Skip to main content
SpringerLink
Log in

Emergency Medicine Management of the Elderly

  • Chapter
  • First Online:
Surgical Decision Making in Geriatrics

  • 432 Accesses

Abstract

Emergency medicine is a clinical field that consists of the knowledge required for the unscheduled diagnosis and management of acute illness including injury across all age groups and all fields of medicine. For any given chief complaint, elderly patients are more likely to have acute disease and worse outcomes. In the United States, there are approximately 50 emergency department visits per year for every 100 people over 65 years old. The US population is undergoing a major shift as “baby boomers” grow older causing a significant increase in the elderly population. According to the United States Census Bureau the over 65-year-old cohort has increased from 37 million in 2006 to 49 million in 2016. This is projected to reach 98 million by 2060. A large increase in emergency department visits by elderly patients can be expected in the United States. To meet the needs of geriatric patients, work has been done to improve the emergency care of this challenging population. These efforts include screening for particular markers of risk among the elderly such as frailty, fall risk and dementia, reducing delays in diagnosis and care, and a focus on the specific characteristics of surgical diseases in elderly patients presenting to emergency departments. In addition, criteria have been developed by the American College of Emergency Physicians in collaboration with the American Geriatric Society, the Emergency Nurses Association, and the Society of Academic Emergency Medicine for accrediting hospitals with an intensive focus on the emergency care of the elderly, the designated “geriatric emergency department.”

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. 2017 Profile of Older Americans. Administration for Community Living|ACL Web site. https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2017OlderAmericansProfile.pdf. Published 2017. Updated 2019. Accessed August 06, 2019.

  2. Morris JN, Howard EP, Steel K, Schreiber R, Fries BE, Lipsitz LA, Goldman B. Predicting risk of hospital and emergency department use for home care elderly persons through a secondary analysis of cross-National Data. [in eng], BMC health Serv res. 2014;519 https://doi.org/10.1186/s12913-014-0519-z.

  3. Sun R (AHRQ), Karaca Z (AHRQ), Wong HS (AHRQ). Trends in Hospital Emergency Department Visits by Age and Payer, 2006–2015. HCUP Statistical Brief #238. 2018. Agency for Healthcare Research and Quality, Rockville, MD. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb238-Emergency-Department-Age-Payer-2006-2015.pdf/

  4. https://www.acep.org/patient-care/policy-statements/triage-scale-standardization/

  5. Baumann, M. R., and T. D. Strout. "Triage of Geriatric patients in the emergency department: validity and survival with the emergency severity index. [in eng]. Ann Emerg Med 49, no. 2 (Feb 2007): 234–240. https://doi.org/10.1016/j.annemergmed.2006.04.011.

  6. Platts-Mills TF, Travers D, Biese K, McCall B, Kizer S, LaMantia M, Busby-Whitehead J, Cairns CB. Accuracy of the emergency severity index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention. [in eng]. Acad Emerg Med. 2010;17(3):238–43. https://doi.org/10.1111/j.1553-2712.2010.00670.x.

    Article  PubMed  Google Scholar 

  7. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.

    PubMed  Google Scholar 

  8. Oakland K, Nadler R, Cresswell L, Jackson D, Coughlin PA. Systematic review and meta-analysis of the association between frailty and outcome in surgical patients. The Annals of The Royal College of Surgeons of England. 2016;98(2):80–5.

    CAS  PubMed  Google Scholar 

  9. Afilalo J, Lauck S, Kim DH, Lefèvre T, Piazza N, Lachapelle K, Martucci G, Lamy A, Labinaz M, Peterson MD, Arora RC. Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR study. J Am Coll Cardiol. 2017;70(6):689–700.

    PubMed  Google Scholar 

  10. van de Ree CLP, Landers MJF, Kruithof N, et al. Effect of frailty on quality of life in elderly patients after hip fracture: a longitudinal study. BMJ Open. 2019;9:e025941. https://doi.org/10.1136/bmjopen-2018-025941.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rizk P, Morris W, Oladeji P, Huo M. Review of postoperative delirium in geriatric patients undergoing hip surgery. Geriatric orthopaedic surgery & rehabilitation. 2016;7(2):100–5.

    Google Scholar 

  12. Dresden SM, Platts-Mills TF, Kandasamy D, Walden L, Betz ME. Patient versus physician perceptions of frailty: a comparison of clinical frailty scale scores of older adults in the emergency department. Acad Emerg Med. 2019;00:1–4.

