The approach to acute abdominal pain in all age groups requires an understanding of the visceral and somatic pathways of pain perception. Neural pathways are not rerouted as we age; however, it is an accepted axiom that the perception of abdominal pain or at least the reporting of it is altered in the elderly. 7 There is limited proof of this axiom for abdominal pain; however, it is fairly clear that ischemic heart disease is associated with altered pain perception or reporting in the elderly. Other factors such as fear, stoicism, and communication problems may affect the reporting of abdominal pain in older persons. 78

Aging is associated with several factors that influence the prevalence and spectrum of abdominal conditions encountered in this population ( T§b!e 69:l). For example, older patients have a statistically increased frequency of abdominal aortic aneurysms that could potentially rupture and present to the ED. The presence of comorbid diseases and their associated therapy certainly contributes to the complexity of care in older patients with abdominal pain. Other important pathophysiologic features to keep in mind regarding this age group include decreased cardiopulmonary reserve, lowered tolerance for hypovolemic shock, and the treatment issues of altered pharmacodynamics and pharmacokinetics.

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