Overview

Quality Care for Older People with Urgent & Emergency Care Needs or “The Silver Book” contains a set of quality standards for the emergency care of older people across all areas, including primary care, out of hours services, ambulance services and hospital-based emergency units of all types.

Eight standards cover a range of issues that are seen as critical to good, timely care for older people. These issues include:

  • Timely clinical assessment (including a Comprehensive Geriatric Assessment in the presence of identified frailty);
  • Maximum response times in primary care, ambulance services and A&E;
  • Access to specialist mental health assessment;
  • Referral to falls and bone health services.

In addition to recommendations across the different settings of care, the Silver Book provides guidelines for assessment and management within the first 24 hours.  This covers the Frailty Syndromes and related conditions and problems.

The Silver Book also pays particular attention to the skills and competencies required by health and care staff in order to properly identify, assess and manage frailty.  These include:

  • Managing complex multi morbidity;
  • Polypharmacy;
  • Multidisciplinary team working skills;
  • Having appropriate levels of knowledge about community services, in order to inform patient focused discharge planning.

The Silver Book also addresses the need for greater use of older people liaison services (OPAL) and the voluntary sector within emergency units, in order to increase the number of older people who could be managed adequately in the community.

The Silver Book can be found by following the link here and viewed below:

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There is also a shorter ‘lite’ version which can be accessed here and also viewed below:

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Background to the Silver Book

The Silver Book was published in 2012 by representatives from a number of organisations involved in health & social care:

British Geriatrics Society

Royal College of Emergency Medicine

National Ambulance Service Medical Directors

Age UK


Association of Directors of Adult Social Services

Chartered Society of Physiotherapy

College of Occupational Therapists

Community Hospitals Association

Society for Acute Medicine

Royal College of General Practitioners

Royal College of Nursing

Royal College of Physicians

Royal College of Psychiatrists

The publication answered a pressing need to comprehensively address how older people should be cared for in the first 24 hours after presenting with an urgent/emergency care need. Research showed that for older people (generally taken to mean those aged 65 yrs or more), going to A&E was associated with an increased risk of admission, a longer stay in hospital and delays in the accurate diagnosis of their problem when compared to younger people.