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13 Emergency problems in older people
  1. P Lawson1,
  2. C Richmond2
  1. 1Consultant Physician and Geriatrician, Northern General Hospital, Sheffield
  2. 2Paramedic Practitioner, South Yorkshire Ambulance Service
  1. Correspondence to:
 P Lawson
 Brearley Wing, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK;

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Medical emergencies are common in older people. They may have difficulty accessing suitable health care once their GP practice is closed. They are less likely to use schemes such as NHS Direct than other parts of the population.1 They or their carers are more likely to dial 999 if they have an urgent medical problem. The care of the elderly is an increasing proportion of work for GP out of hours services, ambulance services, and Emergency Departments (EDs).

The acute medical problems of older people are often similar to those of younger adults but the presentation can be atypical or there can be a number of co-existing problems that make diagnosis difficult. Further difficulties occur in frailer, older adults who continue to manage at home despite the effects of increasing age and multiple medical problems. In these patients an apparently minor illness can lead to deterioration in a non-specific manner leading to immobility, a fall, or acute confusion. The social circumstances and the availability of social support may be of greater importance than the management of the medical illness. Treatment at home is often the preferred and safest option. If a careful clinical and social assessment indicate that the primary problems require social support or nursing expertise, then clinicians must have the option of referring to community support schemes that are now more widely available.

However, major illnesses such as serious infections, heart disease, and cancer can also present in a non-specific way. If the presence of one of these conditions is a possibility, then a planned short admission for investigation or early clinic review will be preferable to leaving the patient at home with subsequent admission in a worse condition at a later time.

The management of trauma and surgical emergencies is covered in other articles in this …

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