Going Home From the Hospital After a UTI or Other Infection

Infections hit older adults differently. A urinary tract infection (UTI), pneumonia, or skin infection that might mean a few rough days for a younger person can bring sudden confusion, weakness, falls, and a hospital stay for someone in their 80s. Sometimes the first sign isn't a fever at all, but a parent who suddenly doesn't seem like themselves.

Coming home is a big step, but recovery isn't over. Many older adults feel weak and tired for weeks after an infection, and some are readmitted because the infection comes back, a new one starts, or the antibiotics cause problems of their own.

This guide walks you through finishing antibiotics safely, what to watch for in the first few days, how to help prevent the next infection, and how to help your loved one get their strength back.

Finishing antibiotics the right way

Most people go home with antibiotics to finish. How they're taken matters as much as which one was prescribed.

• Take it exactly as prescribed. Even if your loved one feels better in two days, keep going until the doctor says to stop. Stopping early can let the infection come back. If you think they should stop, call the doctor first.
• Space doses evenly. "Twice a day" usually means about every 12 hours, not breakfast and lunch. Set phone alarms if needed.
• Check the label. Some antibiotics need to be taken with food, some on an empty stomach, and some shouldn't be taken with dairy, antacids, calcium, or iron. Ask the pharmacist.
• Ask about interactions. Certain antibiotics interact with blood thinners like warfarin, some heart medications, and diabetes medications. Make sure the pharmacist has the full medication list.
• Don't save leftovers or share antibiotics with anyone else.

Common side effects include upset stomach, mild diarrhea, and yeast infections. Call the PCP or pharmacist if these become bothersome, but don't stop the antibiotic without checking first.

A warning about C. diff. Antibiotics can upset the balance of bacteria in the gut and lead to a serious infection called C. difficile (C. diff), which is more common in older adults after a hospital stay. Call the PCP right away for three or more watery stools a day, especially with stomach cramps, fever, or blood in the stool. This can start during treatment or weeks after the antibiotics are finished.

The first 72 hours at home

• Push fluids unless the doctor has limited them (for example, with heart or kidney failure). Offer water, broth, or diluted juice every hour or two while awake. Dehydration slows recovery and raises the risk of another UTI.
• Expect fatigue. Rest is part of healing, but short walks several times a day help prevent weakness, blood clots, and pneumonia.
• Help with getting up. Infections and time in bed cause weakness and dizziness, so falls are common in the first week. Keep the walker close and help with nighttime bathroom trips.
• Watch their eating. Small, frequent meals with protein help rebuild strength.
• Check their temperature once or twice a day and write it down, along with how they're eating, drinking, and thinking.

Confusion and delirium

Sudden confusion, called delirium, is common with infections in older adults. It can look like agitation, seeing things that aren't there, mixing up day and night, or being unusually sleepy and withdrawn. It often improves as the infection clears, but it can take days to weeks.

To help: keep lights on during the day and dim at night, keep glasses and hearing aids in, talk calmly, keep a clock and calendar in view, and have familiar people nearby. Confusion that is getting worse instead of better is a reason to call.

Warning signs: call 911

An infection can spread to the bloodstream and cause sepsis, a life-threatening emergency. Older adults are at higher risk. Call 911 for:

• Confusion that comes on suddenly or gets much worse, or being very hard to wake
• Fast breathing, shortness of breath, or a racing heart
• Fever with shaking chills, or a temperature that's unusually low (below 96.8°F / 36°C)
• Cold, clammy, pale, or blotchy skin
• Very little or no urine for most of a day
• Feeling extremely ill, or a sense that something is badly wrong

Call the PCP or nurse line for a fever that comes back, symptoms that return after improving, new burning or pain with urination, a cough that's getting worse, redness spreading around a skin infection, or not drinking enough.

Helping prevent the next infection

Once an older adult has had one serious infection, they're more likely to have another. These habits lower the risk.

