Geriatrics Emergency Medicine

老年医学：

Foreword

Anybody who has worked in emergency medicine for more than a few
years has undoubtedly noticed a changing patient population: emergency
department (ED) patients are getting older. The elderly represent the fastest
growing segment of the U.S. population, and it is clearly reflected in the
patients presenting to the nations EDs and hospitals. The elderly currently
constitute [15% of all ED patients, 40% of all ambulance arrivals to the
ED, and almost 50% of all intensive care unit admissions. These patients
tend to have greater comorbidities, they have more complicated workups,
they utilize more laboratory and radiologic services, and they have longer
lengths of stay in the ED and in the hospital than younger patients. Des-
pite these more extensive workups, the rate of misdiagnoses, delayed diag-
noses, and ED ‘‘bouncebacks’’ among discharged elderly patients is higher.
The resulting morbidity and mortality in this patient group is also much
higher than in younger patients with similar chief complaints. So why the
problem?
The medical community is now starting to understand the significant
changes that occur with aging that produce altered disease conditions and
presentationsinelderlypatients.Alterationsinphysiologicprocesses,forex-
ample, predispose elderly patients to infection, drug toxicity, dehydration,
and fractures. The elderly are also well known to present with atypical pre-
sentations of common disease, including myocardial infarction, pneu-
monia, urinary tract infection, appendicitis, and shock. There are also
certain diseases that are almost exclusive to elderly patients, including tem-
poral arteritis, aortic dissection, and dementia. Much like pediatric patients,
elderly patients should be thought of as a completely separate patient
population with ‘‘their own’’ physiology, ‘‘their own’’ diseases, and ‘‘their
own’’ presentations.
In this issue of Emergency Medicine Clinics, Guest Editors Drs. Kahn,
Magauran, and Olshaker have assembled an outstanding group of physi-
cians to educate and update us on the challenging topic of geriatric emer-
gency medicine. The editors and authors have addressed physiologic
changes, high-risk conditions, and atypical presentations associated with el-
derly patients in the ED. This issue represents an important contribution to
education, and is certain to improve the care of our patients in the ED.
Amal Mattu, MD, FAAEM, FACEP
Emergency Medicine Residency
University of Maryland School of Medicine
110S Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA

Preface

The percentage of the United States population that is 65 years and
over will rise from the current 12% to 21% by 2050. Currently the elderly
comprise 15% of all emergency department visits in the United States, so
we can expect there will be an even greater increase in the proportion of
emergency department patients who are elderly. Elderly emergency depart-
ment patients have a high acuity level, often without the typical presenta-
tion of serious illness. In this edition, we attempt to provide the emergency
physician with a framework for the resuscitation, evaluation, management,
and disposition of the elderly patient in the emergency department. We
focus on the unique pathophysiology of geriatric patients that makes them
susceptible to serious disease without the usual outward manifestations we
expect to see. We have tried to present the special needs of this vulnerable
patient population so that as practitioners of Emergency Medicine we can
care for the elderly patient as e?ectively, e?ciently, and humanely as
possible.
We wish to thank all of the authors who so meticulously researched and
wrote the various articles in this edition of Emergency Medicine Clinics of
North America. We also wish to thank our families for their support in
the hours needed to revise and assemble this issue. We would like to thank
Karen Sorensen and the sta? at Elsevier for their support and patience.
Most of all, we wish to thank those of you who read this edition; we sin-
cerely hope you find it useful in your practice.
Brendan Magauran, MD, MBA, FACEP
Boston Medical Center
Department of Emergency Medicine
1 Boston Medical Center Place
Boston, MA 02118, USA
Joseph H. Kahn, MD, FACEP
Boston Medical Center
Department of Emergency Medicine
1 Boston Medical Center Place
Boston, MA 02118, USA
Jonathan S. Olshaker, MD, FAAEM, FACEP
Boston Medical Center
Department of Emergency Medicine
1 Boston Medical Center Place
Boston, MA 02118, USA

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