The elderly represent the fastest growing segment of the population in developed countries, reflected in the patient population presenting to EDs and hospitals. These patients more often than not have greater co-morbidities, more complicated workups and utilize more laboratory and radiologic services. This text is designed to teach emergency physicians how best to care for this specific demographic of patients. It addresses physiologic changes, high-risk conditions, and atypical presentations associated with elderly patients in the ED that result in frequent misdiagnosis or delays in diagnosis. It instructs the readers how best to care for elderly patients in order to minimize morbidity and mortality, addressing some of the difficult psychosocial issues that confront health care providers that care for elderly patients, such as psychiatric disease and end-of-life care. The utility of this text is not limited to emergency physicians, but it should be useful to all health care providers involved in the treatment of elderly patients with acute medical or surgical conditions.

Series Editors:Shamai Grossman, Assistant Professor of Medicine; Director, Clinical Decision Unit and Cardiac Emergency Center. Beth Israel Deaconess Medical Center, Boston, MA.

Peter Rosen, Senior Lecturer Emergency Medicine Harvard Medical School; Attending Emergency Physician Beth Israel Deaconess Medical Center; Visiting Clinical Professor Emergency Medicine University of Arizona; Professor Emergency Medicine University of California San Diego, MA.

Editor-Chief:Amal Mattu, MD, Professor of Emergency Medicine and Vice Chair, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.Dr. Mattu is one of the leading emergency medicine educators in the US and a strong advocate for geriatric emergency medicine training. He has authored or co-authored 5 books for Wiley, including his extremely successful ECGs for Emergency Physicians titles, which have been perennial bestsellers. Dr. Mattu is Consulting Editor forEmergency Medicine Clinics of North America; he is a popular speaker at conferences around the world and he has won multiple awards for his excellence in teaching, including national awards from the American College of Emergency Physicians, the American Academy of Emergency Medicine, and the Council of Residency Directors in Emergency Medicine.

List of Contributors vii

1 General assessment of the elderly patient 1Alison Southern& Scott Wilber

2 Physiologic changes with aging 13Kate D. Zimmerman& Robert S. Anderson, Jr.

3 Functional assessment of the elderly 28Kirk A. Stiffler

4 Pharmacological issues in the elderly 43Ruben Olmedo& Denise Nassisi

5 Altered mental status in the elderly 58Josh Joseph& Maura Kennedy

6 Geriatric psychiatric emergencies 71Josh Joseph& Maura Kennedy

7 Acute abdominal pain in the elderly: Surgical causes 83Katren Tyler& Maura Kennedy

8 Nonsurgical abdominal pain in the elderly 99Katren Tyler& Maura Kennedy

9 Back pain 110Nicholas Santavicca& Michael E. Winters

10 Headache 123Benjamin W. Friedman& Rebecca Nerenberg

11 Dyspnea in the elderly 139Mercedes Torres& Siamak Moayedi

12 Acute chest pain in the geriatric patient 152Marianne Haughey

13 Acute cardiac disease in elder patients 168Susanne DeMeester

14 Syncope in Geriatrics 191Timothy C Peck, Nissa J Ali& Shamai A Grossman

15 Stroke 203Julie Watkins-Torrey, Roxanna Sadri& Kama Guluma

16 Infections 218Jason Ondrejka& Scott Wilber

17 Dizziness and vertigo in the geriatric population 234Jonathan Edlow& Alessandro Cancelliere

18 Weakness and functional decline 252Colleen M McQuown

19 Emergency department evaluation of falls in the elderly 264Tania D. Strout& Robert S. Anderson

20 Trauma in the geriatric patient 280Christopher R. Carpenter& Peter L. Rosen

21 Surgical considerations in the elderly 304Charles W. OConnell, Davut Savaser& Colleen Campbell

22 Oncologic emergencies 321Gabriel Wardi, Alexander Bromfield& Leslie C. Oyama

23 Elder abuse and neglect 351Michael C. Bond& Kenneth H. Butler

24 Geriatric emergency pain management case 363Teresita M Hogan& Alexandra Wong

25 Ethical issues and end-of-life care 386Phillip D. Magidson& Jon Mark Hirshon

26 Geriatric dispositions and transitions of care 394Barbara Morano, Carmen Morano, Kevin Biese, Eric A. Coleman& Ula Hwang

27 The geriatric ED, 407Phillip D. Magidson, John G. Schumacher& Elizabeth A. Couser

Index 417