Any time someone starts behaving funny—and by that, I mean in some way that’s unusual for them—it’s not something to laugh at.
A change in behavior, also called altered mental status (AMS), can be so significant that some medical textbooks say it’s often the first sign that something is wrong. That’s why it’s important for family and friends to take note of the change in behavior and, if it continues, try to encourage the person to get medical attention.
While this is true for people of all ages, it’s particularly urgent when it comes to seniors or elderly people. In this population, altered mental status can be a sign of a urinary tract infection.
As you might expect, the typical symptoms of urinary tract infection, or UTI, focus on abnormalities in urination. Think of things like pain or burning while urinating, having a more intense urge to go to the bathroom, having to urinate more often, or an unusual smell or color to the urine. In elderly people, though, these usual symptoms are often accompanied by altered mental status, confusion, or changes in behavior.
It’s important to get prompt diagnosis and treatment of a urinary tract infection, because otherwise it can spread to the kidneys. Beyond that, it can cause a deadly condition known as urosepsis—that’s sepsis caused by a UTI. Sepsis is the body’s system-wide response to an infection and can cause failure of vital organs and death.
Sadly, that’s exactly what happened to a patient in her 60s in the case that I’m currently investigating. What’s shocking to me about her story is that until six weeks before her death, she was active and healthy, living independently with her husband, and basically enjoying a busy retirement.
One day she fell and broke her tailbone. Although the treatment didn’t require surgery, it was very painful, so her doctors referred her to a skilled nursing facility (SNF) for support and rehabilitation care. When she was admitted to this facility, a nursing assessment recorded that she was fully oriented. Healthcare providers refer to this as “oriented x 3,” meaning that the patient is oriented to person, place, and time.
She was placed on various pain medications at the nursing facility and had bouts of constipation and urinary retention. It wasn’t long until she started behaving unusually. Screaming. Yelling. Completely disoriented - not knowing where she was or what she was doing. Sadly, the nursing staff and physicians weren’t on top of things. In fact, their overall care seemed to be in slow motion or lackadaisical.
Two different physicians saw her on numerous occasions and noted a change in her orientation from “oriented x 3” to being only oriented to person. This is a change in mental status that requires prompt and thorough evaluation by a physician. If the doctors aren’t doing their job, the standard of care requires the nursing staff to advocate for the care that the patient needs.
A doctor eventually ordered a urinalysis, but a nurse bizarrely decided to take the sample from a contaminated bedpan. It’s not a surprise that the results came back as useless, and the study had to be repeated. A doctor re-ordered a urinalysis, but the nursing staff ignored it for a day.
Meanwhile, this patient’s condition got so bad that the doctor decided to start her on antibiotics while they were waiting on lab results to get back from the second urinalysis. Her condition got so bad that the doctor said to call 911 and send her to a hospital.
Once she was checked out at the hospital, a doctor noted that her Foley catheter was draining purulent, or pus-filled, urine. Clearly, this poor lady had a long-standing urinary tract infection that went undiagnosed and untreated until it was too late. She was diagnosed with urosepsis and, despite excellent care at the hospital, she died.
The telltale sign was her altered mental status. If the physicians and nurses had acted appropriately, her UTI would’ve been easily treated and she would have recovered to live the rest of her life.
If you or a loved one has been seriously injured because of botched physician or nursing care related to altered mental status, then contact a top-rated Houston, Texas medical malpractice attorney for help in evaluating your potential case.
