Investigation of Geriatric Patients with Abdominal Pain Admitted to Emergency Department

Abstract

Introduction The aim of this study is to detect the possible reasons of abdominal pain in the patients aged 65 and older admitted to emergency department (ED) with complaint of abdominal pain which is not related to trauma, to determine the length of hospitalization of old (65–75 age) and elderly (aged 75 and older) patients, and to define the hospitalization and mortality rates. Material and Methods In the study, 336 patients were included. Groups were compared in respect to gender, internal or surgical prediagnoses, complaints accompanying abdominal pain, vital findings, comorbidities, requested consultations, hospitalizing service, waiting time in the ED and in the hospital, and treatment methods. Results Of the patients, 48.2% were male, and 51.8% were female. While 52.4% of the patients were in 65–74 age group, 47.6% of them were aged 75 years and above. An internal disease was detected in 76.8% of the patients as an origin of abdominal pain. Most common prediagnoses were biliary diseases and diseases related to biliary tract followed by nonspecific abdominal pain, abdominal pain secondary to malignity, ileus, and acute gastroenteritis, respectively. The most frequent finding accompanying abdominal pain was vomiting. The most frequent chronic disease accompanying abdominal pain was hypertension in both age groups. We observed that 75.9% of the patients required consultation. We detected that 48.8% of the patients with abdominal pain were hospitalized and they were hospitalized mostly by gastroenterology ward (24.8%). Surgical treatments were applied to the 17.6% of the patients with abdominal pain. Conclusion Clinical findings become indistinct by age, and differential diagnosis of abdominal pain gets more difficult in geriatric patients. Therefore, physicians should consider age related physiological changes in order to distinguish geriatric patients admitted to emergency service with abdominal pain from pathological cases requiring immediate surgical operation.

Older person with vague symptoms in the emergency department: Where should I begin?

“…Physical examination is obviously important. Physiological changes, multi‐morbidity and polypharmacy in old age mean that lack of physical examination findings does not exclude serious pathology . Older adults can have apparently normal vital signs in the presence of serious illness.…”

Causes of Acute Abdominal Pain in Geriatrics: A Review

“…Table 1 show studies conducted by Pınar HENDEN ÇAM et al [12]; 48.2% were male, and 51.8% were female. An internal disease was detected in 76.8% of the patients as an origin of abdominal pain.…”

Dolor abdominal agudo en el adulto mayor: evaluación clínica, diagnóstico y tratamiento

“…En orden de frecuencia, las principales causas de dolor abdominal en el adulto mayor son: colecistitis aguda, síndrome de intestino irritable, síndrome ulceroso, oclusión intestinal y diverticulitis 2 . En consecuencia, las intervenciones quirúrgicas de urgencia más realizadas en el adulto mayor son secundarias a enfermedades de la vía biliar, adherencias, hernias, diverticulitis, enfermedades vasculares intestinales, enfermedades malignas y apendicitis 1,3,4 ; sin embargo, frecuentemente existen errores en el diagnóstico etiológico del adulto mayor que acude a urgencias por dolor abdominal agudo.…”

“…Debido a diversos factores, como la pérdida progresiva de las reservas fisiológicas, comorbilidades, procedimientos quirúrgicos previos y retrasos en el reconocimiento de enfermedades graves, la tasa de mortalidad en adultos mayores con dolor abdominal agudo es significativamente más alta en comparación con la de los adultos jóvenes 3 .…”

“…El deterioro de las reservas metabólicas en los adultos mayores, los cambios fisiológicos (disminución de la agudeza auditiva, percepción alterada del dolor, problemas para la comunicación, respuestas inesperadas en constantes vitales y estudios de laboratorio, entre otros) y las comorbilidades asociadas disminuyen el rendimiento diagnóstico cuando se evalúan adultos mayores con dolor abdominal agudo en el servicio de urgencias [1][2][3][4] .…”