Geriatric Emergency Medicine
Emergency medicine clinics of North America
Anybody who has worked in emergency medicine for more than a few years has undoubtedly noticed a changing patient population: emergency department (ED) patients are getting older. The elderly represent the fastest growing segment of the U.S. population, and it is clearly reflected in the patients presenting to the nationÕs EDs and hospitals. The elderly currently constitute [15% of all ED patients, 40% of all ambulance arrivals to the ED, and almost 50% of all intensive care unit admissions.
... se patients tend to have greater comorbidities, they have more complicated workups, they utilize more laboratory and radiologic services, and they have longer lengths of stay in the ED and in the hospital than younger patients. Despite these more extensive workups, the rate of misdiagnoses, delayed diagnoses, and ED "bouncebacks" among discharged elderly patients is higher. The resulting morbidity and mortality in this patient group is also much higher than in younger patients with similar chief complaints. So why the problem? The medical community is now starting to understand the significant changes that occur with aging that produce altered disease conditions and presentations in elderly patients. Alterations in physiologic processes, for example, predispose elderly patients to infection, drug toxicity, dehydration, and fractures. The elderly are also well known to present with atypical presentations of common disease, including myocardial infarction, pneumonia, urinary tract infection, appendicitis, and shock. There are also certain diseases that are almost exclusive to elderly patients, including temporal arteritis, aortic dissection, and dementia. Much like pediatric patients, Amal Mattu, MD, FAAEM, FACEP