Hate to admit it, but my dad is a perfect example of an older man who may need to be told "no" when he goes to the ER. He thinks he knows more than his doctors and refuses to take his meds or listen to them about anything else until he finds himself in serious problems. He recently had to spend 10 days in the ICU due to his not taking his blood thinner.
Jack, a lot of older people don't think that they necessarily know better than docs, they just get tired of paying for and taking a bunch of meds, and that causes the problems.
As for doctors knowing it all, during my wife's illness, I found a number of docs that made mistakes treating my wife, and a number of docs that had a helluve ego and 'knew what's good for you' Ultimately, you, the patient, are responsible for your health.
It's too bad, there aren't enough Geriatric physicians out there. The reducing of Medicare payments for the elderly sure won't help. I won't even talk about the Health Care Law!