Older people attending hospital benefit from specialist input. The value and importance of geriatrician and multidisciplinary team review within the emergency department and acute medical unit is recognised, and can help to prevent an unnecessary admission to hospital and ensure a person rapidly accesses the care pathway that they need. The ‘Silver Book’, developed by a multidisciplinary group of stakeholders, sets out the key aspects of care for older people in the first 24 hours of an acute episode.
Such services may be known as interface geriatrics, older persons’ assessment and liaison team (OPAL) or acute geriatrics and their precise method of care delivery will depend on the local set-up. They are likely to proactively identify patients with complex needs using screening tools or other local processes, and instigate early comprehensive geriatric assessment to formulate a treatment plan. They will have links with primary care, community, emergency response and social care services. Patients are managed proactively from the ‘front door’ of the hospital or before, facilitating goal-based planning that helps to reduce length of stay. Patients with more complex needs who would benefit from admission to an acute geriatric medicine ward can be identified, while those who may be suitable for early discharge can benefit from an early focus on this. The aim is to streamline the patient pathway through early assessment and planning. In order to facilitate this, access to the MDT is necessary soon after initial assessment.
Interface settings are one of the areas that have most potential to offer education and training around the needs of older people, due to the extent of the specialties and professionals involved. For example, joint multidisciplinary team meetings with the emergency or acute admission teams allow discussion of the optimal management of common presentations in older people and demonstration of good role modelling.