    Google Scholar 

  13. ISAR questionnaire: https://www.researchgate.net/figure/Six-items-of-ISAR-screening-tool_fig 1_24023264; https://www.researchgate.net/profile/Fabio_Salvi/publication/24023264/figure/fig 1/AS:336610982940672@1457265720159/Six-items-of-ISAR-screening-tool.png" alt="-Six items of ISAR screening tool."/></a>

  14. Tavares JPA, Sá-Couto P, Boltz M, Capezuti E. Identification of seniors at risk (ISAR) in the emergency room: a prospective study. Int Emerg Nurs. 2017;35:19–24. https://doi.org/10.1016/j.ienj.2017.05.008. Epub 2017 Jun 24.

    Article  PubMed  Google Scholar 

  15. Suffoletto B, Miller T, Shah R, Callaway C, Yealy DM. Predicting older adults who return to the hospital or die within 30 days of emergency department care using the ISAR tool: subjective versus objective risk factors. Emerg Med J. 2016;33(1):4–9. https://doi.org/10.1136/emermed-2014-203936. Epub 2015 May 18.

    Article  PubMed  Google Scholar 

  16. Yao JL, Fang J, Lou QQ, Anderson RM. eCollection 2015 a systematic review of the identification of seniors at risk (ISAR) tool for the prediction of adverse outcome in elderly patients seen in the emergency department. Int J Clin Exp Med. 2015;8(4):4778–86.

    PubMed  PubMed Central  Google Scholar 

  17. Clevenger CK, Chu TA, Yang Z, Hepburn KW. Clinical care of persons with dementia in the emergency department: a review of the literature and agenda for research. J Am Geriatr Soc. 2012;60:1742–8.

    PubMed  Google Scholar 

  18. Carpenter CR. Evidence-based emergency medicine/rational clinical examination abstract. Does this patient have dementia? Ann Emerg Med. 2008;52:554–6.

    PubMed  Google Scholar 

  19. Hustey FM, Meldon SW, Banet GA, Gerson LW, Blanda M, Lewis LM. The use of abdominal computed tomography in older ED patients with acute abdominal pain. Am J Emerg Med. 2005;23(3):259–65. PubMed [citation] PMID: 15915395).

    PubMed  Google Scholar 

  20. Han JH, Zimmerman EE, Cutler N, Schnelle J, Morandi A, Dittus RS, et al. Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Acad Emerg Med. 2009;16:193–200.

    PubMed  PubMed Central  Google Scholar 

  21. Kakuma R, Du Fort GG, Arsenault L, Perrault A, Platt RW, Monette J, et al. Delirium in older emergency department patients discharged home: effect on survival. J Am Geriatr Soc. 2003;51:443–50.

    PubMed  Google Scholar 

  22. O'Sullivan D, Brady N, Manning E, O'Shea E, O'Grady S, O'Regan N, Timmons S. Validation of the 6-item cognitive impairment test and the 4AT test for combined delirium and dementia screening in older emergency department attendees. Age Ageing. 2018;47(1):61–8. https://doi.org/10.1093/ageing/afx149.

    Article  PubMed  Google Scholar 

  23. Carpenter CR, Banerjee J, Keyes D, et al. Accuracy of dementia screening instruments in emergency medicine: a diagnostic meta-analysis. Acad Emerg Med. 2019;26(2):226–45.

    PubMed  Google Scholar 

  24. Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009;5(4):210.

    PubMed  PubMed Central  Google Scholar 

  25. Hshieh TT, Yang T, Gartaganis SL, Yue J, Inouye SK. Hospital elder life program: systematic review and meta-analysis of effectiveness. Am J Geriatr Psychiatry. 2018;26(10):1015–33.

    PubMed  PubMed Central  Google Scholar 

  26. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method: a new method for detection of delirium. Ann Intern Med. 1990;113(12):941–8.

    CAS  PubMed  Google Scholar 

  27. Nemec M, Koller MT, Nickel CH, Maile S, Winterhalder C, Karrer C, Laifer G, Bingisser R. Patients presenting to the emergency department with non-specific complaints: the Basel non-specific complaints (BANC) study. Acad Emerg Med. 2010;17(3):284–92. https://doi.org/10.1111/j.1553-2712.2009.00658.x.

    Article  PubMed  Google Scholar 

  28. Liu SW, Sri-On J, Tirrell GP, Nickel C, Bingisser R. Serious conditions for ED elderly fall patients: a secondary analysis of the Basel non-specific complaints study. Am J Emerg Med. 2016;34(8):1394–9. https://doi.org/10.1016/j.ajem.2016.04.007. Epub 2016 Apr 9.

    Article  PubMed  Google Scholar 

  29. Wofford JL, Schwartz E, Timerding BL, Folmar S, Ellis SD, Messick CH. Emergency department utilization by the elderly: analysis of the National Hospital Ambulatory Medical Care Survey. Acad Emerg Med. 1996;3(7):694–9. PubMed [citation] PMID: 8816186.

