EMET Pre-learning: Emergencies in the Elderly

As the Australian population ages, emergency departments and primary clinicians will be increasingly confronted with assessing elderly patients with acute illness. In this pre-learning for the EMET workshop we consider two clinical challenges:

1. The elderly patient presenting with acute confusion

2. The elderly patient presenting with acute abdominal pain

Confusion is a common and challenging acute presentation in the elderly patient. The list of possible causes is extensive and range from benign self limited conditions through to very serious or immediately life threatening disease. A cautious approach should be taken in these patients as the clinical findings for serious underlying disease may be difficult to identify or delayed making missed diagnosis a significant possibility. 

Compared to younger patients, acute abdominal pain in the elderly is associated with a high rate of misdiagnosis. Possibly the most challenging aspect to managing the elderly patient with suspected deterioration is the diagnosis.  A structured approach is essential. A careful assessment of the patient's vital signs, history and examination together with selective testing will generally enable the clinician to significantly narrow down the diagnostic possibilities.