Lower urinary tract infections (UTIs) are a major cause of morbidity and mortality for adults in long-term care (LTC).1 Community studies have shown prevalence rates of bacteriuria to be 11% in the elderly, 18% for those living in congregate living arrangements, and 25-50% for residents in nursing home environments. In fact, the most common cause of bacteremia in LTC residents is due to UTIs.

The prevalence of UTI increases in both sexes with age, resulting in a female-to-male ratio of 2:1 in the elderly population. The annual incidence of symptomatic bacterial UTIs is estimated to be as high as 10%. For asymptomatic bacteriuria, the estimated cumulative prevalence is 30% in women and 10% in men. Interestingly, the female-to-male ratio in the incidence of UTI narrows in the elderly population, which is thought to be related to the fact that with increasing age, men develop an increase in residual urinary volume after voiding, which increases their risk of bacteriuria and UTI; women engage in less sexual activity with age, and thus have one less predisposing risk factor for introduction of bacteria into the urinary tract.

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