    CAS  PubMed  Google Scholar 

  30. Brewer BJ, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL. Abdominal pain. An analysis of 1,000 consecutive cases in a university hospital emergency room. Am J Surg. 1976;131(2):219–23. PubMed [citation] PMID: 1251963.

    CAS  PubMed  Google Scholar 

  31. Fenyö G. Diagnostic problems of acute abdominal diseases in the aged. Acta Chir Scand. 1974;140(5):396–405. No abstract available. PubMed [citation].

    PubMed  Google Scholar 

  32. Fenyö G. Acute abdominal disease in the elderly: experience from two series in Stockholm. Am J Surg. 1982;143(6):751–4. PubMed [citation] PMID: 7091511.

    PubMed  Google Scholar 

  33. van Geloven AA, Biesheuvel TH, Luitse JS, Hoitsma HF, Obertop H. Hospital admissions of patients aged over 80 with acute abdominal complaints. Eur J Surg. 2000;166(11):866–71. PubMed [citation].

    PubMed  Google Scholar 

  34. Lewis LM, Banet GA, Blanda M, Hustey FM, Meldon SW, Gerson LW. Etiology and clinical course of abdominal pain in senior patients: a prospective, multicenter study. J Gerontol A Biol Sci Med Sci. 2005;60(8):1071–6. PubMed [citation] PMID: 16127115.

    PubMed  Google Scholar 

  35. Cooper GS, Shlaes DM, Salata RA. Intraabdominal infection: differences in presentation and outcome between younger patients and the elderly. Clin Infect Dis. 1994;19(1):146–8. PubMed [citation] PMID: 7948517.

    CAS  PubMed  Google Scholar 

  36. de Dombal FT. Acute abdominal pain in the elderly. J Clin Gastroenterol. 1994;19(4):331–5. Review. PubMed [citation].

    PubMed  Google Scholar 

  37. Bassuk EL, Minden S, Apsler R. Geriatric emergencies: psychiatric or medical? Am J Psychiatry. 1983;140(5):539–42. PubMed [citation].

    CAS  PubMed  Google Scholar 

  38. Leuthauser A, McVane B. Abdominal pain in the Geriatric patient. Emerg Med Clin North Am. 2016;34(2):363–75. https://doi.org/10.1016/j.emc.2015.12.009. Epub 2016. Review. PubMed [citation].

    Article  PubMed  Google Scholar 

  39. Potts FE 4th, Vukov LF. Utility of fever and leukocytosis in acute surgical abdomens in octogenarians and beyond. J Gerontol A Biol Sci Med Sci. 1999;54(2):M55–8. PubMed [citation].

    PubMed  Google Scholar 

  40. Wroblewski M, Mikulowski P. Peritonitis in geriatric inpatients. Age Ageing. 1991;20(2):90–4. PubMed [citation].

    CAS  PubMed  Google Scholar 

  41. Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. Am Fam Physician. 2006;74(9):1537–44.

    PubMed  Google Scholar 

  42. Lewis LM, Klippel AP, Bavolek RA, Ross LM, Scherer TM, Banet GA. Quantifying the usefulness of CT in evaluating seniors with abdominal pain. Eur J Radiol. 2007;61(2):290–6. Epub 2006 Nov 7. PubMed [citation] PMID: 17085004.

    PubMed  Google Scholar 

  43. Ibach JR Jr, Hume HA, Erb WH. Cholecystectomy in the aged. Surg Gynecol Obstet. 1968;126(3):523–8. No abstract available. PubMed [citation] PMID: 5637311.

    PubMed  Google Scholar 

  44. Ross SO, Forsmark CE. Pancreatic and biliary disorders in the elderly. Gastroenterol Clin North Am. 2001;30(2):531–45, x. Review PubMed [citation] PMID: 11432304.

    CAS  PubMed  Google Scholar 

  45. Arnold DJ. 28,621 cholecystectomies in Ohio. Results of a survey in Ohio hospitals by the Gallbladder Survey Committee, Ohio Chapter, American College of Surgeons. Am J Surg. 1970;119(6):714–7. No abstract available. PubMed [citation] PMID: 5445995.

    CAS  PubMed  Google Scholar 

  46. Nesvaderani M, Eslick GD, Vagg D, Faraj S, Cox MR. Epidemiology, aetiology and outcomes of acute pancreatitis: A retrospective cohort study. Int J Surg. 2015;23(Pt A):68–74. https://doi.org/10.1016/j.ijsu.2015.07.701. Epub 2015 Sep 16. PubMed [citation] PMID: 26384834.

    Article  PubMed  Google Scholar 

  47. Morrow DJ, Thompson J, Wilson SE. Acute cholecystitis in the elderly: a surgical emergency. Arch Surg. 1978;113(10):1149–52. PubMed [citation] PMID: 708235.

