Geriatric Emergencies

  • Teresita M. Hogan


The emergency department (ED) is becoming an increasingly important health care provider to the elderly. In 1992 approximately 14% of the 90 million ED visits in the United States were by patients over age 65.1 The elderly utilize emergency services at a greater proportion than their numbers in the general population.2,3 As the population of elderly continues its dramatic growth, emergency services must expand and adapt to meet the national need for geriatric emergency care. To understand the demands of emergency geriatric care, this chapter focuses on the emergency health care needs of the geriatric population, the ability of emergency medical systems to meet those needs, and educating health care professionals to improve emergency service to the elderly.


Nursing Home Acute Appendicitis Abdominal Aortic Aneurysm Peptic Ulcer Disease Geriatric Patient 
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  1. 1.
    McCaig LF. National Hospital Ambulatory Medical Care Survey: 1992 Emergency Department Summary. Advance Data from Vital and Health Statistics, No. 245. Hyattsville, MD: National Center for Health Statistics; 1994.Google Scholar
  2. 2.
    Gerson LW, Skvarch L. Emergency medical service utilization by the elderly. Ann Emerg Med. 1982; 11: 610–612.PubMedCrossRefGoogle Scholar
  3. 3.
    Lowenstein, SR, Crescenzi CA, Kern DC, et al. Care of the elderly in the emergency department. Ann Emerg Med. 1986; 15: 528–535.PubMedCrossRefGoogle Scholar
  4. 4.
    Strathers G, Delpech V, Rattos J. Factors influencing the presentation and care of elderly people in the emergency department. Med J Aust. 1992; 156: 197–200.Google Scholar
  5. 5.
    Sanders A. Care of the elderly in emergency departments: where do we stand? Ann Emerg Med. 1992; 21: 792–795.PubMedCrossRefGoogle Scholar
  6. 6.
    Strang G, Chen E, Sanders A. Use of emergency departments by elderly patients: projections from a multicenter data base. Ann Emerg Med. 1992; 21: 819–824.CrossRefGoogle Scholar
  7. 7.
    Eliastam M. Elderly patients in the emergency department. Ann Emerg Med. 1989; 18: 1222–1229.PubMedCrossRefGoogle Scholar
  8. 8.
    Hedges JR, Singal BM, Rousseau EW, et al. Geriatric patient emergency visits. Part II: perceptions of visits by geriatric and younger patients. Ann Emerg Med. 1992; 21: 808–813.PubMedCrossRefGoogle Scholar
  9. 9.
    Ettinger WH, Casani JA, Coon PJ, et al. Patterns of use of the emergency department by elderly patients. J Gerontol. 1987; 42: 638–642.PubMedCrossRefGoogle Scholar
  10. 10.
    Singal BM, Hedges JR, Rousseau EW, et al. Geriatric patient emergency visits. Part I: comparison of visits by geriatric and younger patients. Ann Emerg Med. 1992; 21: 802–807.PubMedCrossRefGoogle Scholar
  11. 11.
    Rosenfeld T, Fahey P, Price M, et al. The fate of elderly patients discharged from the accident and emergency department of a general teaching hospital. Community Health Stud. 1990; 14 (4): 365–372.PubMedCrossRefGoogle Scholar
  12. 12.
    McNamara RM, Rousseau EW, Sanders AB. Geriatric emergency medicine: a survey of practicing emergency physicians. Ann Emerg Med. 1992; 21: 776–801.Google Scholar
  13. 13.
    Wofford J, Schwartz E, Byrum J. The role of emergency services in health care for the elderly: a review. J Emerg Med. 1993; 11: 317–326.PubMedCrossRefGoogle Scholar
  14. 14.
    Rowland K, Maitra A, Richardson D, et al. The discharge of elderly patients from an accident emergency department: functional changes and risk of readmission. Age Ageing. 1990; 19: 415–418.PubMedCrossRefGoogle Scholar
  15. 15.
    Denman S, Ettinger W, et al. Short-term outcomes of elderly patients discharged from an emergency department. J Am Geriatr Soc. 1989; 37: 937–943.PubMedGoogle Scholar
  16. 16.
    Schwab C, Kauder D. Trauma in the geriatric patient. Arch Surg. 1993; 127: 701–706.CrossRefGoogle Scholar
  17. 17.
