Asymptomatic bacteriuria becomes common with age, particularly in care-home residents and people with catheters, so a positive dipstick in an older adult often reflects colonisation rather than infection. Dipsticks are therefore not recommended to diagnose UTI in adults over 65.
Diagnose on new urinary symptoms — dysuria, new frequency or urgency, new incontinence, suprapubic pain, visible haematuria, or fever with loin pain — and send a culture when you treat. Confusion or a fall alone, with a positive dipstick, is not enough; look for other causes before attributing it to the urine.
- Do not use a dipstick to diagnose UTI in adults over 65.
- Base diagnosis on new urinary symptoms or fever with loin pain, and send a culture.
- Do not treat asymptomatic bacteriuria in older adults.
- Look for other causes of confusion or falls before blaming a positive urine test.
Why it matters
Treating colonisation drives resistance and misses the real cause of an older patient's decline.
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