    CAS  PubMed  Google Scholar 

  48. Parker LJ, Vukov LF, Wollan PC. Emergency department evaluation of geriatric patients with acute cholecystitis. Acad Emerg Med. 1997;4(1):51–5. PubMed [citation] PMID: 9110012.

    CAS  PubMed  Google Scholar 

  49. Paranjape C, Dalia S, Pan J, Horattas M. Appendicitis in the elderly: a change in the laparoscopic era. Surg Endosc. 2007;21(5):777–81. Epub 2007 Feb 7. PubMed. [citation] PMID: 17285390.

    CAS  PubMed  Google Scholar 

  50. Lunca S, Bouras G, Romedea NS. Acute appendicitis in the elderly patient: diagnostic problems, prognostic factors and outcomes. Rom J Gastroenterol. 2004;13(4):299–303. PubMed [citation] PMID: 15624027.

    PubMed  Google Scholar 

  51. Hui TT, Major KM, Avital I, Hiatt JR, Margulies DR. Outcome of elderly patients with appendicitis: effect of computed tomography and laparoscopy. Arch Surg. 2002;137(9):995–8; discussion 999-1000. PubMed [citation] PMID: 12215147.

    PubMed  Google Scholar 

  52. Storm-Dickerson TL, Horattas MC. What have we learned over the past 20 years about appendicitis in the elderly? Am J Surg. 2003;185(3):198–201. PubMed [citation] PMID: 12620555.

    PubMed  Google Scholar 

  53. Rub R, Margel D, Soffer D, Kluger Y. Appendicitis in the elderly: what has changed? Isr Med Assoc J. 2000;2(3):220–3. PubMed [citation] PMID: 10774271.

    CAS  PubMed  Google Scholar 

  54. Pooler BD, Lawrence EM, Pickhardt PJ. MDCT for suspected appendicitis in the elderly: diagnostic performance and patient outcome. Emerg Radiol. 2012;19(1):27–33. https://doi.org/10.1007/s10140-011-1002-3. Epub 2011 Dec 1. PubMed. [citation] PMID: 22131057.

    Article  PubMed  Google Scholar 

  55. Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD. Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. Ann Emerg Med. 2010;55(1):51–9. https://doi.org/10.1016/j.annemergmed.2009.06.509. Epub 2009. Review. PubMed [citation] PMID: 19733421.

    Article  PubMed  Google Scholar 

  56. van Randen A, Laméris W, van Es HW, van Heesewijk HP, van Ramshorst B, Ten Hove W, Bouma WH, van Leeuwen MS, van Keulen EM, Bossuyt PM, Stoker J, Boermeester MA, OPTIMA Study Group. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol. 2011;21(7):1535–45. https://doi.org/10.1007/s00330-011-2087-5. Epub 2011 Mar 2. PubMed [citation] PMID: 21365197, PMCID: PMC3101356.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Horattas MC, Guyton DP, Wu D. A reappraisal of appendicitis in the elderly. Am J Surg. 1990;160(3):291–3. PubMed [citation] PMID: 2393058.

    CAS  PubMed  Google Scholar 

  58. Young-Fadok TM, Roberts PL, Spencer MP, Wolff BG. Colonic diverticular disease. Curr Probl Surg. 2000;37(7):457–514. Review. No abstract available. PubMed [citation] PMID: 10932672.

    CAS  PubMed  Google Scholar 

  59. Farrell RJ, Farrell JJ, Morrin MM. Diverticular disease in the elderly. Gastroenterol Clin North Am. 2001;30(2):475–96. Review. PubMed [citation] PMID: 11432301.

    CAS  PubMed  Google Scholar 

  60. Roberts P, Abel M, Rosen L, Cirocco W, Fleshman J, Leff E, Levien D, Pritchard T, Wexner S, Hicks T, et al. Practice parameters for sigmoid diverticulitis. The Standards Task Force American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 1995;38(2):125–32. PubMed [citation] PMID: 7851165.

    CAS  PubMed  Google Scholar 

  61. Place RJ, Simmang CL. Diverticular disease. Best Pract Res Clin Gastroenterol. 2002;16(1):135–48. Review. PubMed [citation] PMID: 11977933.

    PubMed  Google Scholar 

  62. Welch CE, Athanasoulis CA, Galdabini JJ. Hemorrhage from the large bowel with special reference to angiodysplasia and diverticular disease. World J Surg. 1978;2(1):73–83. No abstract available. PubMed [citation] PMID: 307312.

    CAS  PubMed  Google Scholar 

  63. Winzelberg GG, Froelich JW, McKusick KA, Waltman AC, Greenfield AJ, Athanasoulis CA, Strauss HW. Radionuclide localization of lower gastrointestinal hemorrhage. Radiology. 1981;139(2):465–9. PubMed [citation] PMID: 6971455.

