Abstract
Managing urinary tract infections (UTI) in people living with dementia presents a mortality paradox: clinicians must balance the risks of antibiotic overuse against the dangers of delayed treatment in high-risk phenotypes. Standard diagnostic criteria often rely on classic, localizing markers like fever and dysuria. However, these gatekeeper signs are frequently absent or blunted in dementia care due to age-associated immune dysregulation and immunosenescence. Consequently, infections often manifest as nonspecific neurobehavioral changes, leading to predictable misclassification and harmful diagnostic delays. This paper reframes UTI management in dementia as a clinical pathway and measurement architecture problem. We propose a verification-first service pathway that replaces symptom-first heuristics with objective diagnostic certainty and closed-loop follow-up. The model incorporates physiologic stability triage, risk stratification for vulnerable phenotypes, and a standardized confirmation bundle. To ensure operational reliability, the pathway is linked to four auditable key performance indicators focused on verification completion, avoidable antibiotic starts, time-to-action, and stewardship follow-up. By treating diagnostic infrastructure as a system property, this approach aims to reduce "sticky empiricism" and improve safety in the face of clinical ambiguity.
Description
Copyright © 2026 The Author(s): This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY-NC 4.0) which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited.
Publisher
SAR Publication
Date of publication
Summer 6-2026
Language
english
Persistent identifier
http://hdl.handle.net/10950/5080
Document Type
Article
Recommended Citation
Carpenter, R. E. (2026). Beyond the mortality paradox: Redesigning UTI care for people living with dementia through diagnostic stewardship. SAR Journal of Medicine, 7(1), 18–23. https://doi.org/10.36346/sarjm.2026.v07i01.004
Publisher Citation
Carpenter RE. Beyond the mortality paradox: redesigning UTI care for people living with dementia through diagnostic stewardship. SAR J Med. 2026;7(1):18-23. doi:10.36346/sarjm.2026.v07i01.004.