This depends on whether the person is cognitively impaired or not. In elderly individuals who can report symptoms, the most common first signs are changes in urinary habits like increased frequency or urgency and pain during urination.  For cognitively impaired elderly individuals, some signs that may point to UTI include a change in mental status (e.g., change in level of consciousness, periods of altered perception, disorganized speech, or lethargy). A change in the character of urine (e.g., bloody or cloudy urine) may also be noticed.