    CAS  PubMed  Google Scholar 

  64. Brandt LJ, Boley SJ. The role of colonoscopy in the diagnosis and management of lower intestinal bleeding. Scand J Gastroenterol Suppl. 1984;102:61–70. PubMed [citation] PMID: 6332370.

    CAS  PubMed  Google Scholar 

  65. Russell RM. Changes in gastrointestinal function attributed to aging. Am J Clin Nutr. 1992;55(6 Suppl):1203S–7S. https://doi.org/10.1093/ajcn/55.6.1203S. Review. PubMed [citation] PMID: 1590257.

    Article  CAS  PubMed  Google Scholar 

  66. Fischer J, Johnson MA. Low body weight and weight loss in the aged. J Am Diet Assoc. 1990 Dec;90(12):1697-706. Review PubMed [citation].

    Google Scholar 

  67. Pilotto A, Salles N. Helicobacter pylori infection in geriatrics. Helicobacter. 2002;7 Suppl 1:56–62. Review. PubMed [citation].

    Google Scholar 

  68. Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet. 2002 359(9300):14-22. PubMed [citation].

    Google Scholar 

  69. Hilton D, Iman N, Burke GJ, Moore A, O'Mara G, Signorini D, Lyons D, Banerjee AK, Clinch D. Absence of abdominal pain in older persons with endoscopic ulcers: a prospective study. Am J Gastroenterol. 2001 Feb;96(2):380-4. PubMed [citation].

    Google Scholar 

  70. Clinch D, Banerjee AK, Ostick G. Absence of abdominal pain in elderly patients with peptic ulcer. Age Ageing. 1984 Mar;13(2):120-3. PubMed [citation].

    Google Scholar 

  71. Borum ML. Peptic-ulcer disease in the elderly. Clin Geriatr Med. 1999 Aug;15(3):457-71. Review. PubMed [citation].

    Google Scholar 

  72. Permutt RP, Cello JP. Duodenal ulcer disease in the hospitalized elderly patient. Dig Dis Sci. 1982 Jan;27(1):1-6. PubMed [citation].

    Google Scholar 

  73. Sreedharan A, Martin J, Leontiadis GI, Dorward S, Howden CW, Forman D, Moayyedi P. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010 Jul 7;(7):CD005415. doi: https://doi.org/10.1002/14651858.CD005415.pub3. Review. PubMed [citation].

  74. Kauvar DR. The geriatric acute abdomen. Clin Geriatr Med. 1993 Aug;9(3):547-58. Review. PubMed [citation].

    Google Scholar 

  75. Bugliosi TF, Meloy TD, Vukov LF. Acute abdominal pain in the elderly. Ann Emerg Med. 1990 Dec;19(12):1383-6. PubMed [citation].

    Google Scholar 

  76. Avots-Avotins KV, Waugh DE. Colon volvulus and the geriatric patient. Surg Clin North Am. Apr;62(2):249-60. PubMed [citation]. 1982;

    Google Scholar 

  77. Atamanalp SS. Sigmoid volvulus: diagnosis in 938 patients over 45.5 years. Tech Coloproctol. 2013 Aug;17(4):419–24. doi: https://doi.org/10.1007/s10151-012-0953-z. Epub 2012 Dec 6. PubMed [citation].

  78. Kapadia MR. Volvulus of the Small Bowel and Colon. Clin Colon Rectal Surg. 2017 Feb;30(1):40–45. doi: https://doi.org/10.1055/s-0036-1593428. Review. PubMed [citation] PMID: 28144211, PMCID: PMC5179272.

  79. Ballantyne GH, Brandner MD, Beart RW Jr, Ilstrup DM. Volvulus of the colon. Incidence and mortality. Ann Surg. 1985 Jul;202(1):83–92. PubMed [citation] PMID: 4015215, PMCID: PMC1250842.

    Google Scholar 

  80. Rabinovici R, Simansky DA, Kaplan O, Mavor E, Manny J. Cecal volvulus. Dis Colon Rectum. 1990 Sep;33(9):765-9. Review. PubMed [citation].

    Google Scholar 

  81. Delabrousse E, Sarliève P, Sailley N, Aubry S, Kastler BA. Cecal volvulus: CT findings and correlation with pathophysiology. Emerg Radiol. 2007 Nov;14(6):411–5. Epub 2007 Jul 6. PubMed [citation].

    Google Scholar 

  82. Batke M, Cappell MS. Adynamic ileus and acute colonic pseudo-obstruction. Med Clin North Am. 2008 May;92(3):649–70, ix. doi: https://doi.org/10.1016/j.mcna.2008.01.002. Review. PubMed [citation].

  83. Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases. Dis Colon Rectum. 1986 Mar;29(3):203-10. PubMed [citation].

