Erythrocyte sedimentation rate (ESR) despite being a fast and cheap test to evaluate acute phase response, has low sensitivity and specificity. Atypical courses and lack of specific signs and symptoms of the diseases in elderly restrict the use of ESR for diagnosis. We aimed to determine clinical importance and possible etiologies of markedly elevated ESR in older adults.

One thousand six hundred and eighty-two patients consecutively admitted to Ankara University School of Medicine Geriatric clinics were evaluated. A hundred and ten patients with ESR more than 80mm/h were included into study and evaluated for the possible causes of ESR elevation.

Etiology of elevated ESR was due to infectious diseases in 53 (48.2%), malignancy in 19 (17.3%), and collagen tissue diseases in 17 (15.5%) patients. Some of the etiologies coexisted in 10 (9.1%) patients. No specific etiology was detected in 31 (28.2%) patients. Among infectious diseases, pneumonia (n=20/53, 37.7%) was the leading cause followed by urinary tract infections (UTI) (n=17/53, 32.1%). Multiple myeloma (n=7/19, 36.8%) was the leading cause among malignancies. Rheumatoid arthritis (n=10/17, 58.8%) was the leading cause among collagen tissue diseases. Leukocyte count and C-reactive protein levels are useful to determine infectious diseases as a cause of markedly elevated ESR.