13 emergency problems in older people

Abstract

Practitioners dealing with emergencies in older adults in the community must be able to recognise the atypical presentation of illness in older people and have a high index of suspicion that apparently innocent symptoms can be the presentation of serious underlying pathology. It must also be remembered that the common medical emergencies of younger adults generally occur more frequently in older adults and require similar treatment. Necessary skills include clear communication with patients although on occasions witnesses must be used to obtain relevant information. A focussed examination including a mental state test is often necessary when dealing with non-specific illness in the older patient and when determining if someone can be left at home. A home visit allows assessment of the patient's social circumstances and emergency practitioners might sometimes need to make adjustments to ensure the safety of the patient in their surroundings if they are to be left at home or subject to a delay in transfer. Evidence of neglect by the patient or by others should also be looked for when attending the patient at home. The combination of social and medical assessment, linked to knowledge of the services available locally will determine where the patient's care will be best delivered. With an older patient it is safer to err on the side of caution to avoid denying patients a specialist assessment. For many this will need to be a comprehensive Geriatric assessment performed after the emergency episode has passed.