Illness wears a disguise after 75

In a younger adult, a chest infection announces itself with cough and fever. In a frail older person, the same infection may show up as none of that — just a fall in the night, a refusal of breakfast, or a sudden inability to find the right words. Bodies with less reserve signal trouble in quieter, stranger ways, and that single fact shapes everything about emergency care for older people.

It also makes the accompanying relative or carer unexpectedly important. You know what "normal" looks like for this person. The staff do not. This guide is written mainly for you, the companion — though much of it applies if you are the older patient yourself.

The presentations to take seriously

A fall is never "just a fall." It is the commonest reason over-65s come to A&E, and the question that matters is why it happened: a trip over the cat is one thing, but faints, new dizziness, infection and medication effects all masquerade as trips. Falls also carry outsized consequences — hip fractures, and head knocks that can bleed slowly inside the skull for days, a particular risk for anyone on blood thinners. Our head injuries guide and broken bones guide cover when a fall needs emergency care.

New confusion is an alarm bell, not an inevitability. A person who is suddenly more muddled, drowsier or more agitated than last week has delirium until proven otherwise — usually driven by something fixable: infection, dehydration, a medicine, constipation. It is never "just their age", and it is just as significant in someone who already lives with dementia, where the tell is a change from their baseline.

Quiet decline counts too. Stopping eating and drinking, new unsteadiness, sleeping through the day, "not being themselves" — vague as they sound, these are how serious illness often presents in frailty, and they deserve assessment. If you are unsure whether A&E is the right response, NHS 111 can arrange alternatives such as an urgent GP contact or a community rapid-response team, which for a frail person is sometimes the kinder route.

Packing: the extras that matter

Start from our general packing checklist, then add the items that make or break an older person's visit:

  • The medicines, or photos of every box. Older patients commonly take five or more drugs, and those drugs cause or complicate a large share of their emergencies. The actual boxes or blister packs are the most reliable record there is.
  • Glasses, hearing aids and dentures — each in a named case. These three items go missing in hospitals constantly, and losing them turns a capable person into a disoriented one.
  • Their own walking aid. Familiar equipment beats whatever the department can find.
  • Something warm. Waiting rooms run cold, and older bodies lose heat fast.
  • A one-page crib sheet: diagnoses, past operations, allergies, the GP practice, and contact details for any carers, district nurses or social workers involved. Write it now, before you need it.
  • Continence supplies, if used — having their own preserves dignity during a long wait.

Your job at the bedside

Paint the "before" picture

The single most valuable thing a companion does is describe baseline. Triage readings mean little without context: a blood pressure that is "normal" may be far below this person's usual; "confused" means nothing unless staff know she chaired the book club on Thursday. Make the contrast explicit — "Ten days ago he walked to the shop daily; today he can't cross the room" — and repeat it to each new clinician. This is not being pushy; it is how triage works best.

Flag the hidden needs

Tell staff early which ear hears better, that he needs his glasses to sign anything, that she is diabetic and due lunch, that he normally needs prompting to drink, that she gets anxious in noise. Small facts, large consequences over a six-hour visit.

Stand watch for delirium

Hospitals, ironically, are perfect delirium incubators: bright lights, alarms, thirst, pain, missed meals, no day-night cues. Watch for rising agitation, new drowsiness, seeing things, or a mind that flickers in and out. Report changes immediately — delirium is a medical emergency that responds best to early treatment — and meanwhile do the low-tech things that genuinely help: stay in view, remind them where they are and why, keep the hearing aids in and the water within reach.

Guard comfort during the wait

Ask for a trolley or recliner if hard chairs are causing real distress; ask about pressure-area care if they cannot shift their own weight; ask whether they may eat and drink (and if so, keep it coming); ask for pain relief on their behalf — older patients famously under-report pain.

The decisions at the end of the visit

For older patients the closing question is rarely just "what is the diagnosis?" but "can this person manage at home tonight?" Expect staff to weigh stairs, toileting, cooking, medication management and existing care arrangements alongside the medical findings. Be honest here — an over-optimistic account of coping at home sets up a failed discharge and a return visit within days.

Two useful things to know:

  • Admission is not automatically the safe option. Hospital stays carry their own dangers for frail people — muscle loss sets in within days, infections circulate, unfamiliar wards feed confusion. Many trusts now run hospital-at-home or rapid community-support teams that can put extra care in place within hours; it is always worth asking, "Is there a way to support them at home instead?"
  • Discharge is a handover, not an ending. Before leaving, get clear answers to: what changed with the medicines, what symptoms should bring us back, who follows up and when? If the visit involved a fall, ask for a referral to the local falls-prevention service. Then make sure the GP practice knows about any medication changes within a couple of days — the hospital-to-home transition is where errors creep in. Our after your visit guide covers the follow-through in full.

Watch closely for a week after discharge: recovery is slower at this age, and creeping confusion, poor drinking or fading mobility are reasons to seek help again, not to wait and see.

When the pattern keeps repeating

Three A&E visits in two months is a message. Often the underlying problem is not one illness but an unravelling situation — medicines that need a proper review, care that no longer stretches far enough, or plain loneliness, which is strongly tied to repeat attendance. The GP is the place to take that message: ask about a medication review, a frailty or falls assessment, and social-prescribing links to local support such as Age UK. Fixing the situation prevents more emergencies than any wait-time tactic ever will.

Key takeaways

  • Falls, new confusion and quiet decline are how emergencies present in older people — treat changes from baseline as significant.
  • Pack the medicine boxes, the glasses–hearing-aids–dentures trio in named cases, and a one-page history.
  • Your description of "what normal looks like" is clinical gold: give it at triage and to every clinician after.
  • Watch for delirium during the wait and report it straight away.
  • At discharge, nail down medication changes, red flags and follow-up — and if visits keep recurring, take the pattern to the GP. When a trip is unavoidable, compare local waits first to spare them the longest queues.