    Fischer R, Miles D. Elderly trauma victims suffer a higher rate of morbidity and mortality than younger patients with similar injuries. J Trauma. 1987; 27: 1233–1236.PubMedCrossRefGoogle Scholar
  18. 18.
    McCoy FG, Johnstone RA, Duthie RB. Injuries to the elderly in road traffic accidents. J Trauma. 1989; 29: 494–497.PubMedCrossRefGoogle Scholar
  19. 19.
    Finelli FC, Jonsson J, Champion HR, et al. A case control study for major trauma in geriatric patients. J Trauma. 1989; 29: 541–548.PubMedCrossRefGoogle Scholar
  20. 20.
    Shorr RM, Rodriguez A, Indeck MC, et al. Blunt chest trauma in the elderly. J Trauma. 1989; 29: 234–237.PubMedCrossRefGoogle Scholar
  21. 21.
    Mueller MS, Gibson RM. Age difference in health care spending. Soc Sec Bull. 1976; 36: 18.Google Scholar
  22. 22.
    Osler T, Hales K, Baack B, et al. Trauma in the elderly. Am J Surg. 1988; 156: 537–543.PubMedCrossRefGoogle Scholar
  23. 23.
    Bosker G, Grigsby J. Surgical emergencies. In: Bosker G, Schwartz GR, Jones JS, et al., eds. Geriatric Emergency Medicine. St. Louis: Mosby-Year Book; 1990.Google Scholar
  24. 24.
    Jonsson P, Lipsitz L, Kelly M, et al. Hypotensive responses to common daily activities in the institutionalized elderly. A potential risk for recurrent falls. Arch Intern Med. 1990; 150 (7): 1518–1524.PubMedCrossRefGoogle Scholar
  25. 25.
    Nevitt M, Cummings S, Hudes E. Risk factors for injurious falls: a prospective study. J Gerontol. 1991; 46 (5): M164 - M170.PubMedCrossRefGoogle Scholar
  26. 26.
    Parker MJ. Missed hip fractures. Arch Emerg Med. 1992; 9: 23–27.PubMedCrossRefGoogle Scholar
  27. 27.
    Lindberg EJ, Macias D, Gipe BT. Clinically occult presentation of comminuted intertrochanteric hip fractures. Ann Emerg Med. 1992; 21: 1511–1514.PubMedCrossRefGoogle Scholar
  28. 28.
    Wolinsky F, Johnson R, Fitzgerald J. Falling, Health status and the use of health services by older adults. A prospective study. Med Care. 1992; 30: 587–597.PubMedCrossRefGoogle Scholar
  29. 29.
    Tinetti M, Liu W, Claus E. Predictors and prognosis of inability to get up after falls among elderly persons. JAMA. 1993; 269: 65–70.PubMedCrossRefGoogle Scholar
  30. 30.
    Scalea TM. Trauma in the elderly. Emerg Med. 1995; 9: 44–62.Google Scholar
  31. 31.
    Bull TP. The injury severity score of road traffic casualties in relation to mortality, time of death, hospital treatment time, and disability. Accid Anal Prey. 1975; 7: 249–255.CrossRefGoogle Scholar
  32. 32.
    Demarest G, Osler T, Clevenger F. Injuries in the elderly evaluation and initial response. Geriatrics. 1990; 45 (8): 36–42.PubMedGoogle Scholar
  33. 33.
    Levy D, Hanlon D, Townsend R. Geriatric trauma. Clin Geriatr Med. 1993; 9: 601–620.PubMedGoogle Scholar
  34. 34.
    Scalea TM, Howard HM, Duncan AO, et al. Geriatric blunt multiple trauma: improved survival with early invasive monitoring. J Trauma. 1990; 20 (2): 129–136.CrossRefGoogle Scholar
  35. 35.
    Oreskovitch MR, Howard JD, Copass MK, Carrieo JC. Geriatric trauma: injury patterns and outcome. J Trauma. 1984; 24: 565–572.CrossRefGoogle Scholar
  36. 36.
    DeMaria E, Kenney P, Merriam M, et al. Aggressive trauma care benefits the elderly. J Trauma. 1987; 27: 1200–1206.PubMedCrossRefGoogle Scholar
  37. 37.
    Inbus S, Zawacki B. Autonomy for burned patients when survival is unprecedented. N Engl J Med. 1977; 297: 308–311.CrossRefGoogle Scholar
  38. 38.
