Targeting Preventive Measures to the 'Oldest Old' at High Risk of UTI

Urinary tract infections (UTI) are common among the "oldest old" and may lead to a few days of illness, delirium or even to death. Monique AA Caljouw, of the Department of Public Health and Primary Care at Leiden University Medical Center in the Netherlands, and colleagues, studied the incidence and predictive factors of UTI among the oldest old in the general population. Their research was published in BMC Medicine.

The Leiden 85-plus Study is a population-based prospective follow-up study of 86 year old subjects in Leiden, the Netherlands. Information on the diagnosis of UTI was obtained annually during 4 years of follow-up from the medical records and interviews of treating physicians. 157 men and 322 women aged 86 years participated in the study. Possible predictive factors were collected at baseline, including history of UTI between the age of 85 and 86 years, aspects of functioning (cognitive impairment [MMSE<19], presence of depressive symptoms [GDS>4], disability in activities of daily living [ADL]), and co-morbidities.

The incidence of UTI from age 86 through 90 years was 11.2 (95% CI 9.4, 13.1) per 100 person-years at risk. Multivariate analysis showed that history of UTI between the age of 85 and 86 years (HR 3.4 [95%CI 2.4, 5.0]), impaired cognitive function (HR 1.9 [95%CI 1.3, 2.9]), disability in daily living (HR 1.7 [95%CI 1.1, 2.5]) and urine incontinence (HR 1.5 [95%CI 1.0, 2.1]) were independent predictors of an increased incidence of UTI from age 86 onwards.

The researchers conclude that within the oldest old, a history of UTI between the age of 85 and 86 years, cognitive impairment, ADL disability and urine incontinence are independent predictors of developing UTI. These predictive factors could be used to target preventive measures to the oldest old at high risk of UTI.

Reference: Caljouw MAA, den Elzen WPJ, Cools HJM and Gussekloo J. Predictive factors of urinary tract infections among the oldest old in the general population. A population-based prospective follow-up study. BMC Medicine 2011, 9:57doi:10.1186/1741-7015-9-57