Acute abdominal pain in the elderly.

In this article, I review the diagnosis and immediate prognosis of acute abdominal pain in elderly patients. I draw on published work and on three major series of patients, one collected since 1976 by the World Organization of Gastroenterology (OMGE) Research Committee, one by the 1986 United Kingdom National Study of Human and Computer-Aided Diagnosis, and one by the European Community 1993 Concerted Action on Acute Abdominal Pain. These series include approximately 42,000 patients. Acute abdominal pain in the elderly patient presents a significant and challenging problem. Diagnostic accuracy is lower, and mortality far higher, than in younger patients. Reasons for these differences are multifactorial: the case mix is different, the evolution and prognosis of specific diseases are different, and the ways in which diseases present are also different in elderly patients. It is not difficult therefore to understand why serious problems in management occur. I conclude by discussing implications of existing studies and the literature that--if implemented--should significantly improve both management resource utilization and patient outcome.