The hospital emergency department has become a very important access point for health care for elderly persons and this trend will likely continue. The emergency room serves as the site of hospital entry for many patients, with scheduled admissions largely restricted to elective surgical procedures. Elderly patients are more likely to enter the hospital via the emergency room than younger patients (Sanders). Typically, the overall hospital admission rate from an emergency room will be 10 to 30 percent, but admission rates in the population over sixty-five may exceed 40 percent.Due to twenty-four-hour availability and the access to hospital-based technology, the emergency room has become an attractive site for patients with nonemergency medical problems. Call sharing by primary care physicians and their relative decline in numbers may result in increased emergency department use, although elderly persons are more likely to have a personal physician than are younger patients.The emergency room has also become a safety net when a smooth transition from one health care facility or state of health is disrupted. With reductions in hospital length of stay, and the general patchwork of available home care, the emergency room has reluctantly assumed this role.Numerous studies have confirmed the appropriateness of emergency room utilization by the elderly population (Gold and Bergman). Elderly adults tend to have multiple medical conditions, atypical presentation of common diseases, and significant issues in caregiver support, requiring complex assessment in the emergency room and high admission rates to hospital. Use of emergency medical services (ambulances) is also higher in the elderly population (Moir et al.). Although concerns have been raised about the appropriate use of ambulance services, often there are few alternatives for elderly adults because of limited transportation services, mobility problems, and the decline of the primary care physician house call.Due to high visit volumes, all emergency rooms utilize a triage system to sort patients by severity of illness or injury. This system inevitably results in waiting periods, especially for those with less acute problems. This can be frustrating for patients and family. Attempts should be made to make the emergency room environment more receptive to the needs of the elderly patient. A visit to the emergency room may be a key decision point in the health care of an elderly person. The decisions made during this visit may result in hospital admission, consideration of admission to a long-term care facility, or significant alterations in the home environment.The medical history is a key component to the evaluation. This can be challenging and time consuming in a busy emergency environment. Obtaining a collateral history from family members, consulting with the primary care physician, and a review of all health records are critical. A precise review of current medication is important due to the high rate of polypharmacy in elderly persons and should include the use of over-the-counter medication.