European Journal of Cardiovascular Medicine

Because of better living circumstances and lower death rates, the number of older persons (those over 65) is rising. Understanding the traits of senior citizens who are admitted to emergency rooms can help with diagnostic and treatment planning [1]. The number of old people admitted to emergency departments rises in tandem with the number of elderly patients. According to a number of studies, between 9 and 19% of ED admissions come from elderly patients, who are known to exhibit more severe clinical conditions than younger patients [2–5]. Although 10% of all symptoms that come to emergency departments are related to stomach discomfort, 20% of these patients are known to be elderly. Over 50% of these individuals are receiving hospital treatment, and surgery is performed to 1/3 of the patients. Fagbohun et al. reported that biliary system diseases are the most common source of abdominal pain and the primary reason for surgery [6]. According to reports, the mortality rate for patients over 65 ranges from 11% to 14%. According to Mc Namara et al., multiple disorders, prior surgical procedures, multiple drug use, an impotent immune system, and delayed diagnosis of critical illnesses in the emergency department were the main causes of the increased mortality rate among senior patients [7]. Geriatric patients continue to be a clinical challenge for emergency department physicians, even with advancements in the management of these patients. Our study's objectives were to help hospital managers and doctors in the treatment of elderly patients by examining the causes, prevalence, hospitalisation rates, demographic characteristics, and morbidity and mortality rates of patients over 65 who were admitted to our emergency department (ED) with abdominal discomfort

The study was carried out at Department of Medicine, Vijaya Hospital, Kottaarakkara. After ethical approval, medical records of patients older than 65 years admitted to our ED with abdominal pain in the last year were investigated retrospectively. Inclusion criteria were patients with abdominal pain older than 65 years. Medical records of the patients were detected for age, gender, vital signs, complaints accompanying abdominal pain (nausea-vomiting, loss of appetite, constipation, intestinal gas extraction inability, diarrhea, dysuria, jaundice), comorbidities, duration of abdominal pain, length of ED stay (0–6, 6–12, 12–24 and over 24 hours), prediagnosis in the ED, consultations required (internal medicine, general surgery, urology, gynecology, etc.), wards that the patients were admitted to (ED, internal medicine, general surgery, intensive care, etc.), length of stay (LOS) of the patients in the hospital (1 day, 1–4 days, 4–10 days, more than 10 days), choice of treatment (medical, surgical), and outcomes (recovery, vegetative stage, exitus). The patients were divided into subgroups according to age (65–74 years and above 75 years) and diagnoses (medical and surgical). Patients under 65 years and with traumatic abdominal pain were excluded from the study.

Data were analyzed using Statistical Package for Social Sciences (SPSS) for Windows® 21.0 programme. Frequency (n) and percentage (%) were given for categorical variables. Median, minimum, and maximum values were given for continuous variables. In comparison of categorical variables, Pearson's chi-square test and Student T-test were used. For comparison of body temperature between patient groups, Mann–Whitney U test was used. p < 0.05 was considered as statistically significant.

Amongst the research periods, 336 participants over 65 who experienced stomach pain were included to the study. There were 174 female patients (51.8%) and 162 male patients (48.2%) among the patients. 160 patients (47.6%) were in the 75+ category of age, whereas 176 patients (52.4%) were in the 65–74 age range. Mean age of the patients was 74.8 ± 6.5 years (min: 65 years, max: 96 years). While mean age of female patients was 75.3 ± 6.0, mean age of male patients was 74.2 ± 6.0. Mean age of the patients according to gender was not statistically significant (p > 0.05). Comparison of patient characteristics according to age groups is summarized in Table 1.

Table 1-Comparison of patient characteristics according to age groups.

Table 2-Comparison of groups according to diagnoses.

It was found that 77.4% of the patients had a chronic disease. In patients over 75, cerebrovascular disorders (CVD) were statistically significant (p = 0.027). When comparing chronic diseases by gender, it was discovered that diabetes mellitus (DM) and congestive heart failure (CHF) in women and hypertension (HT) in men were statistically significant (p < 0.05). HT and liver cirrhosis were significant in medical sources of abdominal pain (p < 0.05) when comparing concomitant illnesses between medical and surgical procedures. Mean values of vital signs of the patients on admission to ED were as follows: systolic blood pressure: 120.0 ± 20.4mmHg, heart beat: 84.0 ± 13.4 beats/minute, and temperature: 36.6 ± 0.6°C. Blood pressure was found to be significantly higher in females than males (p = 0.008).

The number of elderly individuals admitted to emergency departments rises in tandem with the community's increased life expectancy. Research on elderly patients has revealed that the percentage of elderly patients admitted to emergency departments (EDs) ranges from 9 to 15% [2, 5, 7, 8]. The proportion of elderly patients in our study was 21.2%. Our hospital's status as a district hospital that acts as a last resort for the city and its environs may be the cause of the high percentage in our research.

According to Kılıçarslan et al., the most frequent complaints of elderly patients admitted to the emergency department were headache, shortage of breath, chest discomfort, and abdominal pain. Abdominal pain accounted for 5.7% of the patients' admissions [9]. Abdominal pain accounted for 5–8% of complains upon admission to emergency departments, according to Gallenger et al. [10]. Furthermore, 10% was the rate observed in a study by Fagbohun et al. [6]. According to our research's findings, 4.4% of the elderly patients admitted to our emergency department (ED) had stomach pain, which is consistent with previous research.

It was clearly stated in the literature that women make up the majority of patients who visit emergency departments [11–14]. According to a research by Gardner et al., 60% of the patients were female [15]. Additionally, our research showed that women made up almost all of the individuals. The average age of women was also higher than that of men, according to our survey. This discovery may be due to women's longer life expectancy.

Both pancreatitis and biliary tract infections can be the cause of abdominal pain in elderly persons. The gallbladder's capacity to contract as a reaction to the cholecystokinin enzyme diminishes with age. Furthermore, gallbladder stones are brought on by the bile's elevated cholesterol and phospholipid content, and biliary disorders are caused by an enlarged biliary tract [16–18]. We found that 4.8% of the participants in our study had pancreatitis and 19.6% had biliary tract disorders. The high rate of patients being transferred from nearby cities for endoscopic retrograde cholangiopancreatography is another factor contributing to the high prevalence of biliary tract disorders.

According to several research, nausea and vomiting are the most frequent complaints that accompany stomach pain [4, 11]. The most frequent concomitant concerns in the research we conducted were nausea and vomiting, while solitary stomach discomfort accounted for 20.8% of patient admissions. The primary complaint in the surgical source group was the inability to remove gas and stool, which was consistent with Staniland et al.'s findings [12]. The fact that biliary tract disorders are the most prevalent illnesses among senior citizens is also consistent with this finding. Fever, pain in the right upper quadrant, nausea, and vomiting are thought to be its usual clinical manifestations [19].

The results of our investigation showed that biliary tract diseases are the most frequent reasons for abdominal pain in elderly adults. Additionally, we found that the majority of people with stomach pain also have a chronic condition. The inability to remove gas and nausea/vomiting are the most frequently reported symptoms that accompanies stomach pain. Male patients with abdominal pain have a greater mortality rate (12.2%) than female ones. Both the surgical procedure rate and the fatality rate rise with age.

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