Competing interests The authors declare that they have no competing interests. Authors’ contributions TI, TI, TK, CN, TS, KT, SH, TN, TS, OT, TK, AH, and TS participated in the idea formation, study design, data analyses, interpretation of results and writing of the report. All the authors read and approved the final manuscript. Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-227X/13/24/prepub Acknowledgments We are greatly

indebted to all of the EMS personnel at the Osaka Municipal Inhibitors,research,lifescience,medical Fire Department and concerned physicians in Osaka City for their indispensable cooperation and support. Financial Proteasome inhibition assay support This research was supported by a grant for Emergency Management Scientific Research from the Fire Disaster Inhibitors,research,lifescience,medical Management Agency (Study concerning strategy for applying the results of Utstein report for improvement of emergency service). The study sponsors had no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the manuscript or in the decision to submit the manuscript for publication.
Currently Inhibitors,research,lifescience,medical older persons

make up an important group of patients served by Emergency Departments (EDs). The elderly have higher rates of utilisation of emergency services than other patient groups; in developed countries, older people represent 12% to 21% of all ED encounters [1]. The proportion

of older people aged 60 years and over is expected to rise from 19% in Inhibitors,research,lifescience,medical 2000 to 34% by 2050 [2], resulting in a commensurate increase in ED presentations by older persons. Awareness of the connection between ED use and the health of older people, has led to an increased focus on the quality of geriatric emergency medical care and patient outcomes [3-5]. Emergency practice is characterised by high volumes of high acuity and high complexity patients. This, Inhibitors,research,lifescience,medical combined with often-incomplete information and frequent interruptions, Isotretinoin creates an environment prone to error [6,7]. Older people have been identified as a particularly vulnerable population in ED, having substantially inferior clinical outcomes, with higher rates of missed diagnoses, and medication errors, when compared with younger, severity-matched controls [8-12]. Older persons discharged from ED are at high risk of adverse outcomes, such as functional decline, ED re-admission and hospitalisation, death, and institutionalisation [12-17]. While the quality of care for older people is a key issue, there may also be a need to consider older people with special needs as a separate sub-group as they may have some additional significant quality of care issues.