The ESR is commonly used to assess the acute phase response. It is most useful among patients in whom the probability of disease is moderate following initial history-taking and examination. In this study, we examined retrospectively the patients admitted to our hospital to lighten the cause of a high ESR and accompanying anemia and compared the results between the geriatric population and younger adults. There were 139 patients between ages of 16 and 89 years. Of them, 51.7% were elderly. In 80 patients (57.6%) a specific underlying pathology as a possible cause of elevated ESR was found. Malignancy was the leading cause (21.6%), followed by infectious disorders (10.1%), collagen vascular diseases (9.4%), and non-neoplastic hematologic disorders (5.0%). In 59 patients (42.4%) no specific pathology could be found. There were no statistically significant differences between elderly and non-elderly patients according to the diagnostic groups. Elevated ESRs, while more prevalent in the elderly than in younger individuals, have a similar pathological significance. But as clinical conditions in the elderly are usually obscure, we should be more careful to investigate the issue of high ESR in geriatric population, even when they are asymptomatic. (C) 2009 Elsevier Ireland Ltd. All rights reserved.