The elderly patient presenting to the ED with nonspecific symptoms remains a diagnostic and therapeutic challenge. Often, these patients arrive with general complaints ranging from altered mental status to weakness, subjective ailments that are difficult to quantify or qualify in the space of a brief ED visit. They undergo extensive and relatively unremarkable evaluations, and finish their visits no better than when they arrived. Many physicians are loathe to discharge these patients because they typically carry multiple comorbidities and are known to be among those at the highest risk for near-term poor outcomes. A recurring difficulty in managing these patients is the interpretation of urinalyses. It is well known that urinary tract infections can cause malaise and mental status changes in elderly patients, but consistent clinical data suggest that the overwhelming percentage of “positive” UAs represent asymptomatic bacteriuria and are not truly indicative of UTI nor related to the patient’s nonspecific complaints.

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