    Google Scholar 

  84. Haj M, Haj M, Rockey DC. Ogilvie's syndrome: management and outcomes. Medicine (Baltimore). 2018 Jul;97(27):e11187. doi: https://doi.org/10.1097/MD.0000000000011187. PubMed [citation] PMID: 29979381, PMCID: PMC6076157.

  85. Cosford PA, Leng GC. Screening for abdominal aortic aneurysm. Cochrane Database Syst Rev. 2007 18;(2):CD002945. Review. PubMed [citation].

    Google Scholar 

  86. Lederle FA, Johnson GR, Wilson SE, Chute EP, Littooy FN, Bandyk D, Krupski WC, Barone GW, Acher CW, Ballard DJ. Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group. Ann Intern Med. 1997 15;126(6):441-9. PubMed [citation].

    Google Scholar 

  87. Wilmink TB, Quick CR, Day NE. The association between cigarette smoking and abdominal aortic aneurysms. J Vasc Surg. 1999 Dec;30(6):1099-105. PubMed [citation].

    Google Scholar 

  88. Magidson PD, Martinez JP. Abdominal Pain in the Geriatric Patient. Emerg Med Clin North Am. 2016 Aug;34(3):559–74. doi: https://doi.org/10.1016/j.emc.2016.04.008. Review. PubMed [citation].

  89. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med. 2004;164(10):1054–62. Review. PubMed [citation].

    PubMed  Google Scholar 

  90. Smerud MJ, Johnson CD, Stephens DH. Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases. AJR Am J Roentgenol. 1990;154(1):99–103. PubMed [citation].

    CAS  PubMed  Google Scholar 

  91. Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, Ben-Ishay O, Rubinstein C, Balogh ZJ, Civil I, Coccolini F, Leppaniemi A, Peitzman A, Ansaloni L, Sugrue M, Sartelli M, Di Saverio S, Fraga GP, Catena F. Acute mesenteric ischemia: guidelines of the world Society of Emergency Surgery. World J Emerg Surg. 2017;12:38. https://doi.org/10.1186/s13017-017-0150-5. eCollection 2017. Review. PubMed [citation] PMID: 28794797, PMCID: PMC5545843.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Boley SJ, Feinstein FR, Sammartano R, Brandt LJ, Sprayregen S. New concepts in the management of emboli of the superior mesenteric artery. Surg Gynecol Obstet. 1981;153(4):561–9. PubMed [citation].

    CAS  PubMed  Google Scholar 

  93. Champion HR, Copes SW, Buyer D, et al. Major trauma in geriatric patients. Am J Public Health. 1989;79(9):1278–82.

    CAS  PubMed  PubMed Central  Google Scholar 

  94. Aschkenasy MT, Rothenhaus TC. Trauma and falls in the elderly. Emerg Med Clin N Am. 2006;24:413–32.

    Google Scholar 

  95. American College of Surgeons. Advanced trauma life support for doctors. American College of Surgeons Committee on trauma. 7th ed. Chicago (IL): American College of Surgeons; 2004.

    Google Scholar 

  96. Demetriades D, Sava J, Alo K, et al. Old age as a criterion for trauma team activation. J Trauma. 2001;51:754–6.

    CAS  PubMed  Google Scholar 

  97. McGwin G Jr, Nunn AM, Mann JC, et al. Reassesment of the tri-modal mortality distribution in the presence of a regional trauma system. J Trauma. 2009;66(2):526–30.

    PubMed  Google Scholar 

  98. Bortz WM 2nd. A conceptual framework of fraility: a review. J Gerontol A Biol Sci Med Sci. 2002;57(5):M283–8.

    PubMed  Google Scholar 

  99. Orouji Jokar T, Ibraheem K, Rhee P, et al. Emergency general surgery specific frailty index: a validation study. J Trauma Acute Care Surg. 2016;222(5):805–13.

    Google Scholar 

  100. Tan MP, Kamaruzzaman SB, Zakaria MI, et al. Ten-year mortality in older patients attending the emergency department after a fall. Geriatr Gerontol Int. 2016;16(1):111–7.

    PubMed  Google Scholar 

  101. Broos P. Multiple trauma in elderly patients: factors influencing outcome. Injury. 1993;24:365.

    CAS  PubMed  Google Scholar 

  102. Nordell E, Jarnlo GB, Jetsen C, et al. Accidental falls and related fractures in 65-74 year olds: a retrospective study of 332 patients. Acta Orthop Scand. 2000;71:175–9.

    CAS  PubMed  Google Scholar 

  103. Sasser SM, Hunt RC, Faul M, et al. Guidelines for field triage of injured patients: recommendations of the national expert panel on field triage, 2011. MMWR Recomm Rep. 2012;61(RR-1):1–20.

