All staff working in acute medical units (AMUs) will be familiar with the increasing number of frail older people requiring access to acute care. The AMU provides a key role in identifying the urgent and important issues which, if addressed accurately and comprehensively, will improve patient outcomes. Accordingly, acute medical teams need to possess the knowledge and skills, and demonstrate the appropriate behaviours, for managing frail older people.

One of the challenges is that of non-specific presentations, such as delirium, that can mask serious underlying pathology. Delivering a holistic assessment in the AMU is difficult for acute teams, with large numbers of patients to see quickly. Geriatric liaison teams, which have the skills and time to focus on frail older people, can be helpful. Better integration between primary care, emergency departments, AMUs and geriatric services, all working towards achieving high standards of urgent care, should reduce duplication and improve outcomes.

This toolkit, the third in a series on acute care, recommends procedures for both initial assessment on admission and later comprehensive geriatric assessment (CGA).