect any part of your urinary system—kidneys, ureters, bladder, and urethra—however, most UTIs involve the lower urinary tract (specifically, the bladder). The painful symptoms of a UTI not only irritate the elderly, but they can lead to serious consequences if the infection reaches the kidneys.
 
Women have more chances of developing an infection as compared to male elderly as the urethra of a woman is close to the anus. And the urethral opening is close to the bladder. This makes it easier for bacteria around the anus to enter the urethra and travel to the bladder.
 
UTIs are generally caused by a type of bacteria called E. coli that resides in our digestive tract but when it enters our urinary tract.
 
**Do you have any idea why our elderly develop UTIs more than the young population?**
 
As age advances the muscles of the bladder and pelvic floor become very weak causing urine retention or incontinence. The bacteria remain in the urine present in the urinary tract, they grow and colonize gradually and later develop UTIs in the elderly.
 
Another contributing factor is an indwelling catheter in old age people. Other than these we have to watch out if these conditions are present in the elderly.
Diabetes mellitus
Enlarged prostate (In males)
Bedridden
Kidney stones
 
**How can you identify a UTI in an elderly as a primary care provider?**
Confusion or delirium
Increased or urgent urination
Fever
Painful urination
Nausea
Urine with abnormal color or odor
Pelvic pain
Sudden changes in behavior or agitation
Poor motor skills or dizziness
 
In many cases when you are a caregiver to the elderly with dementia, you may not be able to find all the symptoms in the elderly because they lack communication skills, so watch out for any behavioral changes. Healthy people display physical symptoms like burning when urinating, elderly patients may not complain of such pain. If not detected early, the infection can lead to serious health problems.
 
**Tips for preventing UTIs in elderly**
Hydration is the only key factor helping to prevent UTIs in the elderly. Drink at least 1.5 liters to 2 liters of water a day
Use cranberry juice or tablets. It is suggested by a research paper published in NCBI that daily consumption of 200ml-300ml of cranberry juice cocktail can prevent 50% of the recurrences of UTI and can reduce bacteriuria (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863270/)
 Limit the use of caffeine
Avoid cleaning or wiping from back to front (especially for elderly women)
Use cotton underwear and change on daily basis or when required
Keeping the genital area clean and dry
Avoid catheterization if not required
 
**Tips to prevent UTI if the elderly are on a catheter at home**
Always do handwashing before and after every procedure
Always keep the urobag below hip level to prevent backflow of urine to the bladder
As a caregiver please watch that the catheter tube should not be folded at any point in time else it will cause urine backflow
Perineal care once a day daily around the catheter and more frequently if the elderly are suffering from incontinence
Cleaning the rectal area thoroughly after the elderly passed their motion
Empty the urobag every 8 hours or whenever it is full
Changing the catheter every 14 days if the regular catheter is inserted and if the silicon catheter is inserted change in 1 month
 
**What happens if a UTI is untreated?**
If UTI is not treated, it will cause permanent damage to the urinary tract.
 
**How are UTIs treated?**
UTIs are treated with antibiotics
Antibiotics should be taken for a week or two so that the infection gets cured 
If the kidney gets infected then antibiotics are given for more than a week
 
Every primary caregiver at home has questions about what should be incorporated and what should be avoided if the elderly is diagnosed with UTI.
Here are some of the tips.
 
**Food to be included:-**
 
A higher fiber diet including lentils(dal), nuts, beans, whole grains, and oats
Eat probiotic-rich foods like greek yogurt which are available in the market easily nowadays
Eating cranberries, and blueberries is helpful. Drink cranberry juice which should be sugar-free
Fish oil with omega-3 fatty acids is good. If you are a vegetarian then take walnut, chia seeds, and flax seeds that are readily available in the Indian market
 
**Food to be avoided:-
Avoid coffee, cold drinks, and alcoholic beverages
Do not eat spicy foods
Don't eat acidic fruits like orange, lime, or lemon
 