Urinary tract infections

• Drink enough fluids through the day, unless the doctor has set a limit
• Use the bathroom regularly; don't hold it. Set reminders if needed.
• Wipe front to back, and help with hygiene if your loved one can't manage it well
• Change incontinence briefs and pads promptly, and clean the skin at each change
• If there's a urinary catheter, ask the home health nurse to teach catheter care, and ask the doctor whether it's still needed
• Ask the doctor whether vaginal estrogen might help for women past menopause with repeat UTIs

Pneumonia and respiratory infections

• Encourage deep breathing and coughing several times a day, and get up and moving
• Sit fully upright to eat and for 30 minutes afterward, especially if there's any coughing or choking with meals. Ask about a swallow evaluation if so.
• Keep up with good mouth and denture care; bacteria from the mouth can cause pneumonia
• Keep sick visitors away, and have everyone wash their hands

Skin infections and wounds

• Check feet and skin daily, especially with diabetes
• Keep skin clean and moisturized to prevent cracks
• Change position often if your loved one spends a lot of time in bed or a chair, to prevent pressure sores

Vaccines. Ask the PCP whether your loved one is up to date on the vaccines recommended for older adults, such as flu, COVID-19, pneumonia, RSV, and shingles.

The PCP follow-up visit

Schedule a PCP visit within 7 days of coming home. This visit checks that the infection is clearing and is the best chance to figure out why it happened and how to prevent the next one.

Questions to ask:

• Is the infection clearing? Do we need a repeat urine test, chest X-ray, or blood work?
• What made my loved one more likely to get this infection? Is there anything we can change?
• Should any medications be adjusted now that they've been sick (for example, blood pressure or diabetes medications)?
• Are there signs this could be the start of a pattern, such as repeat UTIs or pneumonia from swallowing problems?
• Would a referral to a urologist, infectious disease specialist, or speech therapist help?
• Is their confusion expected to fully clear, and when should we worry if it doesn't?
• Would home health or physical therapy help with recovery?

Rebuilding strength

Even a few days in a hospital bed can cause a surprising loss of strength in older adults. Recovery often takes longer than the infection itself.

Home health. If your loved one has trouble leaving the house and needs skilled care like nursing or physical therapy, Medicare may cover home health visits at no cost, with a doctor's order. A home health nurse can check vital signs, watch for signs the infection is returning, help manage medications, and teach catheter or wound care. The hospital case manager or PCP can make the referral, and you can request a specific agency.

Outpatient physical therapy. If leaving the home isn't an issue, outpatient physical therapy is a great option. A physical therapist can rebuild strength and balance, lower the risk of falls, and help your loved one return to their usual routines. Ask the PCP for a referral if it wasn't set up at discharge.

Be patient. It's normal for energy to take several weeks to come back. Celebrate small wins, keep a simple daily routine, and let the PCP know if your loved one seems to be getting weaker instead of stronger, or seems down and withdrawn.

When home isn't safe enough

Repeated infections are sometimes a sign that your loved one needs more help day to day. It may be time to talk about more support if:

• Infections keep coming back, or keep leading to ER visits or hospital stays
• They aren't drinking, eating, or managing hygiene well on their own
• Confusion hasn't cleared, or memory changes make it hard to follow the care plan
• They need help with toileting, incontinence, or a catheter that the family can't keep up with
• The family caregiver is worn out

Could it be time to ask about hospice?

These are also common signs that someone may qualify for hospice. Repeated infections and hospital stays, eating and drinking less, growing weakness, more time in bed, and confusion that doesn't clear often mean a serious illness is progressing.

Hospice isn't only for the last few days of life, and choosing it isn't giving up. Medicare covers hospice when a doctor believes life expectancy is six months or less if the illness follows its usual course. Hospice comes to your loved one wherever they live and provides nurse visits, aides to help with bathing, medical equipment, medications related to the illness, and a nurse on call 24/7. Many families say they wish they had called sooner.

How to find out: ask the PCP, "Would my loved one qualify for hospice or palliative care?" You can also call a hospice agency directly and ask for an informational visit. There's no cost, and it doesn't commit you to anything.

More help can mean in-home personal care aides, adult day programs, assisted living, short-term rehab, or, for people with serious illness, palliative care or hospice. Starting the conversation early, while your loved one can take part, makes the decision easier for everyone.

Be ready next time. Read Packing an ER Go-Bag for an Older Adult and download the free printable checklist.

This article is general information for family caregivers, not medical advice. Always follow the instructions from your loved one's care team.