The aim of the paper is to estimate the prevalence of symptomatic and asymptomatic peripheral arterial disease (PAD) in emergency department (ED) patients aged 50 years or more and to identify associated clinical and demographic factors. A prospective cross-sectional study was conducted at a single ED. The main outcome was estimated prevalence of PAD (ankle brachial index <0.9 in either leg). Demographic and clinical history data were collected. The San Diego Claudication Questionnaire (SDCQ), the Intermittent Claudication Questionnaire (ICQ) and the Kessler Psychological Distress Scale (K10) were also administered. Participants with a positive diagnosis of PAD were referred for further management and followed up by telephone. A total of 329 ED patients aged ≥50 years were screened. PAD prevalence was 10.3% (95% CI 7.5–14.1%). The prevalence of symptomatic and asymptomatic PAD was 6.4% (95% CI 4.2–9.6%) and 3.9% (95% CI 2.3–6.7%), respectively. PAD prevalence increased significantly with age rising to 25.7% (95% CI 17.0–36.7) among those ≥80 years. Multivariate analyses revealed that being aged ≥80 years (odds ratio [OR] 5.97, 95% CI 2.74–13.02), having a history of angina (OR 3.034, 95% CI 1.35–6.80) and being a former smoker (2.77, 95% CI 1.23–6.22) were the strongest predictors of PAD. In conclusion, targeted screening for PAD among the older ED population identifies ED patients with PAD.