Juxtaposition

The number of elderly patients presenting to emergency departments has been increasing. In fact, as a result of increasing life expectancy, it’s been estimated that in most countries over 20% of all emergency department attendances are made by patients aged over 65. Unlike their younger counterparts, these patients present unique challenges to doctors, often presenting with non-specific complaints and numerous underlying medical conditions. For example, up to a third of all over-65s have at least one fall per year in the community. Yet we rarely discover the underlying cause of the fall.

Perhaps one reason for our frequent failure to diagnose the underlying cause of falls is due to the inaccuracy of some tests with increasing patient age. Urine dipstick testing, where urine samples are tested for signs of infection or bleeding, are notoriously unreliable in the elderly. Up to 50% of elderly patients have non-harmful bacteria which colonise their urinary tracts, making it impossible to know whether any bacteria detected are harmful or not.

Prescribing antibiotics inappropriately is a major cause of harm, not only because of the potential development of antibiotic resistance, but also due to side effects. Studies have shown that one in three elderly patients prescribed antibiotics will suffer from a side effect, ranging from mild complications such as stomach pain through to serious complications including death. As clinicians, we must therefore use antibiotics sparingly and only when indicated.