    Josephson KR, Fabacher DA, Rubenstein LZ: Home safety and fall prevention. Clin Geriatr Med. 1991; 7: 707–731.PubMedGoogle Scholar
  39. 39.
    Svanstrom L. A multifocal genesis for the increasing incidence of fall injuries in the elderly. The need for a scientific approach to reducing injuries. Scand J Soc Med. 1990; 18 (3): 165–169.PubMedGoogle Scholar
  40. 40.
    Cannon LA, Marshal JM. Geriatric emergency care: cardiac disease in the elderly population. Clin Geriatr Med. 1993; 9: 499–525.PubMedGoogle Scholar
  41. 41.
    Aronow WS. Cardiac risk factors: still important in the elderly. Geriatrics. 1990; 45: 71–80.PubMedGoogle Scholar
  42. 42.
    Rodstein M. The characteristics of non-fatal myocardial infarction in the aged. Arch Intern Med. 1956; 98: 84.CrossRefGoogle Scholar
  43. 43.
    Bayer A, Chada T, Farang R, et al. Changing presentation of myocardial infarction with increasing old age. J Am Geriatr Soc. 1986; 34: 263–266.PubMedGoogle Scholar
  44. 44.
    Karlson B, Herlite J, Petterson P, et al. Patients admitted to the emergency room with symptoms indicative of acute myocardial infarction. J Intern Med. 1991; 230: 251–258.PubMedCrossRefGoogle Scholar
  45. 45.
    Pathy MS. Clinical presentation of myocardial infarction in the elderly. Br Heart J. 1967; 29: 190–199.PubMedCrossRefGoogle Scholar
  46. 46.
    Bayliss R. The silent coronary. Br Med J. 1985; 290: 1093–1099.CrossRefGoogle Scholar
  47. 47.
    Althouse R, Maynard C, Cerqueira M, et al. The Western Washington myocardial infarction registry and emergency department tissue plasminogen activator treatment trial. Am J Cardiol. 1990; 66: 1298–1303.PubMedCrossRefGoogle Scholar
  48. 48.
    Kurihara H, Kuramoto K, Terasawa F, et al. Reliability of abnormal Q and QS patterns classified by the Minnesota code for the diagnosis of myocardial infarction in aged people. Jpn Heart J. 1967; 8: 514–521.PubMedCrossRefGoogle Scholar
  49. 49.
    Phibbs B. Transmural verses subendocardial infarction: an ECG myth. J Am Coll Cardiol. 1983; 1: 561–568.PubMedCrossRefGoogle Scholar
  50. 50.
    Spodick DH. 0-wave versus ST infarction: nonspecificity of ECG criteria for differentiating transmural and nontransmural lesions. Am J Cardiol. 1983;51:913–920.Google Scholar
  51. 51.
    Goldberg R, Gore J, et al. The impact of age on the incidence and prognosis of initial AMI: the Worcester Heart Attack Study. Am Heart J. 1989; 117: 543–549.PubMedCrossRefGoogle Scholar
  52. 52.
    Weaver W, Litwin P, et al. Effect of age on use of thrombolytic therapy and mortality in AMI. The MITI project group. J Am Coll Cardiol. 1991; 18: 657–662.PubMedCrossRefGoogle Scholar
  53. 53.
    Maddens M. Cardiovascular physiology of aging. In: Tintinalli JE, Krome RL, Ruiz E, eds. Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill; 1992.Google Scholar
  54. 54.
    Adams J, Sicard G, Allen B, et al. Diagnosis of perioperative myocardial infarction with measurement of cardiac Troponin I. N Engl J Med. 1994; 330: 670–674.PubMedCrossRefGoogle Scholar
  55. 55.
    Adams J, Bodor G, Davila-Roman V, et al. Cardiac Troponin I: a marker with high specificity for cardiac injury. Circulation. 1993; 88: 101–106.PubMedCrossRefGoogle Scholar
  56. 56.
    Brogan G, Friedman S, McCuskey C. Evaluation of a new rapid quantitative immunoassay for serum myoglobin verses CK-MB for ruling out acute myocardial infarction in the emergency department. Ann Emerg Med. 1994; 24: 665–671.PubMedCrossRefGoogle Scholar
  57. 57.
