Older people and frailty in the emergency department

Purpose of review Our population is ageing and this is driving rising emergency department (ED) attendances and critical care use. Frailty, not age, is the key predictor of outcomes and brings complex, multidimensional needs. However, emergency care systems were designed around single-issue presentations. This review highlights why frailty-attuned emergency care is timely and relevant, and examines evolving approaches aimed at improving person-centred outcomes. Recent findings Frailty affects a substantial proportion of ED patients and is associated with poorer outcomes including mortality, longer stays, and higher admission rates. Meaningful outcomes prioritize quality rather than necessarily longevity of life. Geriatric emergency medicine promotes holistic assessment, multidisciplinary involvement, and goal-oriented care, but many centres are still being reconfigured to provide for this. Meanwhile, systems can work to implement frailty screening and attuned triage, encouraging use of person-centred and pragmatic approaches based on shared decision-making to support appropriate resource use and alignment of care with patient values. Summary Frailty-attuned geriatric emergency care involves cohort identification, broadened assessment, and goal-based person-centred decision-making. These principles can be integrated as the basis for meaningfully grounded quality improvement and service design.