Quality care for older people with urgent and emergency care needs in UK emergency departments

Over the next 20 years, the number of people aged 85 years and over in the UK is set to increase by two-thirds, compared with a 10% growth in the overall population. Hospital episode statistics indicate that patients over 70 years of age accounted for 15.5% of attendances to emergency departments (EDs) in 2010–2011.1 The same hospital episode statistics data also show that patients aged 60 years or over account for 23% of attendances to the EDs and, compared with the 21–59 age group, are more likely to arrive by ambulance, have more investigations done and despite similar booking in and assessment times, spend a longer time in the ED. The admission rates for the over 60s is also higher compared with the 21–59 years age group and they currently account for 43% of all admissions to hospitals in England and Wales. A health service ombudsman's report2 drew attention to the poor quality of care provided to older people in healthcare settings. There is a pressing need to change how we care for older people with urgent care needs, to improve quality (including outcomes, safety and experience) and efficiency, and this needs to happen urgently. The multidisciplinary document ‘Quality care for older people with urgent and emergency care needs’ (the Silver Book),3 published on 20 June 2012, is a best practice guideline that describes the urgent care needs of older people and the competencies required to meet these needs within the context of the National Health Service in the UK, although the majority are universally applicable. The project was jointly led by representatives of the College of Emergency Medicine and the British Geriatrics Society and sponsored by another 11 signatory organisations that provided the membership and peer reviewed the document at several stages. Several other non-signatory organisations also provided crucial feedback …