Measuring the burden of illness potentially related to asymptomatic bacteriuria in the elderly is, however, limited by several factors. First, no population-based studies in the ambulatory elderly document the occurence and impact of symptomatic urinary infection. Second, chronic genitourinary symptoms are frequent in the elderly population. Thus, while not due to bacteriuria, they may complicate the identification of symptomatic infection. Finally, the multiple co-morbid illnesses and functional disability of the elderly institutionalized population leads to impaired communication and identification of symptomatic infection.
Limited reports document the frequency of symptomatic infection in elderly populations.
Only 5 patients of the initial bacteriuric group became symptomatic and they were apparently treated with antimicrobial therapy with resolution and without further complication. Women over age 65 with acute non-obstructive pyelonephritis are more likely to be bacteremic than younger women. Several other clinical presentations in the elderly are frequently attributed to urinary infection because of the difficulty in ascertainment of symptoms and high prevalence of bacteriuria in this population. Where specific symptom presentations other than pyelonephritis or lower tract irritative symptoms have been critically studied, however, urinary infection has not been documented to be an important contributor to such symptoms. For instance, gross hematuria is seldom attributable to hemorrhagic cystitis in institutionalized elderly subjects despite a high prevalence of bacteriuria in residents with gross hematuria.