OBJECTIVE: To investigate demographic changes in attenders at an accident and emergency (A&E) department. METHODS: Patients attending Leeds General Infirmary A&E department in 1990 were compared with those attending in 1993 and 1994. Internal quality control suggested that 99% of patients were correctly registered for details of method of arrival, age, and departure (admission/discharge). RESULTS: By 1994 there had been a 6.9% increase in total numbers, including a disproportionate rise in elderly patient attendances. The overall number of patients admitted increased, as did the proportion of those attending the A&E department. There was a 28% increase in number of patients arriving by ambulance between 1990 and 1993, and this rose to 32% in 1994. CONCLUSIONS: The increasing number of new patients, especially elderly people, has implications for future planning of A&E departments. The expected demographic rise in the elderly population means that A&E departments must expect to receive more elderly patients. Our figures, if generally applicable, suggest that this is already occurring. Staffing requirements and the physical space necessary to care for these extra patients needs to take these figures into account. These factors are of relevance to both purchasers and providers.