The percentage of elderly patients presenting to EDs will continue to provide some of the greatest challenges to our profession. The high incidence of atypical presentations in the elderly, the close association of fever with bacterial infection, the prevalence of chronic disease, and an aging immune system all mandate special care in dealing with this fragile population.

There are several key principles that direct the care of the geriatric patient: Serious disease may occur despite a relatively benign exam; functional decline may be the only clue to grave infection; and temperature elevations may be marginal. The emergency physician should always consider pneumonia, urinary tract, and soft-tissue infections in the differential diagnosis. Use laboratory and radiographic tests liberally, and maintain a low threshold for admission. When discharging an elderly patient with fever, always ensure close follow-up. Administer antibiotics early! With these principles in mind, emergency physicians will more successfully navigate the turbulent waters of geriatric infectious disease.