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The objectives of this study are to estimate the prevalence of weakness and fatigue visits in older emergency department (ED) patients, to compare demographics and resource use in these patients with those without these complaints, and to determine their ED diagnoses and disposition.We performed a cross-sectional cohort analysis of ED visits in patients aged older than 65 years from the 2003 to 2007 National Hospital Ambulatory Medical Care Surveys. Weakness and fatigue visits had a reason for visit code of generalized weakness (1020.0) or tiredness and exhaustion (1015.0); the comparison cohort lacked these codes. Descriptive data are presented as totals, means, and proportions with 95% confidence intervals (CIs). Comparisons between cohorts used χ2 for proportions and the adjusted Wald test for means.There were an estimated 575 million ED visits, those aged 65 years and older made 14.7% (95% CI, 14.2-15.3) of visits. Overall, 6.0% (95% CI, 5.6-6.4) of these visits had weakness and fatigue; this was the fifth most common primary reason for visit. Weakness and fatigue visits increased with age. Weakness and fatigue visits had longer ED lengths of stay (300 vs 249 minutes, P < .001), more diagnostic tests (7.7 vs 5.0, P < .001), procedures (5.7 vs 4.7, P < .001), and hospital admissions (55% vs 35%, P < .001). The most common primary diagnoses for the weakness and fatigue cohort were “other malaise and fatigue,” pneumonia, and urinary tract infection.Weakness and fatigue are common in older ED patients. These patients undergo more tests and procedures, and most are admitted.We reviewed 5 years of data from the National Hospital Ambulatory Medical Care Survey.Weakness and fatigue were the fifth most common ED visit for older patients.This cohort receives more diagnostic tests than those without weakness and fatigue.Most older patients with weakness and fatigue are admitted to the hospital.