Backround <p>Urinary tract infections (UTIs) are among the most common infections in older adults receiving home health care services (HHCS) and are frequently associated with antimicrobial resistance. Frailty, comorbidities, and functional dependence complicate diagnosis and management in this population. This study aimed to investigate UTI prevalence, associated risk factors, urinalysis findings, and antimicrobial resistance patterns among elderly patients receiving HHCS.</p> Methods <p>This retrospective study included patients receiving HHCS at a tertiary hospital between July 2020 and June 2021 who presented with symptoms suggestive of UTI and had simultaneous urinalysis and urine culture performed. Demographic characteristics, clinical factors, urinalysis parameters, urine culture results, and antimicrobial resistance profiles were analysed. Descriptive statistics and comparative analyses were conducted using appropriate nonparametric and categorical tests.</p> Results <p>A total of 120 patients (mean age: 81 years; 64.2% female) were included. Urine culture positivity was detected in 70.0% of patients. Pyuria was present in 80.8% of cases and demonstrated the highest sensitivity (92.8%) for culture positivity, while nitrite positivity showed the highest specificity (100%). <i>Escherichia coli</i> was the most frequently isolated pathogen, accounting for half of culture-positive samples, with 50.0% of isolates identified as extended-spectrum beta-lactamase (ESBL) producers. Urinary catheter use was significantly associated with urine culture positivity (<i>p</i> = 0.038). High resistance rates were observed for ciprofloxacin and trimethoprim–sulfamethoxazole, whereas fosfomycin retained relatively favourable activity.</p> Conclusion <p>Elderly patients receiving HHCS represent a high-risk group for UTIs, particularly those with urinary catheterisation and significant comorbidities. Pyuria remains a sensitive indicator supporting clinical suspicion, while nitrite positivity strongly suggests culture-confirmed infection. Given the high prevalence of antimicrobial resistance, careful clinical assessment and judicious antibiotic selection are essential to optimise UTI management in home-based elderly care.</p> Clinical trial registration <p>Not applicable. This is a retrospective observational study.</p>