Urgent care for older people

Geriatric medicine is the clinical speciality that focuses upon the care of older people – especially those with frailty (a state of increased vulnerability). In hospital, older people living with frailty are at high risk of developing a range of unpleasant outcomes such as delirium, falls, fractures, pressure sores and death.

Comprehensive Geriatric Assessment is a form of holistic care that incorporates a specific set of clinical competencies that are able to reduce these adverse outcomes. Over the years, geriatric medicine has moved from being more of a community-based service towards a more acute speciality – encroaching now upon emergency department care. The challenge now is to work out how best to deliver geriatric care across the whole hospital (older people with frailty are not just cared for in geriatric wards!).

This collection outlines key articles that are attempting to develop solutions to this challenging conundrum. We hope that you enjoy reading them.

A full commentary has been published in the Age and Ageing journal to accompany this collection.

1. What is Comprehensive Geriatric Assessment (CGA)? An umbrella review. S G Parker, P McCue, K Phelps, A McCleod, S Arora, K Nockels, S Kennedy, H Roberts, S Conroy

2. The validation of a care partner-derived frailty index based upon comprehensive geriatric assessment (CP-FI-CGA) in emergency medical services and geriatric ambulatory care. Judah Goldstein, Ruth E. Hubbard, Paige Moorhouse, Melissa K. Andrew, Arnold Mitnitski, Kenneth Rockwood

3. Frailty status at admission to hospital predicts multiple adverse outcomes. Ruth E. Hubbard, Nancye M. Peel, Mayukh Samanta, Leonard C. Gray, Arnold Mitnitski, Kenneth Rockwood

4. Identifying frailty in the Emergency Department—feasibility study. Amy Elliott, Kay Phelps, Emma Regen, Simon Paul Conroy

5. The predictive properties of frailty-rating scales in the acute medical unit. Franklin Wou, John R. F. Gladman, Lucy Bradshaw, Matthew Franklin, Judi Edmans, Simon Paul Conroy

6. The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency. Opinder Sahota, Ruth Pulikottil-Jacob, Fiona Marshall, Alan Montgomery, Wei Tan, Tracey Sach, Pip Logan, Denise Kendrick, Alison Watson, Maria Walker, Justin Waring

7. The oral health status of older patients in acute care on admission and Day 7 in two Australian hospitals. Jennifer Mary Gibney, Clive Wright, Anita Sharma, Mario D'Souza, Vasi Naganathan

8. Nutritional screening of older people in a sub-acute care facility in Australia and its relation to discharge outcomes. Renuka Visvanathan, Robert Penhall, Ian Chapman

9. Delirium risk stratification in consecutive unselected admissions to acute medicine: validation of a susceptibility score based on factors identified externally in pooled data for use at entry to the acute care pathway. Sarah T. Pendlebury, Nicola G. Lovett, Sarah C. Smith, Rose Wharton, Peter M. Rothwell

10. Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study. Kirsty Hendry, Terence J. Quinn, Jonathan Evans, Valeria Scortichini, Hazel Miller, Jennifer Burns, AnneLouise Cunnington, David J. Stott

11. Major depression among medically ill elders contributes to sustained poor mental health in their informal caregivers. Jane McCusker, Eric Latimer, Martin Cole, Antonio Ciampi, Maida Sewitch

12. Improving patient safety for older people in acute admissions: implementation of the Frailsafe checklist in 12 hospitals across the UK. Chrysanthi Papoutsi, Alan Poots, Jake Clements, Zoe Wyrko, Natalie Offord, Julie E Reed

13. Can comprehensive geriatric assessment be delivered without the need for geriatricians? A formative evaluation in two perioperative surgical settings. David Kocman, Emma Regen, Kay Phelps, Graham Martin, Stuart Parker, Thomas Gilbert, Simon Conroy

14. Outcomes of Mobilisation of Vulnerable Elders in Ontario (MOVE ON): a multisite interrupted time series evaluation of an implementation intervention to increase patient mobilisation. Barbara Liu, Julia E Moore, Ummukulthum Almaawiy, Wai-Hin Chan, Sobia Khan, Joycelyne Ewusie, Jemila S Hamid, Sharon E Straus, on behalf of the MOVE ON Collaboration

15. A controlled evaluation of comprehensive geriatric assessment in the emergency department: the ‘emergency frailty unit’. Simon Paul Conroy, Kharwar Ansari, Mark Williams, Emily Laithwaite, Ben Teasdale, Jeremey Dawson, Suzanne Mason, Jay Banerjee