There are limited data on the number of emergency department (ED) visits for abdominal pain in the elderly. Patients aged 65 or older accounted for 9 percent of ED visits for abdominal pain in an adult ED population (age > 15).1 A recent study from a rural ED reported that abdominal pain in those age 65 and greater represented 0.23 percent of all ED visits.2 In the United States, abdominal pain is the most frequent reason for an ED visit, accounting for 5.1 million of the 96 million ED encounters in 1996.3 The preceding figures would create estimates ranging from 230,000 to 450,000 elderly patients presenting to U.S. EDs per year with abdominal pain.
Regardless of the current frequency of ED visits for abdominal pain in the elderly, one can count on a steadily rising volume of such cases. The U.S. population is rapidly aging. Current projections predict that those aged 65 and older will rise from 13 percent of the population in the year 2000 to approximately 20 percent by the year 2030.4 Since the elderly use the ED more frequently than their proportionate numbers in the general community would indicate, this trend will affect emergency care significantly.5 Practicing emergency physicians rate abdominal pain as the most challenging clinical situation in this population. 4 Over half of the patients aged 65 or greater who present to the ED with abdominal pain require admission, and one-third or more will require surgical intervention at some point during their hospital stay.13 The mortality rate across all causes of abdominal pain in the elderly is 11 to 14 percent, justifying its anxiety-provoking reputation. 6 The role of the emergency service in the care of these patients is critical, as the mortality rate doubles if the diagnosis rendered in the ED is incorrect. 67
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