Older person with vague symptoms in the emergency department: Where should I begin?

Vague presentations or nonspecific complaints are present in up to twenty percent of older people attending emergency departments. Such symptoms include weakness, fatigue, dizziness, confusion, recent falls, anorexia, gait disturbance and functional decline. These symptoms don’t convey enough information to follow a standard diagnostic pathway. Serious illness may present vaguely and misdiagnosis is common. Good assessment requires time and a meticulous approach, obtaining information from multiple sources. Understanding the patient in their biopsychosocial context, along with their goals-of-care enables tailored investigations, management and disposition.