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Abstract
The issue of ageing is a pressing one. Tremendous progress will have to be made over the next years to avoid problems in caring for our senior citizens.(1) The number of people over 60 years of age was around 580 million in 1999 (2)and is expected to reach 1200 million by the year 2025.(3) Over 60% of the elderly will live in developing countries. In Egypt the population aged 60 and over was 2,959,000 representing 6 % of the population in 1985, reached 3,955,000 representing 6.5 % of the population in 1995 and is expected to reach 23,432,000 representing 19.3 % of the population by the year 2050.(4, 5)
The population within the geriatric homes represents a wide spectrum of clinical disability. The clinical impact and significance of infections differ among geriatric homes, depending on associated comorbidities and functional status of the residents.(6)
The population and environment provides several risk factors that permit the development of infectious diseases and their transmission.(7-10) The epidemiology, clinical presentation, and natural history of many infections may be unique in this population. Increasing recognition that the environment and patient care practices in the geriatric home promote emergence of antimicrobial agent-resistant organisms has heightened awareness of the significance and complexity of infections in this setting.(11) Sites of infection that have particular importance in such settings, include respiratory tract infection, skin and soft tissue infection and urinary tract infections (UTIs).(12)
UTIs are amongst the most common infections in the elderly population. They account for 25% of community acquired infections and 25% to 30% of infections among institutionalized elders.(13) The reported incidence of symptomatic UTI varies from 0.1 to 2.4 per 1,000 resident days.(6)
UTIs in the elderly present many diagnostic and therapeutic challenges. Signs and symptoms may be confusing, and complications are more likely to occur. Prompt recognition, appropriate treatment and thorough follow-up are essential to minimize morbidity and mortality. After upper respiratory tract infections, UTIs are the most common cause of fever in persons over 65 years of age.(14) The typical presentation of dysuria, frequency and urgency, with or without fever, in a healthy individual of any age generally poses few problems in diagnosis or treatment. In some elderly patients, however, the atypical presentation of urinary tract disease and the chronic illnesses that often occur with aging make diagnosis more difficult, treatment more urgent and complications more common. A rational and thorough diagnostic evaluation is mandatory in these patients, because a delay in diagnosis may increase morbidity and mortality.(15)