    PubMed  Google Scholar 

  104. Meldon SW, Reilly M, Drew B, Mancusco C, Fallon W. Trauma in the very elderly: a community-based study of outcomes at trauma and non-trauma centers. Acad Emerg Med. 2000;7(10):1166.

    PubMed  Google Scholar 

  105. Morris JA, MacKenzie EJ, Edelstein SL. The effects of preexisting conditions on mortality in trauma patients. JAMA. 1990;263(14):1942–6.

    PubMed  Google Scholar 

  106. Baumgarten M, Margolis DJ, Localio AR, et al. Pressure ulcers among elderly patients in the hospital stay. Gerontol A Biol Ned Sci. 2006;61(7):749–54.

    Google Scholar 

  107. Callaway DW, Wolfe R. Geriatric trauma. Emerg Med Clin N Am. 2007;25:837–60.

    Google Scholar 

  108. Knudson MM, Lieberman J, Morris J, et al. Mortality factors in geriatric blunt trauma patients. Arch Surg. 1994;129(4):448–53.

    CAS  PubMed  Google Scholar 

  109. van Aalst JA, Morris JA Jr, Yates HK, et al. Severely injured geriatric patients return to independently living: a study of factors influencing function and independence. J Trauma. 1991;31(8):1096–101.

    PubMed  Google Scholar 

  110. Schwab CW, Kauder DR. Trauma in the geriatric patient. Arch Surgery. 1992;127:701.

    CAS  Google Scholar 

  111. McNelis J, Marini CP, Jurkiewicz A, et al. Prolonged lactate clearance is associated with increased mortality in the surgical intensive care unit. Am J Surg. 2001;182(5):481–5.

    CAS  PubMed  Google Scholar 

  112. Asckhenasy MT, Rothenhaus TC. Trauma and falls in the elderly. Emerg Med Clin N Am. 2006;24:413–32.

    Google Scholar 

  113. Masson F, Thicoipe M, Mokni T, et al. Aquitaine group for severe brain injury study. Epidemiology of traumatic comas: a prospective population – based study. Brain Inj. 2003;17(4):279–93.

    PubMed  Google Scholar 

  114. Susman M, DiRosso SM, Sullivan T, et al. Et al. traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity. J Trauma. 2002;53:219–24.

    PubMed  Google Scholar 

  115. Cohen DB, Rinker C, Wilberger JE. Traumatic brain injury in the anticoagulated patients. J Trauma. 2002;53:219–24.

    Google Scholar 

  116. Ohm C, Mina A, Howells G, et al. Effect of antiplatelet agents on outcome for elderly patients with traumatic intracranial hemorrhage. J Trauma. 2005;58:518–22.

    CAS  PubMed  Google Scholar 

  117. Franko J, Kish KJ, O’Connell BG, et al. Advanced age and preinjury warfarin anticoagulation increase the risk of mortality after head trauma. J Trauma. 2006;61:107–10.

    CAS  PubMed  Google Scholar 

  118. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37:975–9.

    CAS  PubMed  Google Scholar 

  119. Bulger EM, Arneson MA, Mock CN, et al. Rib fractures in the elderly. J Trauma. 2000;48(6):1040–7.

    CAS  PubMed  Google Scholar 

  120. Blackmore CC, Cummings P, Jurkovich GJ, et al. Predicting major hemorrhage in patients with pelvic fracture. J Trauma. 2006;61(2):346–52.

    PubMed  Google Scholar 

  121. Kimbrell BJ, Velhamos GC, Chan LS, et al. Angiographic embolization for pelvic fractures in older patients. Arch Surg. 2004;139(7):728–32.

    PubMed  Google Scholar 

  122. Brown CV, Antevil JL, Sise MJ, et al. Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures: its time has come. J Trauma. 2005;58(5):890–5.

    PubMed  Google Scholar 

  123. Quattromani E, Normansell D, Storkan M, et al. Olioganalgesia in blunt geriatric trauma. The Journal of Em Med. 2014;48(6):653–9.

    Google Scholar 

  124. Jones JS, Johnsons K, McNinch M. Age as a risk factor for inadequate emergency department analgesia. Am Jour of Em Med. 1996;14(2):157–60.

    CAS  Google Scholar 

  125. Turnheim K. Drug therapy in the elderly. Exp gerontology. 2004;39:1731–8.

    CAS  Google Scholar 

  126. Boltz MM, Podany AB, Hollenbeck CS, et al. Injuries and outcomes associated with traumatic falls in the elderly population on oral anticoagulant therapy. Injru. 2015, 46(9):1765–71.

    Google Scholar 

  127. Smith K, Weeks S. The impact of pre-injury anticoagulation therapy in the older adult patient experiencing a traumatic brain injury: a systematic review. JBI Libr Syst Rev. 2012;10(58):4610–21.

