Geriatric Emergencies

  • Sethu Babu


  • 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.


Emergency Department Functional Decline Clinical Pathway Altered Mental Status Acute Abdominal Pain 
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  1. 1.
    Sieber CC. The elderly patient-who is that? Internist (Berl). 2007;48(11):1190. 1192–4.CrossRefGoogle Scholar
  2. 2.
    United Nations, Department of Economic and Social affairs, Population Division. World population Ageing 2013. ST/ESA/SER.A/348. 2013. Available at Accessed 3 May 2015.
  3. 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 Accessed 3 May 2015.
  4. 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
  5. 5.
    Olsen H, Vernersson E, Länne T. Cardiovascular response to acute hypovolemia in relation to age. Implications for orthostasis and hemorrhage. Am J Physiol Heart Circ Physiol. 2000;278(1):H222–32.PubMedGoogle Scholar
  6. 6.
    Kimmoun A, Novy E, Auchet T, Ducrocq N, Levy B. Hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside. Crit Care. 2015;19(1):175.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Hustey FM, Meldon SW. The prevalence and documentation of impaired mental status in elderly emergency department patients. Ann Emerg Med. 2002;39:248–53.CrossRefPubMedGoogle Scholar
  8. 8.
    Elie M, Rousseau F, Cole M, et al. Prevalence and detection of delirium in elderly emergency department patients. CMAJ. 2000;163:977–81.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detections of delirium. Ann Intern Med. 1990;113:941.CrossRefPubMedGoogle Scholar
  10. 10.
    Gill TM, Gahbauer EA, Han L, et al. Trajectories of disability in the last year of life. N Engl J Med. 2010;362(13):1173–80.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 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. 12.
    Orces CH. Trends in hospitalization for fall-related injury among older adults in the United States, 1988–2005. Ageing Res 2009;1.
  13. 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. Accessed 3 May 2015.
  14. 14.
    Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008;34:17–60.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Masterton RG. Sepsis care bundles and clinicians. Intensive Care Med. 2009;35:1149–51.CrossRefPubMedGoogle Scholar
  16. 16.
    Barochia AV, Cui X, Vitberg D, Suffredini AF, O’Grady NP, Banks SM, Minneci P, Kern SJ, Danner RL, Natanson C. Bundled care for septic shock: an analysis of clinical trials. Crit Care Med. 2010;38:668–78.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    El Solh AA, Akinnusi ME, Alsawalha LN, Pineda LA. Outcome of septic shock in older adults after implementation of the sepsis “bundle”. J Am Geriatr Soc. 2008;56:272–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Field TS, Gurwitz JH, Harrold LR, Rothschild J, DeBellis KR, Seger AC, et al. Risk factors for adverse drug events among older adults in the ambulatory setting. J Am Geriatr Soc. 2004;52:1349–54.CrossRefPubMedGoogle Scholar
  19. 19.
    Wiffen P, Gill M, Edwards J, Moore A. Adverse drug reactions in hospital patients. Bandolier Extra. 2002:1–15. Accessed 3 May 2015.
  20. 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

Copyright information

© Springer India 2016

Authors and Affiliations

  1. 1.Department of Critical CarePushpagiri Institute of Medical SciencesThiruvallaIndia

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