امرأة عمرها ٨٦ سنة في دار رعاية، صارت مشوشة فجأة منذ يوم، وتسقط، وتأكل قليلاً. لا تشتكي ألماً واضحاً. الحرارة ٣٧٫٨، والنبض ١٠٤، والضغط ١١٦/٧٠. البول عكر وكريه الرائحة، ولم تتغير أدويتها. ما الأرجح؟

An 86-year-old care-home resident has been suddenly confused for a day, is falling and eating little, without clear pain. T 37.8 °C, HR 104, BP 116/70. Urine is cloudy and malodorous, and her medicines are unchanged. What is most likely?

1. A urinary tract infection with atypical symptoms
2. A sudden onset of Alzheimer’s disease this week
3. A small stroke without limb weakness
4. Normal ageing that needs no assessment

Answer: A) A urinary tract infection with atypical symptoms. In older adults UTI may present as confusion, falls and poor intake rather than dysuria. Urinalysis and culture are taken, avoiding treatment of asymptomatic bacteriuria.