    PubMed  Google Scholar 

  128. Petrey LB, Weddle RJ, Richardson B, et al. Trauma patient readmissions: why do they come back for more? J Trauma Acute Care Surg. 2015;79(5):717–24.

    PubMed  Google Scholar 

  129. Hall C, Essler S, Dandashi J, et al. Impact of fraility and anticoagulation status on readmission and mortality rates following falls in patients over 80. Proc Bayl Univ Med Cent. 2019;32(2):181–6.

    PubMed  PubMed Central  Google Scholar 

  130. Strosberg DS, Housley BC, Vasquez D, et al. Discharge destinations and readmission rates in older trauma patients. J Surg Res. 2017;207:27–32.

    PubMed  Google Scholar 

  131. https://www.cdc.gov/nchs/fastats/emergency-department.htm

  132. American GS, Geriatric ED. American College of Emergency Physicians, emergency nurses association. Geriatric emergency department guidelines. Ann Emerg Med. 2014;63(5):e7.

    Google Scholar 

  133. Banerjee J, Conroy S, O’Leary V. The silver book: quality care for older people with urgent and emergency care needs. British Geriatric Society. 2012:1–02.

    Google Scholar 

  134. Adapted from https://www.acep.org/globalassets/sites/geda/documnets/geda-criteria-final_1.17.2019.pdf

  135. (World Health Organization. Palliative care 2002. Available online: www.who.int/cancer/palliative/definition/en/)

  136. Wu FM, Newman JM, Lasher A, Brody AA. Effects of initiating palliative care consultation in the emergency department on inpatient length of stay. J Palliat Med. 2013;16(11):1362–7.

    PubMed  Google Scholar 

  137. Khandelwal N, Kross EK, Engelberg RA, Coe NB, Long AC, Curtis JR. Estimating the effect ofpalliative care interventions and advance care planning on ICU utilizaation: a systematic review. Crit Care Med. 2015;43(5):1002–11.

    Google Scholar 

  138. George N, Phillips E, Zaurova M, Song C, Lamba S, Grudzen C. Palliative care screening and assessment in the emergency department: a systematic review. J Pain Symptom Manag. 2016;51(1):108–119.e102. https://doi.org/10.1016/j.jpainsymman.2015.07.017.

    Article  Google Scholar 

  139. Lamba S, DeSandre PL, Todd KH, Bryant EN, Chan GK, Grudzen CR, et al. Integration of palliative care into emergency medicine: the improving palliative Care in Emergency Medicine (IPAL-EM) collaboration. J Emerg Med. 2014;46(2):264–70.

    PubMed  Google Scholar 

  140. Grudzen CR, et al. Palliative care needs of seriously ill, older adults presenting to the emergency department. Acad Emerg Med. 2010:1253–7.

    Google Scholar 

  141. http://www.choosingwisely.org/nations-emergency-physicians-announce-list-of-test-and-procedures-to-question-as-part-of-choosing-wisely-campaign/

  142. Ballou JH, Brasel KJ. Palliative care and Geriatric surgery. Clin Geriatr Med. 2019;35(1):35–44.

    PubMed  Google Scholar 

  143. Rivet EB, et al. Characteristics of palliative care consultation at an academic level one trauma center. Am J Surg. 2017;214(4):657–60.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Westchester Medical Center, Valhalla, NY, USA

    Ivan T. Miller

  2. Department of Emergency Medicine, New York Medical College, Valhalla, NY, USA

    Ivan T. Miller

  3. Department of Emergency Medicine, Morristown Medical Center, Morristown, NJ, USA

    Susan Boyle

  4. Department of Emergency Medicine, Richmond University Medical Center, Staten Island, NY, USA

    Harry Kopolovich

  5. Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, USA

    Harry Kopolovich

  6. Geriatric Emergency Department, Morristown Medical Center, Morristown, NJ, USA

    Anar Shah

  7. Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Anar Shah & Dan E. Wiener

  8. Department of Emergency Medicine, Morristown Medical Center, Morristown, NJ, USA

    Dan E. Wiener

Authors
  1. Ivan T. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan Boyle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harry Kopolovich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anar Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dan E. Wiener
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ivan T. Miller .

Editor information

Editors and Affiliations

  1. Department of Surgery, New York Medical College, School of Medicine and Westchester Medical Center Health Network, Valhalla, NY, USA

    Rifat Latifi

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Miller, I.T., Boyle, S., Kopolovich, H., Shah, A., Wiener, D.E. (2020). Emergency Medicine Management of the Elderly. In: Latifi, R. (eds) Surgical Decision Making in Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-030-47963-3_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-47963-3_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-47962-6

  • Online ISBN: 978-3-030-47963-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation