Recommendation ID

Specialised units for older people:- What is the most clinically and cost effective way to configure services to assess frail older people who present to hospital with a medical emergency?

Any explanatory notes
(if applicable)

Why this is important:- Older people are more likely to be admitted for medical emergencies, and to stay longer in hospital, than younger people. This is because there is more multimorbidity, frailty and polypharmacy in older people. Hospital services have adapted to the growing population of older patients by introducing liaison services such as Frail Older Persons' Assessment and Liaison (FOPAL) services. These are now widespread, and share characteristics such as medication reviews and the use of
comprehensive geriatric assessments.
However, it is not clear whether there are additional benefits from admitting older people with
multimorbidity and frailty to a specialised elderly care assessment unit or an acute frailty unit.
Theoretical advantages could include better planning of investigation and diagnosis, multidisciplinary working, dedicated discharge teams, and direct links with community and social care. The question is important because of the potential for large reductions in length of hospital stays and readmissions, and improved quality of care. New units with varying designs are emerging throughout the NHS but there is currently no strong evidence for their effectiveness. [See the evidence review on admission through elderly care assessment units.]

Source guidance details

Comes from guidance
Emergency and acute medical care in over 16s: service delivery and organisation
Date issued
March 2018

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 31/03/2018