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Background: Indiscriminate orders for urinalysis and urine cultures (UC) drive inappropriate antibiotic treatment (Abx), especially in older adults with mental health disorders. Lack of data regarding the prevalence of and treatment for infections in acute geriatric psychiatric units (GPU) motivated us to initiate this project., Aim: Our goal was to improve urine test utilization and reduce unnecessary Abx for asymptomatic bacteriuria (ASB) and contaminated UC. Methods: This retrospective review and prospective evaluation of bundled interventions was conducted in a 22- bed GPU in a community-based teaching hospital. Four hundred twenty-seven (427) patient records were reviewed for Abx and indication and 157 patients were assessed for the impact of bundled interventions., Results: Near 27% received Abx, primarily for a misdiagnosed urinary tract infection. Only 20% met clinical criteria; 80% were unnecessarily treated for ASB or contaminated cultures. Over two-thirds of the Abx consisted of fluoroquinolones or trimethoprim-sulfamethoxazole, neither of which are recommended due to adverse events and/or resistance. The impact of bundled interventions was marginally effective., Conclusion: Urinalysis and UC are indiscriminately ordered in older adults, resulting in inappropriate Abx with non-recommended agents. Urinalysis should not be a requirement for admission in asymptomatic patients given the high prevalence of ASB and pyuria in older adults. There is an opportunity for more collaboration within referring networks to standardize best practice., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 International Journal of Applied and Basic Medical Research.)

Dementia is a progressive neurodegenerative illness that affects a growing number of older adults in our country. We discuss ways to improve the management of persons with dementia within current healthcare models. Specifically, we argue that structured communication at regular intervals is essential for dementia care at all phases of illness. We emphasize the need for a single healthcare provider to take on a central role in organizing communication between patient, family and other healthcare providers in the outpatient setting. We also emphasize the need for healthcare providers to begin conversations about prognosis, care transitions and end of life early while balancing these difficult conversations with a hopeful attitude of realistic optimism that the disease can be managed.