A&E for Older Adults: Extra Considerations and Support

Why A&E visits are different for older adults

Older adults — generally those over 65, though age is less important than frailty — face distinct challenges in A&E. They are more likely to have multiple medical conditions, take numerous medications, experience confusion in unfamiliar environments, and have mobility limitations that make long waits physically difficult. They are also more likely to need admission and to experience complications from both their presenting condition and the A&E environment itself.

This guide covers the specific considerations for older adults attending A&E, whether you are the patient yourself or accompanying an older relative or friend.

Common reasons older adults attend A&E

Falls

Falls are the most common reason for A&E attendance in older adults and the leading cause of injury-related death in over-65s. The consequences range from minor bruising to hip fractures and head injuries. What makes falls particularly significant in older adults is the potential for underlying causes — medication side effects, postural hypotension, cardiac arrhythmias, infection — and the risk of serious injury from relatively minor mechanisms.

If an older person has fallen, our fractures and sprains guide covers when a fall needs A&E and when it can be managed with a UTC or GP visit. Our head injury guide is particularly relevant for older adults, who are at higher risk of subdural haematomas — slow bleeds inside the skull that can develop days after an apparently minor head knock.

Infections

Urinary tract infections, chest infections and skin infections in older adults can present very differently from younger patients. Instead of the classic symptoms, an older person may simply become confused, drowsy, unsteady or stop eating. These non-specific presentations often delay recognition, meaning the infection is more advanced by the time they reach A&E.

Breathlessness

Heart failure, chronic obstructive pulmonary disease (COPD), pneumonia and pulmonary embolism all become more common with age. Breathlessness that comes on suddenly or gets significantly worse over hours warrants A&E assessment.

Confusion and delirium

New confusion in an older adult is a medical emergency until proven otherwise. It can signal infection, stroke, medication toxicity, dehydration, metabolic disturbance or many other treatable conditions. Do not assume confusion is just "old age" — it always needs investigation. If the person is already known to have dementia, a sudden change from their baseline level of confusion is equally significant.

Preparing for the visit

Preparation makes an even bigger difference for older adults than for younger patients. Our general what to bring guide covers the essentials, but for older adults, add:

• A complete, up-to-date medication list. This is critical. Older adults often take multiple medications prescribed by different doctors, and interactions and side effects are common causes of A&E presentations. If you cannot list them, bring the medication boxes or blister packs. A photograph of each box is a good backup.
• Details of their GP and any community services involved — district nurses, social workers, community matrons, care agency details.
• A brief summary of their medical history — conditions, previous operations, known allergies. If they carry a medical summary card, bring it.
• Mobility aids — walking stick, zimmer frame, wheelchair. The department may have some, but their own equipment will be more familiar and comfortable.
• Hearing aids, glasses and dentures — these are frequently lost in hospital. Bring a labelled case for each.
• Continence pads if used — the department will provide them, but having familiar supplies reduces dignity concerns.
• Warm clothing and a blanket — A&E departments can be cold, and older adults are more susceptible to hypothermia in clinical environments.

During the visit

Advocate actively

If you are accompanying an older adult, your role as an advocate is vital. Speak up about their baseline condition — what is normal for them and what has changed. A person with dementia who is confused in A&E may be dismissed as "just confused" unless someone explains that yesterday they were alert, conversational and walking unaided.

Communicate their needs clearly

Tell staff about:

• Hearing difficulties — which side is better, whether they use aids
• Vision impairment — ensure they have their glasses
• Cognitive impairment — their normal level of function and what has changed
• Mobility — what they can normally do versus what they can do now
• Dietary needs — diabetes, swallowing difficulties, food allergies
• Continence — whether they normally manage independently or need assistance

Monitor for delirium

A&E environments can trigger or worsen delirium in older adults: bright lights, noise, disrupted sleep, unfamiliar surroundings, pain, dehydration, constipation and medication changes are all triggers. Signs of delirium include increased confusion, agitation, hallucinations, drowsiness, or rapid fluctuation between these states.

If you notice these changes developing, tell staff immediately. Delirium is a medical condition that needs assessment and treatment, not a behavioural problem to be managed.

Ensure comfort

Long waits on hard waiting-room chairs can be extremely difficult for older adults with arthritis, back pain or pressure-sore risk. If your relative is struggling, ask whether a trolley or reclining chair is available. If they are diabetic, ensure their blood sugar is monitored and meals are not missed. Keep them hydrated unless staff have said nil by mouth.

The triage process for older adults

Triage follows the same system for all patients, but experienced triage nurses know that older adults often present differently. Vital signs need age-specific interpretation — a heart rate of 90 may be significant in someone normally at 60, even though 90 is technically within normal range. Pain may be underreported because of stoicism, cognitive impairment or the mistaken belief that pain is just part of aging.

If you feel the triage assessment has not captured the full picture, say so. "They're not normally like this" is one of the most valuable things a companion can say in triage.

Medication review

One of the most important things A&E does for older adults — though it is often invisible — is reviewing their medication. Polypharmacy (taking five or more medications) is extremely common in older adults, and drug interactions, side effects and dosing errors are frequent contributors to A&E presentations. Falls, confusion, dizziness, bleeding and nausea can all be medication-related.

Ensure the treating clinician has your full medication list, including over-the-counter medications, herbal supplements and anything recently started or stopped.

Admission considerations

Older adults are more likely to be admitted than younger patients, and the admission decision involves different considerations. Staff will assess not just the medical condition but also:

• Whether it is safe for the person to return home
• Whether they can manage stairs, cooking, toileting and medication independently
• Whether existing care packages (carers, meals services) are adequate given the new situation
• Whether equipment (hospital bed at home, commode, raised toilet seat) is needed

A discharge to assess or hospital at home team may be involved. These teams can sometimes set up enhanced care at home within hours, avoiding a hospital admission that carries its own risks — deconditioning, hospital-acquired infections and disorientation in unfamiliar environments.

After the visit

Recovery from illness or injury takes longer in older adults, and the risk of complications is higher. Our after discharge guide covers follow-up care, but for older adults specifically:

• Medication changes: If any medications were started, stopped or changed, ensure the GP knows within 48 hours. Medication errors at the hospital-to-home transition are a common and serious problem.
• Falls follow-up: If the visit was fall-related, ask the GP about a falls risk assessment and referral to falls prevention services.
• Rehabilitation: Physiotherapy, occupational therapy and reablement services can help restore independence after a hospital visit.
• Monitoring for deterioration: Older adults can deteriorate after discharge as the stress of the visit and any new treatment takes effect. Watch for increasing confusion, reduced mobility, poor eating and drinking, and new symptoms.

Loneliness and repeat attendance

Older adults who live alone and have limited social contact are significantly more likely to attend A&E repeatedly, sometimes for conditions that could be managed in the community. If you notice a pattern of frequent A&E visits for a relative or neighbour, it may indicate unmet social or care needs rather than purely medical ones. Speak to their GP about a social prescribing referral, Age UK services, or local befriending schemes. Addressing isolation can improve health outcomes and reduce the distress of repeated emergency department visits.

Bottom line

A&E visits for older adults require more preparation, more advocacy and more follow-up than for younger patients. Bring a comprehensive medication list, communicate baseline function clearly, and watch for delirium. If A&E is not urgently needed, 111 can sometimes arrange alternatives — a GP home visit, a community assessment team or an out-of-hours service that avoids the stress of the emergency department entirely. When A&E is needed, check current wait times to choose the quietest option and time the visit for a less busy period if the condition allows.