Development of resources for the management of UTIs in older adults - qualitative findings specific to decision making and current practice in primary care
PHE ePoster Library. Gold N. 04/09/19; 259610; 15578
Dr. Natalie Gold
Dr. Natalie Gold
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Abstract Introduction

To help decrease E.coli bacteraemia and improve antimicrobial use in older adults, we undertook a needs assessment specific to resources around the diagnosis and prevention of UTI using qualitative methods.


Focus groups and interviews were held with 123 GP, nursing and residential home staff, and members of the public. Questions explored diagnosis, management, prevention of UTIs and antibiotic use in older adults, focusing on those in care. A UTI leaflet and diagnostic guide were modified iteratively. Discussions were transcribed and analysed using Nvivo.


Many GP staff relied on urine dip sticks to diagnose a UTI in older adults, though some knew this was unhelpful. The high prevalence of asymptomatic bacteriuria was understood by GP staff, but not untrained care home staffs who were fearful of having no diagnostic test. GP staff were also greatly influenced by the consistent use of dipsticks in care homes.Carers of older adults reported they had an important role in identifying UTIs in older adults by flagging symptoms such as confusion or changes in behaviour to nurses or GP staff. Many would conduct a urine dipstick before contacting the GP.All staff welcomed the development of diagnostic guidance for UTIs, and complementary information in parallel to information leaflets that could be shared with patients and carers; promoting consistent messages across the care pathway. Hydration and prevention were highlighted as key areas within the resources and participants thought a colourful leaflet with large print could improve patient care.


Resources should highlight the appropriateness of using urine dipsticks in the diagnosis on UTI in older adults with non-specific symptoms, including clear explanations of asymptomatic bacteriuria and possible alternative causes of confusion. Resources on UTI prevention, pyelonephritis and sepsis would be valued by care staff in particular.
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