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Arizona Geriatric Education Center
Arizona Reynolds Program of Applied Geriatrics
Aging Pearls: Emergency Medicine
Carol L. Howe, MD, MLS, College of Medicine, University of Arizona
Did you know that, except for infants under 12 months of age, adults over 75
have the highest rate of ED visits of any population group-- at 62.0 visits [in
2007] per 100 U.S. persons or about 10.6 million visits1
 Four times as many patients ≥ 65 seen in the ED (approximately 42%) require
hospitalization when compared with adults aged 18-64.2 (p. 54)
 Older adults presenting to the ED commonly have impaired cognition (dementia
and/or delirium) a fact which often remains unrecognized by the emergency
physician and which can greatly complicate and compromise the patient’s care.
 Other serious problems common among the elderly which can easily go
unrecognized in a busy ED are:
o Alcoholism
 Between 5% and 14% of older adults presenting to the ED have an
alcohol related problem.3
 Among elderly alcohol abusers, only 21% are detected during their ED
visit.4
o Elder abuse
 “It is estimated that for every one case of elder abuse, neglect,
exploitation, or self-neglect reported to authorities, about five more go
unreported.”5
o Polypharmacy
 “Adverse drug effects lead to 11% of ED visits in patients older than 65
years versus 1% to 4% in the general population.” 3(p.264)
 One third of patients ≥ 65 arrive in the ED by ambulance.2(p. 56)
 One third of patients ≥ 85 require EMS transport every year.2(p. 56)
Questions for Discussion:
1. What is the number one chief complaint of elderly patients presenting to the emergency
department?
2. Among patients with long-bone fractures, the elderly are less likely to receive pain
medications in the ED, wait longer to receive medications, and receive the medications
at lower doses than do their younger counterparts. True or False? Please discuss.
Last updated 04/13/2011
3. Are physicians in Arizona required to report suspected cases of abuse, neglect or
exploitation of vulnerable older adults (or any) vulnerable adults)?
4. It is safe to assume that older patients presenting to the ED for trauma or a fall are up to
date in terms of their tetanus vaccinations and have adequate levels of protective
antibodies. True or False? Please discuss.
1
Niska R, Bhuiya F, Xu J.. National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department
Summary. August 6, 2010; http://www.cdc.gov/nchs/data/nhsr/nhsr026.pdf . Accessed 04/12/2011.
2
Wilber ST. Geriatric Emergency Medicine. In: Solomon DH, LoCicero J, Rosenthal RA, American Geriatrics Society,
John A. Hartford Foundation. New Frontiers in Geriatrics Research: An Agenda for Surgical and Related Medical
Specialties. New York: American Geriatrics Society; 2004:53-83.
3
Samaras N, Chevalley T, Samaras D, Gold G. Older patients in the emergency department: a review. Ann Emerg
Med. 2010 Sep;56(3):261-9.
4
Samaras N, Chevalley T, Samaras D, Gold G. Older patients in the emergency department: a review. Ann Emerg
Med. 2010 Sep;56(3):261-9.
5
National Center on Elder Abuse. Fact Sheet.2005.
http://www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/publication/FinalStatistics050331.pdf Accessed 04/13/11.