**As a Senior Nurse & a Training Manager, I believe that prevention is better than cure.**
In our Epoch Elder Care facilities, we have elders who are in the age group of 75-100. Our elderlies are also prone to develop UTIs.To decrease the morbidity rate caused by this infection, continuous training is given to our staff. Training is given to our care attendants and nurses to identify the symptoms in the elderly such as a sudden change in behavior, complaints of pain, and changes in toilet habits like frequent urination.
We apply various preventive measures like frequent diaper changes, giving catheter care to the elders, and also keeping them hydrated by giving them flavored drinks. 
Hygiene is another important tip that helps in prevention. So, here at our Epoch homes, we make it a habit to do perineal care daily. If the elderly has a catheter, we make sure that we do proper catheter care and ensure that during the insertion procedure all aseptic techniques are applied to prevent CAUTI (Catheter-associated urinary tract infection). Our elders who are living with later stages of dementia face difficulty in conveying their urge to urinate. So, on regular intervals, we do take them to the toilet and help them with toileting.
 
Urinary tract infections are very common. Anyone living with or caring for an elderly family member should be aware of the potential for UTIs. Knowing how to avoid a UTI and knowing what symptoms to look out for can make all the difference in an elder’s quality of life.
P.S.: Never ignore the signs of infection in your elderly loved ones!

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Urinary tract infections in the elderly and their management

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There’s the music of sarod playing in the background while I write this, helps me write my memoirs!

When I was a child, I used to write diaries. What’s enticing to me at that point in time was the smell of new vintage-looking pages, and a unique feeling to ink it down. It all started then. Who knew the passion for writing would grow so strongly on me!

Hi, I’m Sneha, Business Assistant & Content Writer at Epoch. Yes, I own these words and wear them with pride. The journey to earn this was pretty savage, and I’ll like you to be a part of this! Hence, sharing a page from my memoir.

It was the dawn of the year 2020 when I promised myself to come out of the University with a Mass Communication and Journalism degree in one hand and a placement in other. Things started turning upside down when the covid wave came along and washed away all the aspirations I had of starting my career in a corporate world. Later that year, after graduating, I started freelancing.

Little did I know that the universe had something else up in its sleeves.  On 1st Feb, I started my journey at Epoch, and it’s already a year now! I’ll need pinches from myself to believe so. When I stepped out of my comfort zone, came to a new city, I met amazing people, especially women, who inspired me in the most unusual ways. It is my sheer luck and fortune that I landed in Epoch right after college. The journey of amazement and learning didn’t stop for me, I would say.

How often does it happen that a CEO of an organization holds your hand, mentors you, and walks you through your journey? Well, happened to me and to all those who started anew! Here, at Epoch, I saw myself under the guidance of domain experts. From each one of them, I learnt something, both applicable in personal and professional lives. My team pushed me one notch beyond my threshold, surprisingly that brought different colours to my work. To date, I am told to be the owner of not only my projects, but also my decisions, successes, and failures. I am learning.

Epoch has played a vast role in shaping me into Sneha 2.0. If you know me and don’t believe, let’s go out for a cup of coffee! A confident and radiant Sneha, you’ll see.

Epoch homes abode elderly those who need dementia care and assisted daily living support. When I started, I was briefed about dementia but the understanding of the daily life of a senior 75+, came to me when I was in their presence. Recently through one of the Epoch webinars, I heard a doctor/geriatrician say, and I quote, “there’s a person still behind the dementia patient”, and this made me realize how naïve are we to not notice this in our elderly loved ones!

Amidst the pandemic, there were fewer interactions with our elderly residents, regarding their own safety. But whenever I got the chance, covered in PPE kit, I would jump to know each one of them. With some I sang era old songs, with some I recited poems of Harivansh Rai Bachchan, Dinkar, Nirala, with some I learnt the concept of perspective, with some I learnt fashion, some taught me to live life with a bang, and that’s what I am doing!

Epoch in a way turned out to be a blessing in disguise. I would like to stop the roller coaster of my emotions here by simply being grateful. One day, when I close my eyes, I would love the memories with Epoch to roll in the cassette of my life. 

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To Epoch, a cassette of my life

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I want to share my unique professional journey with you. Personally, I have been someone who is always up for trying new things.

