**1. Introduction**

Aging can be defined as a decline in functional properties at cellular, tissue, and organic levels, with the consequent loss of homeostasis and adaptability to internal and external noxas, increasing vulnerability to disease and death [1].

As a result of the increase in the number of elderly people, their health problems have increased significantly. Parallel to the demographic change that conditioned population aging, the "epidemiological transition" appeared that modified the profile of prevalent diseases, chronic noncommunicable diseases being the core of attention. All these conditions present frequent exacerbations and relapses, making the elderly require repeatedly assessment in an emergency service. However, it is clear that the care models in the emergency services are not adapted to the geriatric patient [2].

The demand in the attention to the emergency services has been growing progressively in the last years, and this increase is more noticeable in the population of older adults. Older people have differential features, in relation to younger age groups, starting from the biological point of view with not only physiological changes related to aging but also functional, psychological, and social changes, all of which lead to a decrease or narrowing of the homeostatic

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

responses to the different noxas, placing them in a state of greater vulnerability, which has an effect of greater comorbidity, loss of autonomy, disability, sensory alterations, cognitive deterioration, and a social-familiar problematic that can occur simultaneously, determining a special difficulty for their evaluation and treatment and, many times, altering its prognosis adversely [3].

serious therapeutic errors, affecting adversely the outcome; the aim of this paper is to provide knowledge that leads to the identification of these factors and may lead to earlier and more

The Elderly in the Emergency Department http://dx.doi.org/10.5772/intechopen.75647 87

Recent studies have shown a progressive increase in emergency visits, which is much more noticeable in the elderly population. In fact, some studies mention that up to 25% of all emergency visits correspond to elderly patients. In general, they represent more than 15% of all consultations and almost 50% of all admissions to intensive care units. Therefore, some

In the United States, the Centers for Disease Control and Prevention (CDC) report that between 1993 and 2003, there was an increase in the absolute number of visits to the emergency department, with the group of people over 65 years of age, who had the highest frequency of visits (an increase of 26%). If this trend is maintained, it is expected that the frequency of emergency consultations in the elderly will double from 6.4 million to 11.7 million by 2013 [10]. Elderly patients are four to six times more likely to be admitted to an emergency unit than a non-

The organic response to different acutely unbalanced pathologies is altered in some elderly, especially in the fragile ones [11]. Among the most relevant physiological changes associated

• Alteration in the homeostasis of intercellular junctions and the production of the second messengers, which causes some adrenergic receptors to be internalized, decreasing the ef-

• Presbycardia or cardiac aging conditioned by the increase in cardiac stiffness with a decreased diastole capacity and greater dependence on atrial contraction, which results in less tolerance to increased extravascular volume and lower tolerance to tachyarrhythmias. • The physiological changes of lung aging make it more difficult to adapt to situations that generate hypoxemia. Among them are an increase of the rib cage rigidity, decrease in the forces of elastic retraction of the lung parenchyma, and decline in the strength of the respiratory muscles. All this generates changes in pulmonary dynamics with an increase in residual volume, decrease in tidal volume, and decrease in FEV1 associated with age. The

**3. Conditions that can alter the evolution and prognosis of the** 

authors mention that "the emergency units are aging" [9].

**elderly in the emergency department**

fectiveness of catecholaminergic responses.

**3.1. Physiological response to stress**

with age are mentioned:

successful intervention lines.

**2. Epidemiology**

elderly patient.

In this way, the concept of biological aging is important, understood as the state of an individual resulting from the wear and tear associated with age plus its conditions of illness, functionality, mental well-being, and social support. This biological aging is very different among the elderly, regardless of their chronological age and condition differences in the functional capacity [4].

In a recent Spanish study, it was established that older patients had a higher priority in the care by severity, had more complementary tests taken, had a longer average stay, had a higher probability of hospital admission and of being exitus, and needed assessment by the social services. In addition, it requires more complex evaluations, more consultations with other specialists, and a higher percentage of readmissions [5]; however, they attend in a justified manner and with a significantly used pattern different from young adults. Therefore, the progressive aging of the population may seriously affect the dynamics and functioning of the hospital emergency services.

In young patients admitted to an emergency department, it has been determined that there are undoubtedly clinical factors related to the acute disease, which decisively influence the outcome. However, this is not so clear in the elderly, and the characteristics that go beyond the severity of the acute disease modify the prognosis. More specifically, these conditions refer to the functional, emotional, and cognitive states, the level of comorbidity, the degree of polypharmacy, and the social support networks. Due to their condition of high vulnerability or fragility, in the elderly patients, the health problems are explained in the multicausality model, and the resolution of these does not derive from the attention of a single cause, but from a comprehensive identification and treatment of all related factors that affect the prognosis [6].

Hospitalization alone is already a negative factor in the outcome of elderly patients. Survival decreases by the mere fact of being reduced to a hospital bed, immobilized, both in men and women, but above all in the older groups (>80 years) [7]. Even if you take into account that the emergency services are noisy, in constant movement and lack of privacy, which can be disconcerting for the elderly and enhance their deterioration in relation to hearing, vision, attention, and understanding.

In general, the elderly patients have a longer stay in the emergency department, requiring more time for medical assessment and nursing care, and alarmingly they have a higher frequency of readmissions, generating a great assistance pressure on the professionals that attend these services [8].

The lack of knowledge of the elements that affect the prognosis of the elderly patients in the emergency services is still notorious, which results in diagnostic errors and what is more serious therapeutic errors, affecting adversely the outcome; the aim of this paper is to provide knowledge that leads to the identification of these factors and may lead to earlier and more successful intervention lines.
