**3. Conditions that can alter the evolution and prognosis of the elderly in the emergency department**

#### **3.1. Physiological response to stress**

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 with age are mentioned:


effectiveness of protective airway reflexes is also altered. The alveoli flatten and the gaseous exchange surface decreases. In general, all these changes produce a decrease in the PO<sup>2</sup> , for which one must be cautious when interpreting the arterial gases in an older adult and apply a formula to correct them by age.

• Serum creatinine does not reflect renal function, if one considers that it is a protein of mus-

The Elderly in the Emergency Department http://dx.doi.org/10.5772/intechopen.75647 89

• It is common to find in the elderly of the community (20%) and institutionalized patients (50%) the presence of asymptomatic bacteriuria, which should not be misinterpreted as a

• The readings of hemoglobin and hematocrit in the elderly are the same as for the adult

• The same applies for the serum sodium values, being these from 135 to 145 mosm/Lt and being an error to believe that the elderly tolerate hyponatremia better; in fact, studies have shown an increase in cognitive alterations, falls, and acute coronary mortality, with values

When using drugs in the elderly, it is necessary to know some changes that can alter the

• In general terms, there is no alteration in the absorption of oral medications, and this re-

• There is a decrease in liver size, hepatic blood flow, and liver microsomal enzymes, which

• The free fraction of drugs that travel bound to albumin or alpha-2-microglobulin, which are

• With aging, there is a greater proportion of body fat and less water and lean mass, which

• Specific pharmacodynamic alterations for some molecules due to changes in the quantity

Next, emphasis will be placed on the most frequent pathologies in an emergency department

In the past, it was controversial to define the readings for normal blood pressure in the elderly and when to administer pharmacological treatment. Today, it is clear that the normal readings

• Greater toxicity of some molecules associated with decreased renal function.

**4. Most frequent pathologies in the elderly at the emergency** 

urinary infection and even less should be given an antibiotic treatment.

population. The myth of the so-called anemia of aging is false.

variably decreased with age, increase and so does toxicity.

cular origin and the sarcopenia associated to age.

less than 135 mosm/Lt.

**3.4. Pharmacological response**

responses to medications [14]:

mains one of the choices.

**department**

alter the metabolism of some drugs.

changes the bioavailability of drugs.

or sensitivity of receptors at the cellular level.

and their differential characteristics in the elderly.

**4.1. Hypertension in the emergency room in the geriatric patient**


#### **3.2. Characteristics of the disease as it ages**

The disease presentation in the elderly makes it difficult to approach it, due to situations such as:


#### **3.3. Laboratory tests**

Although laboratory tests are an invaluable aid, in the elderly they cannot get altered in the presence of disease or have higher rates of false positives, related to physiological changes [12]. The following are worthy of mention:

• In the elderly the erythrocyte sedimentation rate is not a reliable indicator of the presence of inflammation. C-reactive protein (CRP) is more sensitive, with the disadvantage that it can take up to 12–24 h to rise after a bacterial aggression and maintain its levels even days after healing. Recently, it has been published in a systematic review that PCR accuracy decreases as the patient's age increases. Procalcitonin maintains a good diagnostic capacity in this patient profile, and a value of >0.5 ng/ml is significantly associated with greater mortality at 30 days [13].


#### **3.4. Pharmacological response**

effectiveness of protective airway reflexes is also altered. The alveoli flatten and the gaseous exchange surface decreases. In general, all these changes produce a decrease in the PO<sup>2</sup>

which one must be cautious when interpreting the arterial gases in an older adult and ap-

• The most important changes that affect the aged kidney are a reduction in size, decreased renal blood flow, and a drop in the glomerular filtration rate. Therefore, older adults have difficulty managing water loads, either in hypervolemia or in dehydration states, as well as

• Deregulation of the immune system, low-grade inflammation, and alteration of acquired

• There is desensitization of the vascular mechanoreceptors with alteration of the vasocon-

• Endocrine changes with pancreatic aging, islets decrease, and insulin resistance increases, causing an increase in fasting plasma glucose. There is also an alteration in the production

The disease presentation in the elderly makes it difficult to approach it, due to situations such

Although laboratory tests are an invaluable aid, in the elderly they cannot get altered in the presence of disease or have higher rates of false positives, related to physiological changes

• In the elderly the erythrocyte sedimentation rate is not a reliable indicator of the presence of inflammation. C-reactive protein (CRP) is more sensitive, with the disadvantage that it can take up to 12–24 h to rise after a bacterial aggression and maintain its levels even days after healing. Recently, it has been published in a systematic review that PCR accuracy decreases as the patient's age increases. Procalcitonin maintains a good diagnostic capacity in this patient profile, and a value of >0.5 ng/ml is significantly associated with greater

ply a formula to correct them by age.

immunity make the responses to infections less effective.

strictive responses upon hypotension states.

regulating plasma osmolarity.

of counter-regulatory hormones.

as:

88 Gerontology

• Multipathology

• Complex medication regime

• Atypical presentation

• Frequent Iatrogenic

**3.3. Laboratory tests**

• Multiple consultations

mortality at 30 days [13].

**3.2. Characteristics of the disease as it ages**

[12]. The following are worthy of mention:

, for

When using drugs in the elderly, it is necessary to know some changes that can alter the responses to medications [14]:

