Acute confusion and a positive urine culture in long-term care

Mrs. Béliveau, 86, has lived in a long-term care home for three years. She has stable mild to moderate Alzheimer's disease, walks with a walker, recognizes staff and takes part in group activities. Since yesterday evening, the nurse has noticed a change: Mrs. Béliveau dozes off during meals, loses the thread of conversation, leaves sentences unfinished and, overnight, twice tried to climb out of bed. Lucid periods alternate with disorganized ones. Vital signs: lying BP 118/68 mmHg, standing BP 96/58 mmHg with dizziness, pulse 98/min, temperature 37.1 °C, SpO2 95% on room air. She has taken less than half of the fluids offered for two days and her urine output is reduced, with dark urine. No urinary complaints are reported. A urine culture drawn as routine screening comes back positive. The family states: "her dementia is getting worse."