Objective: To determine the diagnoses and outcomes of geriatric patients wi
th abdominal pain, and to identify variables associated with adverse outcom
es. Methods: Geriatric emergency patients (aged 65 years and older) with a
complaint of abdominal pain were participants in this longitudinal case ser
ies. Eligible patients were followed by telephone contact and chart review,
to determine outcomes and final diagnoses. Results: Of 380 eligible patien
ts, follow-up information was available for 375 (97%), for the two months f
ollowing the ED visit. Final diagnoses included infection (19.2%), mechanic
al-obstructive disorders (15.7%), ulcers/hypersecretory states (7.7%), urin
ary tract disease (7.7%), malignancy (7.2%), and others. Although 5.3% of t
he patients died (related to presenting condition), most (61.3%) patients u
ltimately recovered. Surgical intervention was required for 22.1% of the pa
tients. Variables associated with adverse outcomes (death, and need for sur
gical intervention) included hypotension, abnormalities on abdominal radiog
raphy, leukocytosis, abnormal bowel sounds, and advanced age. Most physical
examination findings were not helpful in identifying patients with adverse
outcomes. This study demonstrated a higher incidence of malignancy (7.2%)
and a lower incidence of disease necessitating surgical intervention (22.1%
) than previously reported. Conclusions: The majority of geriatric emergenc
y patients with abdominal pain have significant disease necessitating hospi
tal admission. Morbidity and mortality among these patients are high, and s
pecific variables are strongly associated with death and the need for surgi
cal intervention. Absence of these variables does not preclude significant
disease. Physical examination findings cannot reliably predict or exclude s
ignificant disease. These patients should be strongly considered for hospit
al admission, particularly when fever, hypotension, leukocytosis, or abnorm
al bowel sounds are present.