OBJECTIVE To determine the use pattern of the emergency department by people 65 years of age and older. METHODS Cross-sectional survey from chart audits and personal interviews of all people older than 64 years attending an emergency department in a Canadian teaching hospital. METHODS All patients older than 64 years attending the emergency department during the months of February, May, August, and November. Comparison samples of adults aged 16 to 64 years attending the same emergency department and patients older than 64 years attending the emergency department of a similar hospital during the same period were obtained. RESULTS Fifteen percent of the total population attending the emergency department in 1 year were 65 years of age and older (N = 1744). The average age was 75 years; 57% were female, 53% were married, and 40% were widowed. Eighty-four percent lived in their own homes and 6% lived in nursing homes. Twenty-two percent were classified as emergent, 75% as urgent, and 3% as deferrable; 45% were admitted. The discharge diagnoses were widely divergent, with the most common being soft-tissue injury (9.1%), fracture (7.1%), arteriosclerotic heart disease (6.1%), congestive heart failure (4.1%), and abdominal pain (3.4%). Patients tended to appear in the emergency department more frequently during the day shift (60%) and less frequently on weekends. Forty-five percent had never attended the emergency department or been admitted to hospital in the previous year; 30% had attended or been admitted once. CONCLUSIONS Elderly persons do not misuse the services of the emergency department. They come because they are acutely ill; they are not frequent attenders, and their presenting complaints do require intervention (frequently hospitalization). The study findings are generalizable to the older population in the Hamilton-Wentworth region and raise such questions as whether some hospital admissions could have been avoided by earlier interventions in the community.