14 Chapter 1 Olderadults insocietyandintheemergencydepartment Although there are commonly used definitions of old age, there is no agreement on the age at which a person becomes an older adult. Most developed countries worldwide accept the age of 65 years to define older adults (5), and the United Nations has defined older adults as those aged 60 or 65 years or over (6). The proportion of older adults in the Netherlands has steadily increased after the second world war (7). Moreover, the average age of the older population in the Netherlands has become increasingly high. In the twentieth century, the number of adults over 65 years increased more than tenfold: from 0.3 million in 1900 to 3.4 million in 2020 (8). This resulted in a rising share of adults over 65 years in the total population, from 6% (in 1900) to 19.5% (in 2020) (8). In addition, almost a quarter of adults over 65 years old are older than 80 years (8). The proportion of people aged 65 and older in the Netherlands (19.5%) is comparable to the European average (20%) but higher than that in Australia (16%) and the United States (16%) (9). Compared to young adults (18-60 years), older adults (65 years and older) present to EDs with a higher level of emergency and more serious medical illnesses (10). They often present with nonspecific complaints and have cognitive and functional impairment, multimorbidity and polypharmacy (11). Compared to younger patients, they require transport by ambulance more often, utilize more diagnostic resources and have a longer duration of stay at the ED (12). They are 2.5 to 4.6 times more likely to be hospitalized and have a fivefold higher admission rate to the intensive care unit (13), although hospitalization has been shown to carry significant risk for older adults (14). They are also more likely to be misdiagnosed and consequently are more frequently discharged with unrecognized and untreated health problems (12). Studies have shown that many of these patients have repeat ED visits in the following months (15, 16).
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