In August 2014, after completing my training as a General Duty Assistant, I got placed at Epoch Elder Care as a care attendant.  Even though I had prior care training, being a care attendant in an assisted living home was new for me and there was much to learn, especially about dementia care. At Epoch, everyone is encouraged to ask questions whenever they do not understand, your colleagues and seniors will answer them patiently and help you understand your issues. I realised how tough life can be with dementia and at Epoch I was able to increase the quality of life of elders with dementia and this was very satisfactory for me. 

Given my inclination to try new roles, back in 2018, I was chosen for the role of Admin Assistant which was a huge change for me professionally as I was moving from  care to an administrative role. With much support of senior colleagues, I was able to manage this role with confidence. Here I learnt new skills like vendor management, maintenance planning, and working with multiple departments. Being an ex-care attendant, I was able to understand the importance of this role where I had to ensure the upkeep of Epoch homes and how crucial it was for our care attendants to take care of our residents. Iss dauran maine apni life ko bahut hadd tak personally, professionally and financially grow bhi kiya hai (During this time, I was able to grow personally, professionally and financially). 

Then in January 2020, I saw an opportunity to move to a new role within Epoch as a Human Resource (HR) assistant and I confidently took the leap. Given my prior experience as a care attendant, I was quickly able to connect to prospective candidates for Care Attendant role and understand who could be a good fit at Epoch, and I learnt the aspect of people management. Ab dedication and guidance of my manager and colleagues ke sath grow kar raha hun or hope aage bhi yun hi grow karta rahunga. (With the dedication and guidance of my manager and colleagues, I am learning & growing  ,and will continue doing so!)

Thanks to Epoch, I have been able to understand this industry well and grow myself professionally in many different perspectives by gaining many new skills.

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Trying new roles and gaining new skills at Epoch

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I want to share my journey so far with Epoch Elder Care. I started my journey as a care attendant with Epoch’s Monet house at Pune location on 15th May 2016 and sab kuch naya tha mere liye (everything was new to me). It was a great year well spent at Monet house; and bohot kuch sikhne ko mila (great learnings came along). Under the guidance of our Facility Managers and Facility Nurses and other care attendants, I was properly trained to look after our residents. Epoch work culture bohot welcoming and unique tha mere liye (Epoch culture was welcoming and unique for me) - where the team was great & they treated me like a family member. Not only this, the relationship and bond I developed with residents was an amazing feeling. The concept of dementia and its management was something jo mujhe dhire dhire samajh aya. (The concept of dementia and its management was something I learned over a period of time).

After the completion of one year, the management decided to transfer me to Epoch’s other home (Vermeer House) in Gurugram. I was happy with the decision for two reasons. Firstly, my learning was about to expand and secondly, my hometown was nearby. After working as a care attendant for a year and a half at the Vermeer House, the management decided to promote me to the role of Head Care Attendant. Finally, my dedication & honesty paid off. My responsibilities increased and I had to oversee all errands related to our residents, other care team members, and the house overall, which I enjoyed throughout.

Then again on 1st May 2019, I was offered a role change based on my skills and eagerness to work. This time the management decided to offer me the role of Admin Assistant, which I accepted confidently. It was challenging at first, but with the constant guidance of the then corporate team, I managed with quite ease.

Epoch has not only helped me professionally but also personally. It is here that I met Sarita (Care Attendant at Vermeer House), married her and started another chapter of my life. She is always there to support & motivate me. 

During the outbreak of COVID-19, around Feb 2020, I was handed over the role & responsibilities of an Office Assistant in the new Vermeer house at Gurgaon. Covid ke first wave me hume bohot kuch naya experience karne ko and samajhne ko mila. Ye time humare liye bohot difficult tha but hum sabne milkar Epoch and ek doosre ko sambhala. (New learnings came along whilst managing and experiencing the first wave of coronavirus. It was a difficult time, but we managed to pull through). I was presented with the COVID warrior award. Epoch ke saath ab itne memories jud gaye hain ki yahan har koi apna sa lagta hai. 

Epoch me hamesha kuch na kuch naya sikhne ko and samajhne ko milta hi hai and mere liye bohot unique experience banta raha hai.

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My journey of multiple roles at Epoch

Do you have elderly people at your home? Are they not able to hold their urination?
Are they on a catheter?
If your answer is yes, then they all are prone to urinary tract infection...

Urinary tract infections in the elderly and their management

Anju Bobin , Training Manager

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