    Smith S, Gilden E, et al. Outlook after acute myocardial infarction in the very elderly compared with that in patients aged 65 to 75 years. Am Coll Cardiol. 1990; 16: 784–792.CrossRefGoogle Scholar
  58. 58.
    Jugdutt B. Intravenous nitroglycerin infusion in acute myocardial infarction: myocardial salvage. Cardiovasc Rev Respir Dis. 1984; 5: 1145–1163.Google Scholar
  59. 59.
    Goldstein R, Boccezzi S, Cruess S, et al. The adverse experience committee. The multicentered diltiazem post-infarction research group. Circulation. 1991; 83: 52–60.PubMedCrossRefGoogle Scholar
  60. 60.
    Sequeria M, Cannon L. Intervention in acute myocardial infarction. In: Bosker G, Schwartz GR, Jones JS, et al., eds. Geriatric Emergency Medicine. St. Louis: Mosby-Year Book; 1990.Google Scholar
  61. 61.
    TIMI Research Group. Immediate versus delayed catheterization and angioplasty following thrombolytic therapy for acute myocardial infarction (TIMI) trail: phase I findings. N Engl J Med. 1985; 312: 932–936.Google Scholar
  62. 62.
    Bugliosi T, Meloy T, Vukov L. Acute abdominal pain in the elderly. Ann Emerg Med. 1990; 19: 1383–1386.PubMedCrossRefGoogle Scholar
  63. 63.
    Fenyo G. Acute abdominal disease in the elderly. Experience from two series in Stockholm. Am J Surg. 1982; 143: 751–754.PubMedCrossRefGoogle Scholar
  64. 64.
    Brewer R, Golden G, Hitch D, et al. Abdominal pain. An analysis of one thousand consecutive cases in a university hospital emergency room. Am J Surg. 1976; 131: 219–224.PubMedCrossRefGoogle Scholar
  65. 65.
    Bender J. Approach to the acute abdomen. Med Clin North Am. 1989; 73: 1413–1422.PubMedGoogle Scholar
  66. 66.
    Cooke M, Sande M. Diagnosis and outcome of bowel infarction on an acute medical service. Am J Med. 1983; 75: 984–982.PubMedCrossRefGoogle Scholar
  67. 67.
    Bender J, Busuito M, Graham C, et al. Small bowel obstruction in the elderly. Am J Surg. 1989; 55: 385–388.Google Scholar
  68. 68.
    Horattas M, Guiton D, Wu D. A reappraisal of appendicitis in the elderly. Am J Surg. 1990; 160: 291–293.PubMedCrossRefGoogle Scholar
  69. 69.
    Kauvar D. The geriatric acute abdomen. Clin Geriatr Med. 1993; 9: 547–576.PubMedGoogle Scholar
  70. 70.
    Ponka J, Welborn J, Brush B. Acute abdominal pain in aged patients: an analysis of two hundred cases. J Am Geriatr Soc. 1963; 11: 993–1007.PubMedGoogle Scholar
  71. 71.
    Vogt D. The acute abdomen in the geriatric patient. Cleve Clin J Med. 1990; 57: 125–130.PubMedGoogle Scholar
  72. 72.
    Fenyo G. Diagnostic problems of acute abdominal disease in the aged. Acta Chir Scand. 1974; 140: 396–405.PubMedGoogle Scholar
  73. 73.
    Clinch D, Banerjee A, Ostick G. Absence of abdominal pain in elderly patients with peptic ulcer. Age Ageing. 1984; 13: 120–123.PubMedCrossRefGoogle Scholar
  74. 74.
    Way, L. Abdominal pain. In: Sleisinger W, ed. Gastrointestinal Disease. 3rd ed. Philadelphia: WB Saunders; 1983.Google Scholar
  75. 75.
    Davidson S, McNamara R. Surgical causes of abdominal pain. In: Harwood-Nuss AL, ed. The Clinical Practice of Emergency Medicine. Philadelphia: JB Lippincott; 1991.Google Scholar
  76. 76.
    Andersson A, Bergdahl L, Van Der Linden W. Volvulus of the cecum. Ann Surg 1976; 181: 876–880.CrossRefGoogle Scholar
  77. 77.
    Ottinger L. Mesenteric ischemia. N Engl J Med. 1982; 307: 535–537.PubMedCrossRefGoogle Scholar
  78. 78.
