Investigation of suspected urinary tract infection in older people

#### Learning points An 84 year old woman, who lived in a residential home, was referred to the acute medical assessment unit with a two day history of increasing confusion of unclear cause. She was unable to provide a clear history, but her daughter mentioned that she was not usually confused. On examination, her temperature was 36.8°C, her heart rate was 67 beats per minute, and her blood pressure was 135/70 mm Hg. She looked dehydrated and was noted to be incontinent of dark, offensive smelling urine. Urinary tract infection was suspected. Suspected urinary tract infection is a common scenario when evaluating ill older adults. The diagnosis may be challenging, as patients are often unable to provide a history of acute urinary symptoms (for example, owing to delirium or dementia), and asymptomatic bacteriuria (see table 1⇓ for definitions) is common in older people. The prevalence of …