Posterior epistaxis most commonly affects the elderly (>60 years) due to the increased fragility of blood vessels and the presence of comorbidities such as hypertension and atherosclerosis, which predispose to arterial bleeding. In contrast to anterior epistaxis, which typically arises from Kiesselbach’s plexus in younger patients, posterior bleeds often involve branches of the sphenopalatine artery. Management often requires surgical intervention such as cauterization or artery ligation because posterior bleeds are usually more severe and less accessible than anterior bleeds. Prompt recognition in the elderly is critical for effective control and prevention of complications.

Reference: Cummings Otolaryngology, 7th Edition.