British Geriatrics Society

Acute Medical Care for Frail Older People - RCP launches Acute Care Toolkit 3

The Royal College of Physicians (London) has published the third in a series of acute care toolkits.

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The toolkit (available for download from the BGS website - select [Reading by Subject / Acute Care] sets out recommendations around the assessment of frail older people in the acute setting. For example, it encourages the education of all staff working in the AMU to distinguish delirium from dementia by using, for example, the delirium toolkit or RCP guidelines (2006).

It provides a 30-second guide to identifying frailty syndromes, saying that the presence of one or more frailty syndromes should prompt consideration of a fuller assessment.

The toolkit recommends that services be configured to deliver early comprehensive geriatric assessment for frail older people and suggests the rotation of staff through community services to promote better understanding of the role of each sector and its pressures.

Models of Care

The toolkit recognises the various models of service provision for older people: needs-related, age-defined and integrated and makes several recommendations which need to be taken into account, regardless of the age-related model, for example: “Older people coming into contact with any healthcare provider or services following a fall - with or without a fragility fracture - should be assessed for immediately reversible causes and subsequently referred for a falls and bone health assessment using locally agreed pathways.” Another recommendation states that, “older people should not be routinely catheterised unless there is evidence of urinary retention.”

Education and Training

“The AMU is an ideal opportunity to augment training and education in geriatric medicine,” says the toolkit. Patients with frailty syndromes present at the AMU every day and all day. “Perhaps most importantly, clinicians in the AMU can model the behaviours necessary to implement geriatric expertise. For example: not attributing immobility to age alone; not ascribing every confusional state to urosepsis...” etc.

The toolkit sums up its purpose by reiterating what all geriatricians know - that older people are major users of acute care and that the AMU is the key to initial decision-making, education and training around the care of older people. It also has strong links with community health and social services and it is therefore important that it incorporates the geriatrics expertise to identify older people who may be safely managed in the community, the likely outcome of which will be improving patient outcomes and reducing hospital bed-days.