    Krawford E. The diagnosis in management of aortic dissection. DAMA. 1990; 264: 2537–2541.CrossRefGoogle Scholar
  79. 79.
    Phillips S, Burns G. Acute abdominal disease in the aged. Med Clin North Am. 1988; 72: 1213–1244.PubMedGoogle Scholar
  80. 80.
    Menaker G. The physiology and mechanism of acute abdominal pain. Surg Clin North Am. 1962; 42: 241–248.PubMedGoogle Scholar
  81. 81.
    Silen W, ed. Cope’s Early Diagnosis of the Acute Abdomen. 17th ed. New York: Oxford University Press; 1987.Google Scholar
  82. 82.
    Steinheber F. Medical conditions mimicking the acute surgical abdomen. Med Clin North Am. 1973; 57: 1559–1567.PubMedGoogle Scholar
  83. 83.
    Pierce G, Brockenbrough E. The spectrum of mesenteric infarction. Am J Surg. 1970; 119: 233–239.CrossRefGoogle Scholar
  84. 84.
    Irvin T. Abdominal pain: a surgical audit of 1,190 emergency admissions. Br J Surg. 1989; 76: 1121–1127.PubMedCrossRefGoogle Scholar
  85. 85.
    Ponka J, Welborn J, Brush B. Acute abdominal pain in aged patients: an analysis of two hundred patients. J Am Geriatr Soc. 1963; 11: 993–1007.PubMedGoogle Scholar
  86. 86.
    Huber D, Martin E, Cooperman M. Cholecystectomy in elderly patients. Ann Surg. 1983; 146: 719–722.CrossRefGoogle Scholar
  87. 87.
    Caesar R. The acute geriatric abdomen. In: Bosker G, Schwartz GR, Jones JS, et al., eds. Geriatric Emergency Medicine. St. Louis: Mosby-Year Book; 1990.Google Scholar
  88. 88.
    Becker W. Perforated gall bladder. Surg Gynecol Obstet. 1957; 105: 636–639.PubMedGoogle Scholar
  89. 89.
    Roslyn J, Busuttil R. Perforation of the gall bladder: a frequently mismanaged conditioned. Am J Surg. 1979; 137: 307–312.PubMedCrossRefGoogle Scholar
  90. 90.
    Andersson A, Zederfeldt B. Gall stone ilious. Acta Chir Scand. 1969; 135: 713–717.PubMedGoogle Scholar
  91. 91.
    Day E, Marks C. Gall stone ilious. Am J Surg. 1975; 129: 552–558.PubMedCrossRefGoogle Scholar
  92. 92.
    Glenn F. Surgical management of acute cholecystitis in patients 65 years of age or older. Ann Surg. 1981; 193: 56–59.PubMedCrossRefGoogle Scholar
  93. 93.
    Blake R, Lynn J. Emergency abdominal surgery in the aged. Br J Surg. 1976; 63: 956–960.PubMedCrossRefGoogle Scholar
  94. 94.
    Boley S, Brandt L, Weitgh F. Ischemic disorders of the intestines. Curr Probl Surg. 1978; 15: 12–38.CrossRefGoogle Scholar
  95. 95.
    Boley S, Sprayregan S, Siegelman S, et al. Initial results from an aggressive roentgenological and surgical approach to acute mesenteric ischemia. Surgery. 1977; 82: 848–855.PubMedGoogle Scholar
  96. 96.
    Ottinger L, Austen W. A study of 136 patients with mesenteric infarction. Surg Gynecol Obstet. 1967; 124: 251–261.PubMedGoogle Scholar
  97. 97.
    Harward T, Green D, Bergan J, et al. Mesenteric venous thrombosis. J Vasc Surg. 1989; 9: 328–333.PubMedGoogle Scholar
  98. 98.
    Scsachs S, Morton J, Schwartz S. Acute mesenteric ischemia. Surgery. 1982; 92: 646–653.Google Scholar
  99. 99.
    Balsano N, Cayten C. Surgical emergencies of the abdomen. Emerg Med Clin North Am. 1990; 8: 399–410.PubMedGoogle Scholar
  100. 100.
    Wertkin M, Aufses A. Management of volvulus of the colon. Dis Colon Rectum. 1978; 21: 40–45.PubMedCrossRefGoogle Scholar
  101. 101.
