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In 2016, there were 49.2 million people age 65 and over in the United States, accounting for 15% of the population [32]. By 2030, the number is projected to represent nearly 21% of the total U.S. population [33]. This population represents high‐volume users of the EMS system [34]. Compared to younger patients, geriatric patients have higher mortality when admitted to a hospital with abdominal pain and a higher rate of surgical intervention [34–36]. One third of elderly patients who present with abdominal pain require surgery, as compared with 10% for other adult patients [37].

The higher mortality rate in geriatric patients is due to several factors. Elderly patients delay seeking medical care for abdominal complaints and will often present later in their disease processes than younger patients. They tend to have more vague symptoms, which can make the evaluation difficult. The elderly have a decreased perception of abdominal pain [38]. Because of this, many elderly patients with significant underlying pathology are misdiagnosed with benign conditions.

Use of medications such as beta‐blockers, nonsteroidal anti‐inflammatory drugs, pain medications, anticoagulants, and steroids are more common in this population. In addition, other physiologic responses including fever, immune responsiveness, rebound tenderness, and laboratory abnormalities may not be as prominent in the older patient. Complex medical problems predispose this population to certain conditions, such as abdominal aortic aneurysm and mesenteric ischemia.

Common diagnoses found in the geriatric population with abdominal pain include diverticulitis, diverticulosis, small bowel obstruction, volvulus, malignancy, perforated viscous, urinary tract infection, appendicitis, and biliary tract disease. This list is not all‐inclusive. As mentioned previously, cardiac or pulmonary pathology can also present as abdominal pain, and must be entertained based on the patient’s history and physical exam. Additional historical information about abdominal pain as related to food intake, vomiting and/or diarrhea, melena or bright red blood per rectum, previous abdominal surgeries, fever, sick contacts, and other areas of pain should be elicited. Focus is necessary on the cardiac, pulmonary, and abdominal components of the physical exam. Cardiac and pulse oximetry monitoring is recommended.