Most women will experience a urinary tract infection (UTI) more than once in their lives. Men can also contract UTIs but at a lower rate. UTIs affect millions of people yearly and are generally caused by the bacteria E. Coli in the urinary tract and colon.

Activities Can Reveal Subtle UTI Symptoms in People with Dementia

People with dementia often have difficulty expressing discomfort or pain. Because of this, urinary tract infections can go unnoticed until the symptoms become severe. However, caregivers and activity staff may start to notice changes during routine engagement. A person who usually enjoys doing a crossword may suddenly be unable to focus. Someone who typically loves trivia or online games might become easily irritated or even refuse to participate altogether. These small behavior shifts may not seem like much on their own, but in the context of regular activity, they can be the first indicators of an underlying health issue. When someone with dementia begins to act differently during familiar, low-stress activities, it's worth considering whether something medical, like a UTI, might be the cause. By keeping a steady routine and offering games that the person is used to, caregivers create an environment where these changes stand out, making it easier to detect issues early.

As people age, the chances of contracting a UTI go up due to many factors:

Incontinence - a weakened bladder and using pads and adult diapers increase the chance of a UTI.
Poor hygiene can result from a person with dementia not caring for themselves. They may not bathe enough or improperly wipe and clean areas susceptible to infections.
A weakened immune system - as people age, the immune system is generally weaker and more susceptible to bacteria, viruses, and infections.

Dementia and UTIs

A concern for people with dementia is frequent urinary tract infections (UTIs). In the Journal of American College of Emergency Physicians Open (JACEP), a retrospective analysis of a national Medicare claims dataset suggests there are twice as many reported UTIs in the Emergency room for people 65 and older with dementia compared to those who are 65 and older without a diagnosis of dementia. *1

Using Activities to Encourage Fluids and Bathroom Breaks

One of the simplest ways to help prevent UTIs is to make sure the person is staying hydrated and going to the bathroom regularly. But for people with dementia, this isn’t always easy. They might not feel thirst in the same way, or they may forget where the bathroom is, or even how to ask. That’s where activities come in. You can naturally build hydration and bathroom breaks into your daily routine without it feeling forced or clinical. For example, use short games like trivia or matching cards as “checkpoints.” After each activity, offer a drink in a favorite cup or suggest a trip to the restroom. You can even set a gentle rhythm throughout the day, a water break after every two rounds of bingo, or a bathroom visit before moving on to a coloring sheet or movement video.

These routines help reinforce healthy habits while keeping things light and engaging. They also give caregivers more opportunities to monitor behavior and physical comfort without interrupting the flow of the day.

Do immune factors drive dementia onset?

“Infections have been associated with the incidence of Alzheimer’s disease and related dementias, but the mechanisms responsible for these associations remain unclear.” *2 Up until the 2024 study, the medical community believed there was a correlation between certain infections that negatively impact the brain, resulting in brain atrophy (a loss of brain volume) and an increased risk of dementia.*3 This study revealed that infections cause the protective proteins to degrade, resulting in brain atrophy and a risk for dementia. The scientists identified 35 immune-specific proteins that correlated with infection history and predicted patterns of brain atrophy that were specific to infections. (see illustration below) Infections can promote the development of dementia and other adverse neurocognitive outcomes (lower arrow) and can directly lead to brain atrophy and neurodegeneration (upper arrows). Illustration courtesy of Michael Duggan. *4

Side effects of a UTI -signs to look out for

The side effects of an untreated UTI include:

Hallucinations and delirium
Disorientation
Inability to remember words
Becoming sleepy or withdrawn
Difficulty concentrating
Agitation or restlessness

Red Flags to Watch For During Activities

Caregivers and activity professionals who work closely with seniors are often the first to notice when something changes — especially during daily activities. These changes might show up in subtle ways. Someone who once loved group bingo might stop showing interest. A resident who enjoys conversation and laughter may become unusually quiet or withdrawn. These are often the earliest red flags that something is wrong, and with people who have dementia or Alzheimer’s, they can be signs of a urinary tract infection. Unusual confusion, sudden agitation, refusing to participate in familiar games, or getting upset over something that normally wouldn’t bother them — these behavioral shifts during structured activities deserve a closer look. Being tuned into these red flags helps caregivers catch issues early. Activities don’t just offer entertainment. They provide a meaningful way to observe mental status and behavior over time.

Tips for caregivers in reducing UTIs for people with dementia

The Alzheimer’s Association gives tips for preventing UTIs:

Stay hydrated. People with dementia forget to drink and are not aware they are thirsty. Keep water or other liquids nearby in a clear glass or a colored one.
Encourage the person to go to the toilet often. Urinating frequently and not holding it is important for preventing bacteria.
Constipation can also contribute to UTIs. Prescriptions and over-the-counter drugs may contribute to constipation. Vegetables and fruits have plenty of natural roughage. Encourage the person to eat healthy foods, drink lots of water, and exercise.
Use good personal hygiene. Wash the area with non-scented soap or wet wipes.

Treating UTIs

Lab tests are administered and performed for diagnosis. Imaging tests can be used to ensure the urinary tract is normal. Antibiotics and different strengths will be administered depending on the diagnosis. Recovery depends on the person and the time the medicine takes effect.

Recovery Time: Rebuilding Focus with Low-Stimulation Games

Recovering from a UTI can be draining, especially for someone with dementia or cognitive challenges. After treatment starts, it may take days or even weeks for confusion, fatigue, or emotional changes to fade. During this time, overstimulation can sometimes make things worse. That’s why it’s important to choose activities that are easy to follow and calming to the mind. Instead of fast-paced games or group sessions, try offering low-pressure, solo activities. Printable coloring sheets, gentle memory games, or even listening to a playlist of familiar songs can all be great choices. Activities should be familiar and flexible — not something the person needs to “get right.” These kinds of low-stimulation games give the brain time to rest while still offering gentle engagement.

They also give caregivers a chance to reconnect and spend quality time together, without overwhelming the person recovering.

Helping with recovery and memory

While the person is recovering, it may be a good time to gently introduce interactive games, which can be done easily from a place of comfort. Memory and cognitive-style games stimulate the areas of the brain affected by a UTI illness. It’s also a way to encourage the recovery and spend quality time. Activity Uplift suggests these games and activities:

Printable coloring pages from easy to involved. Coloring may help calm the carer and aid concentration.
Trivia - Download and print these fun trivia games built around specific subjects: history, food, movies and actors, literature, and more..
Matching pairs is an easy printable that helps stimulate cognition.
Memory games can either be downloaded and printed or played online. Memory cards are another game where matching cards are all laid face down, and each player has two chances to pick up two cards for each turn.
Interactive Bingo gives hundreds of types of bingo to play with one or more people.
Everyone loves jokes. Download a joke handout and have fun with the puns!

Sources:

https://www.jacepopen.com/article/S2688-1152(24)00715-X/fulltext
https://www.nia.nih.gov/news/infections-and-immune-specific-proteins-may-increase-dementia-risk-and-brain-atrophy
https://www.cedars-sinai.org/newsroom/unlocking-the-cause-of-uti-induced-delirium/
Duggan MR, et al. Proteomics identifies potential immunological drivers of postinfection brain atrophy and cognitive decline. Nature Aging. 2024;4(9):1263-1278. doi: 10.1038/s43587-024-00682-4.
https://www.alzheimers.org.uk/sites/default/files/2019-09/528LP%20UTIs%20and%20dementia.pdf