The clinical characteristics and needs of elderly in the emergency department are quite different than the younger patient.
Life-endangering diseases can present with atypical features or with subtle symptoms and signs in elderly often leading to a delayed or missed diagnosis.
Presence of multiple comorbid conditions and cognitive impairment usually complicates the clinical presentations as well as treatment decisions.
A comprehensive workup including detailed history, physical examination, and liberal investigations and imaging is recommended than a brief goal-directed or symptom-based workup.
Altered mental status, falls, functional decline, acute coronary syndromes, stroke, infections with or without sepsis, acute abdominal and trauma are the common geriatric syndromes in the emergency department.
Psychosocial and environmental issues are important and necessitate multidisciplinary input to ensure safe and effective disposition of these patients from the emergency department.
KeywordsEmergency Department Functional Decline Clinical Pathway Altered Mental Status Acute Abdominal Pain
- 2.United Nations, Department of Economic and Social affairs, Population Division. World population Ageing 2013. ST/ESA/SER.A/348. 2013. Available at http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf. Accessed 3 May 2015.
- 3.Albert M, McCaig LF, Ashman JJ. Emergency department visits by persons aged 65 and over: United States, 2009–2010. NCHS data brief, no 130. Hyattsville: National Center for Health Statistics. 2013. Available at http://www.cdc.gov/nchs/data/databriefs/db130.htm. Accessed 3 May 2015.
- 4.Evans R. Trauma and falls. In: Sanders AB, editor. Emergency care of the elder person. St. Louis: Beverly Cracom Publications; 1996. p. 171–96.Google Scholar
- 11.Cathleen S, Heather E, Juliessa P, et al. Functional decline in older adults. Am Fam Physician. 2013;88(6):388–94.Google Scholar
- 12.Orces CH. Trends in hospitalization for fall-related injury among older adults in the United States, 1988–2005. Ageing Res 2009;1. http://www.pagepress.org/journals/index.php/ar/article/view/ar.2010.e1/153.
- 13.Owens PL (AHRQ), Russo CA (Thomson Reuters), Spector W (AHRQ), Mutter R (AHRQ). Emergency department visits for injurious falls among the elderly, 2006. HCUP Statistical Brief #80. October 2009. Agency for Healthcare Research and Quality, Rockville. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb80.pdf. Accessed 3 May 2015.
- 19.Wiffen P, Gill M, Edwards J, Moore A. Adverse drug reactions in hospital patients. Bandolier Extra. 2002:1–15. http://www.bandolier.com. Accessed 3 May 2015.
- 20.Wolf, R, Daichman, L, Bennett, G. Abuse of the elderly. In: EG Krug, LL Dahlberg, JA Mercy, AB Zwi, R Lozano (Eds.) World report on violence and health. World Health Organization, Geneva; 2002:123–43.Google Scholar