The demographics of the population in the United States demonstrate the importance of older persons in our society, the rapid growth of the elderly from 1920 projected to 2050, and the potential effects of these demographic changes on our health care system ( Fig.^300-1). About 12 percent of the population was 65 years of age or older in 1990, whereas 20 percent of the population (or 55 million persons) will be 65 years of age or older by the year 2030. 2 The oldest elderly, those 85 years and above, are the most rapidly increasing segment of the population. This is also the population with the most health problems and in greatest need for health care. There is great variability in the physiologic age of individual patients. A 55-year-old with multiple chronic diseases and poor physiologic reserve may have a physiologic age much older than a healthy 80-year-old.

FIG. 300-1. Percentage increase of elderly population from 1920 projected to 2050. (From Eliastam M: Elderly patients in the emergency department. Ann Emerg Med 18:1222, 1989.)

In 1990, about 15 percent of ED visits were made by patients 65 and older, and over 30 percent of older patients use ambulances to come to the ED. 3 The rate of ambulance use increases with age: more than half of those 85 years of age and older are transported by ambulances. Older patients require comprehensive emergency department services, and more than 40 percent are admitted to the hospital.3 Older patients spend more time in the ED, require more ancillary tests, and are more likely to be admitted to critical care units.4 A survey by the National Center for Health Statistics (NCHS) found that persons aged 65 to 74 years had an estimated 3l.4 ED visits per 100 persons per year, and persons aged 75 years and older had 55.8 visits per 100 persons per year, twice the rate for younger persons. 5

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