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Elderly Patients with Abdominal Pain
Elderly patients presenting with abdominal complaints warrant a complete evaluation.
- Up to 50% of those over 65 yr of age will ultimately have a process evolving that
requires medical or surgical intervention. Therefore, it is judicious to check laboratory
and imaging studies.
- While physical examination is important, elderly patients frequently present atypically.
They will often lack fever and leukocytosis. For instance, it is well documented
that elderly patients will have perforated appendicitis at an early time and with a less
obvious exam, than their younger counterparts. Higher morbidity and mortality from
higher rates appendiceal perforation is the rule. After 50 yr of age perforation rates are
from 32-70%.
Delays in the diagnosis are typically due to:
- Atypical presentations
- Anatomy
- Less blood supply to appendix most likely
- One-third of perforations are in those with symptoms < 24 h.
Additionally, the risk of solid masses increases as does the presence of
intra-abdominal infections. Elderly patients often will lack vital sign abnormalities.
They may have hemoperitoneum with normal vital signs.
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