Of all the reasons older adults find themselves in an emergency room, abdominal pain comes in third place for adults over age 65, representing 6.6% of all visits nationally—just behind chest pain (7.8%) and shortness of breath (7.1%).
And according to research, those gut pains shouldn’t be taken lightly. In fact, 60% of older adults presenting to the emergency department with abdominal pain will be admitted to the hospital, 20-30% will require surgery, and five to 10 will die from their disease.
But why are abdominal conditions so serious for older adults? It turns out that physical changes associated with aging cause numerous subtle and delayed presentations of serious abdominal disease in older adults.
For example, most older adults take multiple medications, which blunts the body’s compensatory mechanisms. Plus, specific medications can be problematic: Narcotics for pain management mask pain, which is the body’s natural alarm system, and beta-blockers artificially normalize vital signs even if something is askew internally.
Also, older adults present differently than younger adults do—both in terms of pain as well as other hallmark symptoms like fever, nausea and vomiting. Older adults take longer to develop pain, or may not develop pain at all during an acute abdominal emergency. They may present with only a fever or nausea (with or without vomiting). Sometimes, they may arrive at the emergency department with seemingly unrelated thoracic complaints when the underlying cause is actually an acute abdominal emergency.
Types of abdominal pain and the emergencies they might signify in older adults
Abdominal pain should always be taken seriously, especially if the pain is unusual for your loved one. Remembering that older adults present with very different symptoms than younger adults can mean the difference between life and death. Read the table below and stay vigilant and alert for any of the symptoms in your loved one:
|Upper abdominal pain or pain in the upper abdomen near the rib cage||Heart failure, heart attack, cardiac arrest|
|Bloating/distention, nausea, vomiting and possibly a mass (even if it’s difficult to palpate or physically feel), tenderness all over the abdomen, colicky pain (i.e., sharp, localized pain that comes abruptly and tends to come and go in spasm-like waves) in numerous locations in the belly||Small bowel obstruction|
|Pain in the right side of the abdomen that’s ongoing and intensifying over time, often associated with fever and vomiting||Cholecystitis|
|Bloating/distention, rigid abdomen, decreased bowel sounds and a mass; possible fever (research has shown that only 23% of older adults present with fever)||Appendicitis|
|Nausea, vomiting or diarrhea, and malaise (general feeling of discomfort, illness or uneasiness whose exact cause is difficult to identify)||Pneumonia|
|Temporary loss of consciousness accompanied with abdominal, flank, back, groin or scrotal pain, particularly accompanied by hypotension (low blood pressure), often easily confused for a kidney stone, especially if there is blood in the urine.||Abdominal aortic aneurysm|
|Abdominal pain with a sudden and severe onset (up to 50% of elderly patients have a gradual onset), localized to the lower abdomen||Perforated peptic ulcer|
When to be concerned about abdominal pain
If the pain is sudden, severe and doesn’t ease within 30 minutes, seek emergency medical care.
- Sudden pain: Although benign diseases such as gallstones can cause sudden abdominal pain, this type of pain is often an indicator of a serious intra-abdominal disease, such as a perforated ulcer or a ruptured abdominal aneurysm. This is an emergency. Call 911.
- Severe pain that (3.) does not ease within 30 minutes: Severe abdominal pain that’s continuous – or abdominal pain accompanied by continuous vomiting – can point to a serious or life-threatening condition, like an aneurysm or a perforated peptic ulcer.
When in doubt, always call 911, regardless of duration, extent or type of pain.
In general, older adults with abdominal pain should go to the nearest emergency department. The sheer complexity of abdominal pain in older adults places the condition above the care level of an urgent care center.
The sheer complexity of abdominal pain in older adults places the condition above the care level of an urgent care center.
You should also seek emergency care if your loved one’s severe stomach pain is accompanied by any of the following symptoms:
- A feeling of lightheadedness or that they could faint
- Dark or black stool
- Difficulty breathing or chest pain
- Irregular heartbeat
- Unable to eat without vomiting
- Vomiting blood
- Abdomen that’s tender to the touch
- Pain that extends to the back
- Debilitating pain that prevents standing
Preexisting conditions that make abdominal pain even more dangerous
Certain medical conditions make abdominal pain an even more serious event, especially in older adults.
If your loved one has abdominal pain and any of these medical conditions, call 911 or visit an emergency department immediately:
- Recent surgery in the abdomen
- Upper abdominal pain or tightness in the chest (may indicate a heart attack)
- Recent gastric bypass surgery
- Recent endoscopy, colonoscopy or abdominal surgery
Once in the emergency department, be sure to notify the care team of any past surgeries to the abdomen right away.
Every minute counts when it comes to abdominal pain and your loved one, so don’t second guess yourself. If you’re wondering if it’s serious, it is—call 911 or go to the ER.
NOTE: This article is not meant to substitute for medical advice. Always call 911 if there is any hesitation or question about abdominal pain in your loved one.