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It is often said visits to A&E units are rising rapidly. That is true, but it does not tell the whole story - as a new report shows.

Over the last four years the numbers attending A&E in England have risen by 11% to nearly 22m last year.

However, this has largely been driven by patients going to minor injury units and walk-in clinics, which are included in the national figures.

If you look at the 140 major A&E hospital trusts the numbers have been pretty steady.

So why have many hospitals been missing their waiting time target and, hence, said to be in crisis?

A by the Health and Social Care Information Centre sheds light on this.

Its report shows that there has been a small, but significant increase in the number of over-65s attending the major A&E units.

As a proportion of overall attendances they now account for 21% of the total - up from 19% four years ago.

This is likely to be largely driven by the ageing population, although some have suggested cuts in community health and social care budgets have made it harder to keep elderly people well,

In numbers terms it amounts to a surprisingly small amount of patients, about 150,000.

However, these people are more likely to need tests and monitoring and, therefore, take longer to see in A&E.

The change - described as a "subtle shift" by information centre chair Kingsley Manning - has meant standards have dropped.

Performance is measured by the proportion of patients who wait longer than four hours to be seen.

In 2008-9, just under 3% did, but by last year this had risen to just over 6% for major A&E units.

The NHS is meant to keep it below 5%.

The growth in older patients is, in effect, the straw that has broken the camel's back.