    Stubenbord W, Thorbjarnarson B. Intussusception in adults. Ann Surg. 1970; 172: 305–310.CrossRefGoogle Scholar
  102. 102.
    Greenly H, Pienkos E, Vanderbilt P, et al. Acute large bowel obstruction. Arch Surg. 1974; 108: 470–476.CrossRefGoogle Scholar
  103. 103.
    Blake R, Lynn J. Emergency abdominal surgery in the aged. Br J Surg. 1976; 63: 956–960.PubMedCrossRefGoogle Scholar
  104. 104.
    Anderson J, Lee D. The management of acute sigmoid volvulus. Br J Surg. 1981; 68: 117–120.PubMedCrossRefGoogle Scholar
  105. 105.
    Ballantyne G, Brandner N, Beart R, et al. Volvulus of the colon: incidence in mortality. Ann Surg. 1985; 202: 83–92.PubMedCrossRefGoogle Scholar
  106. 106.
    Shearman C, Simms M. Cecal volvulus: a method of management. Ann Coll Surg Engl. 1985; 67: 247–248.Google Scholar
  107. 107.
    Zinken L, Katz L, Rosin J. Volvulus of the transverse colon: report of case and review of the literature. Dis Colon Rectum. 1979; 22: 492–496.CrossRefGoogle Scholar
  108. 108.
    Ogilvee H. Large intestinal colic due to sympathetic denervation: a new clinical syndrome. Br Med J. 1948; 1: 671–673.CrossRefGoogle Scholar
  109. 109.
    Geelhoed G. Colonic pseudo-obstruction in surgical patients. Am J Surg. 1985; 149: 258–265.PubMedCrossRefGoogle Scholar
  110. 110.
    Hyatt R. Colonic pseudo-obstruction: an important complication in hospitalized elderly patients. Age Ageing. 1987; 16: 145–152.PubMedCrossRefGoogle Scholar
  111. 111.
    Almy TP, Howell DA. Medical progress. Diverticular diseases of the colon. N Engl J Med. 1980; 302: 324–331.PubMedCrossRefGoogle Scholar
  112. 112.
    Bosker G, Grigse J. Evaluation and management of surgical and abdominal disorders in the elderly. Res Staff Phys. 1990; 36: 41–49.Google Scholar
  113. 113.
    Vorhes C. Appendicitis in the elderly: a case for better diagnosis. Geriatrics. 1987; 42: 89–96.PubMedGoogle Scholar
  114. 114.
    Freund H, Rubinstein E. Appendicitis in the aged. Is it really different? Ann Surg. 1984; 50: 573–576.Google Scholar
  115. 115.
    Owen B, Hamit H. Appendicitis in the elderly. Ann Surg. 1978; 1987: 392–396.Google Scholar
  116. 116.
    Levrat M, Pasquier J, Lambert R, et al. Peptic ulcer in patients over 60: experience in 287 cases. Am J Dig Dis. 1966; 11: 279–285.PubMedCrossRefGoogle Scholar
  117. 117.
    Sterup K, Mosbeach J. Trends in the mortality from peptic ulcer in Denmark. Scand J Gastroenterol. 1973; 8: 49–53.PubMedGoogle Scholar
  118. 118.
    Stafford C, Foergenson E, Murray G. Complications of the peptic ulcer in the aged. California Med. 1956; 84: 92–94.PubMedGoogle Scholar
  119. 119.
    Diethelm A. The acute abdomen. In: Sabiston DC, ed. Sabiston’s Textbook of Surgery. Philadelphia: WB Saunders; 1986.Google Scholar
  120. 120.
    Maull K, Readth D. Pneumogastrography in the diagnosis of perforated peptic ulcer. Am J Surg. 1984; 148: 340–345.PubMedCrossRefGoogle Scholar
  121. 121.
    Roj J, Thompson J, Harned R, Hodgson P. Value of pneumoperitoneum in the diagnosis of visceral perforation. Am J Surg. 1983; 146: 830–833.CrossRefGoogle Scholar
  122. 122.
    Birnbaumer D. Abdominal emergencies in later life. Emerg Med. 1993; 25 (5): 74–77.Google Scholar
  123. 123.
    Darling R, et al. Autopsy study of unoperated abdominal aortic aneurysms: the case for early resection. Circulation. 1977; 56 (suppl 2): 161–168.Google Scholar
  124. 124.
