🚨 UTIs in Older Adults: Why Dipsticks Can Mislead – and What You Can Do Instead

For Domiciliary Carers and Care Teams

👵 A Little Story…

Jean is 86 and usually chatty when her carer comes in. But one morning, she seemed quiet, confused, and didn’t want her tea. Her carer noticed she was off her food and hadn’t passed much urine. Jean didn’t complain of pain — but something just wasn’t right.

Thanks to that carer’s instincts, Jean’s GP was called. A UTI was suspected, and antibiotics were started. But within 48 hours, Jean had chest pain and was rushed to hospital with a heart attack.

The team later found out that UTI's in older adults can increase the risk of heart problems — especially in the week after infection starts. Early warning signs matter. And the carer’s early concern helped Jean get the right care just in time.

❗ Why This Matters

UTIs are very common in older people — but they don’t always show up clearly. And a recent UK study has shown something new: a UTI can raise the risk of heart attacks and strokes, especially in the first week after it starts. https://bmjopen.bmj.com/content/15/6/e097754

At the same time, Public Health England (PHE) and NICE say urine dipsticks are not reliable in older adults. They can lead to wrong results, delayed treatment, and even miss serious illness.

🧪 Why We Don’t Use Dipsticks in Older Adults

• Older adults often have bacteria in their urine even when they are well – this is called “asymptomatic bacteriuria” and doesn’t need antibiotics.
• Dipsticks can pick this up, giving a false impression there is an infection.
• This can lead to unnecessary antibiotics – and miss the real cause of someone’s illness.
• PHE and NICE recommend: don’t use dipsticks in anyone aged 65+ or with a catheter.

✅ What To Look For Instead: Signs and Symptoms

You know your clients best. These changes matter and are often the first sign that something’s wrong.

📝 UTI Symptom Checklist for Domiciliary Carers

Use this checklist when supporting someone who seems unwell.

✅ General Wellbeing, a suspected "Delirium"

• Sudden confusion or muddled thinking
• Unusually sleepy or drowsy
• Loss of appetite or not drinking
• Just “not themselves”

✅ Toileting

• Needing the toilet more than usual
• Accidents or urgent need to wee
• Pain or burning when weeing
• Cloudy or strong-smelling urine

✅ Physical Signs

• New or high temperature
• Shivering or shaking
• Tummy, side, or back pain

🚩 Red Flags – Call 999 or GP Urgently

• Fast breathing or racing heart
• Pale or grey skin
• Difficult to wake or very drowsy
• No wee for 12+ hours
• Blood in the urine

🧭 What You Should Do

1. Notice and write down the changes – when they started, what’s different.
2. Do not use a dipstick – trust the signs, not the strip.
3. Report to your manager or GP clearly and quickly.
4. Encourage fluids if it’s safe – dehydration makes things worse.
5. Follow the care plan and watch for improvement.
6. Escalate if needed – trust your gut, especially if someone gets worse.

🌍 Public Health Matters

• Avoiding unnecessary antibiotics helps fight resistance.
• Spotting real UTIs early can prevent hospital stays — and even heart attacks.
• Your care, your observation, and your voice can save lives.

💬 Final Thought

Jean’s carer noticed something small — and it changed everything.

You don’t need a dipstick to make a difference. You just need your eyes, your ears, and your care.

📱 Need help deciding if your client is unwell?

Talk to us about CareBoodle

As a co-founder of CareBoodle I am so excited to announce we will be soon launching our digital product to help carers and care agencies.

CareBoodle is a new digital tool designed for domiciliary carers just like you. It gives you an easy checklist to spot signs of illness and "Delirium" — like confusion, infection, or dehydration — and helps you decide when to escalate.

✅ Built by experts in frailty and community care

✅ Quick, clear questions to guide your next step

✅ Supports safer care and faster decisions

If you are interested in this as a care agency owner or manager please get in contact and DM me. We are looking for early adopters and innovative agencies to work with.

CareBoodle Liz Blacklock Stella Shaw