Quality care for older people with urgent and emergency care needs: the silver book

SCIE Social Care Online
British Geriatrics Society
Publication date:
01 January 2012


Despite the majority of urgent care being delivered in the primary care setting, an increasing number of older people are attending emergency departments and accessing urgent care services. There is a pressing need to address how older people are cared for over the first 24 hours of an urgent care episode. The aim of this book is to address the care for older people, specifically frail older people, during the first 24 hours of an urgent care episode. It recommends ways in which emergency admissions can be reduced and the experience of those admitted improved. It considers all the clinical contacts which a patient might have during an emergency and suggests minimum standards and responses for each service. A core focus is the skills and competencies needed by healthcare staff to ensure they are better able to assess and manage frail older people. This includes: appropriate communication skills (both with patients and other health and social care professionals); clinical reasoning and assessment skills in respect of complex co-morbidities, poly-pharmacy and altered physiological response to trauma and illness; and risk management skills surrounding discharge planning with knowledge of community services. The book suggests that in acute medical units, greater use of geriatric liaison services should increase the proportion of older people able to be managed in community settings.