    Yeager R. Rapid recognition, evaluation and management of the acute vascular insult. In: Bosker G, Schwartz GR, Jones JS, et al., eds. Geriatric Emergency Medicine. St. Louis: Mosby-Year Book; 1990.Google Scholar
  125. 125.
    Perler B, Burdick J. Abdominal aortic aneurysms: diagnosing and treating on time. Geriatrics. 1985; 40: 73–78.PubMedGoogle Scholar
  126. 126.
    Johansen K, Kohler T, Nicholls S, et al. Ruptured abdominal aortic aneurysms: the Harborview experience. J Vasc Surg. 1991; 13: 240–247.PubMedCrossRefGoogle Scholar
  127. 127.
    Marston W, Alhquist R, Johnson G, et al. Misdiagnosis of ruptured abdominal aortic aneurysms. J Vasc Surg. 1992; 16: 17–22.PubMedCrossRefGoogle Scholar
  128. 128.
    Ernst C. Abdominal aortic aneurysm. N Engl J Med. 1993; 328: 1167–1171.PubMedCrossRefGoogle Scholar
  129. 129.
    Lougrhan C. A review of the plain abdominal radiograph an acute rupture of abdominal aortic aneurysms. Clin Radiol. 1986; 37: 383–387.CrossRefGoogle Scholar
  130. 130.
    Hirst A, Johns V, Kime S. Dissecting aneurysm of the aorta: review of 505 cases. Medicine. 1958; 37: 217–279.PubMedCrossRefGoogle Scholar
  131. 131.
    Gustafson R, McDowell D, Sarvrin R. The use of the MAST suit in ruptured abdominal aneurysms. Am Surg. 1983; 49: 454–459.PubMedGoogle Scholar
  132. 132.
    Naughton B, Moran M, Kadah H, et al. Delirium in other cognitive impairment in older adults in an emergency department. Ann Emerg Med. 1995; 25: 751–755.PubMedCrossRefGoogle Scholar
  133. 133.
    Gerson L, Counsell S, Fontanarosa B, et al. Case finding for cognitive impairment in elderly emergency department patients. Ann Emerg Med. 1994; 23 (4): 813–817.PubMedCrossRefGoogle Scholar
  134. 134.
    Inouye S, Van Dyke C, Alessi C, et al. Clarifying confusion: the confusion assessment method: a new method for detection of dementia. Ann Intern Med. 1990; 113: 941–948.PubMedGoogle Scholar
  135. 135.
    Sanders S, ed. The Emergency Care of the Elder Person. St. Louis: Beverly Cracrom Publications; 1995.Google Scholar
  136. 136.
    Folstein M, Folstein S, McHugh P. Mini mental status: a practical method for grading the cognitive status of patients for the clinician. J Psychiatr Res. 1975; 12: 189–198.PubMedCrossRefGoogle Scholar
  137. 137.
    U’Ren R. Emergency geropsychiatry. In: Bosker G, Schwartz GR, Jones JS, et al., eds. Geriatric Emergency Medicine. St. Louis, Mosby-Year Book; 1990.Google Scholar
  138. 138.
    Lewis L, Miller D, Morley J, et al. Missed delirium in geriatric patients seen in the emergency department. Ann Emerg Med. 1993; 22: 915–918.Google Scholar
  139. 139.
    Pousada L. Common neurologic emergencies in the elderly population. Clin Geriatr Med. 1993; 9: 577–590.PubMedGoogle Scholar
  140. 140.
    Rafal R. Dementia confusion and altered mental status. In: Bosker G, Schwartz GR, Jones JS, et al., eds. Geriatric Emergency Medicine. St. Louis: Mosby-Year Book; 1990.Google Scholar
  141. 141.
    Rubenstein LZ, Ouslander JG, Wieland D. Dynamics and clinical implications of the nursing home-hospital interface. Clin Geriatr Med. 1988; 4: 471–491.PubMedGoogle Scholar
  142. 142.
    Jones JS, Dwyer P, Firman R, et al. Patient transfer from nursing home to emergency department: outcome and policy implications. Acad Emerg Med. 1994; 1: A16.Google Scholar
  143. 143.
    Caesar R. Dangerous complaints: the acute geriatric abdomen. Emerg Med Rep. 1994; 3 (20): 191–202.Google Scholar

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© Springer Science+Business Media New York 1997

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  • Teresita M. Hogan

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