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Silver Book

Health and Social Care Services Must Adapt to Meet Older People’s Urgent Care Needs

Health and social care services must adapt to meet the urgent care needs of older people, argues a multidisciplinary group of stakeholders which today launches the Silver Book. This is a set of quality standards for the emergency care of older people. The launch coincides with the first ever Acute Medicine Awareness Day. 

More older people than ever before 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.  Attending an Emergency Department is associated with a high risk of admission for older people.  Not only are older people admitted to hospital more frequently but they stay in hospital longer than other patient groups.

The Silver Book 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 including: primary care – in and out of hours; ambulance services; emergency departments; urgent care units – including minor injury units and walk-in-centres; acute medical units and community hospitals.

A core focus of the Silver Book 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 Silver 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.  It also encourages greater use of the voluntary sector.

Jay Banerjee, lead author of the Silver Book said: “We need to change how we care for older people in an emergency.  At the moment services are too fragmented and poor communication between different clinical settings and professionals is affecting the quality of care older people receive.  The Silver Book explains what services and skills are needed to ensure high quality care for older people in an emergency, leading to better outcomes for patients and a more efficient health and social care service.”

Matthew Cooke, National Clinical Director for Urgent and Emergency Care, Department of Health and Professor of Emergency Medicine at Warwick Medical School said: “The nature of 21st century healthcare is changing.  The majority of people cared for by NHS services are older and increasingly frail as they live with multiple long-term conditions.  It is essential that emergency and urgent care services respond appropriately to their often more complex needs.  The Silver Book provides necessary and important guidance to support all those involved in delivering emergency care to meet the needs of older patients and to promote continuous improvement in the standards of care.”

For more information and interviews with the authors of the Silver Book please contact Iona-Jane Harris on 07807 231432 or Tom Thorpe on 07766 227724 or email .

Notes to Editors

1.The Silver Book has been developed by a multidisciplinary group of stakeholders including:

  • Age UK
  • Association of Directors of Adult Social Services
  • British Geriatrics Society
  • Chartered Society of Physiotherapy
  • College of Emergency Medicine
  • College of Occupational Therapists
  • Community Hospitals Association
  • National Ambulance Services Medical Directors
  • Royal College of General Practitioners
  • Royal College of Nursing
  • Royal College of Physicians
  • Royal College of Psychiatrists
  • Society for Acute Medicine

Specialist Advisors:

  • Matthew Cooke, National Clinical Director for Urgent & Emergency Care
  • David Oliver, National Clinical Director for Older People
  • Alistair Burns, National Clinical Director for Dementia

The lead authors are Jay Banerjee, College of Emergency Medicine, University Hospitals of Leicester NHS Trust and Dr Simon Conroy, British Geriatrics Society, University of Leicester.

2.All the stakeholders involved will be promoting the quality standards and building on the recommendations of the Silver Book to improve urgent care for older people.  The Silver Book is available to download from the British Geriatrics Society’s website: and is also available via other stakeholders’ websites.


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