Silver Book: Quality Care of Older People with Urgent and Emergency Care Needs (University of Leicester)

[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 2 Issue 12, July 2012].


Older people seldom have one single condition; they frequently have multiple physical and mental health problems. This “Silver Book” is a comprehensive review of the clinical and social problems likely to be encountered by older people over the first 24 hours of an urgent care episode. The authors produced this review to help decrease variations in practice and influence the development of appropriate urgent care services and policy. The overall aim is to identify and spread best practice. Comprehensive standards are proposed for a “whole system approach”. This document is an important reference for people commissioning these services.

“Over the next 20 years, the number of people aged 85 and over is set to increase by two-thirds, compared with a 10 per cent growth in the overall population. Recent national reports including those from Patient UK, Care Quality Commission, NCEPOD and the Health Service Ombudsman highlighted major deficiencies in the care of older people in acute hospitals ranging from issues around privacy and dignity to peri-operative care. Older people are admitted to hospital more frequently, have longer length of stay and occupy more bed days in acute hospitals compared to other patient groups. There is a pressing need to change how we care for older people with urgent care needs, to improve quality, outcomes and efficiency. Emergency departments need to be supported to deliver the right care for these patients, as no one component of the health and social care systems can manage this challenge in isolation; implementation of improved care for older people requires a whole system approach”. (p.3)

Older frail people accessing urgent care should be assessed routinely for:

  • Activities of daily living.
  • Continence.
  • Delirium and dementia.
  • Depression.
  • End of life care issues.
  • Falls and mobility.
  • Nutrition and hydration.
  • Pain.
  • Safeguarding issues.
  • Sensory loss.
  • Skin integrity.
  • Vital signs.

Broad sections of the Silver Book include:

  1. Silver Book: Clinical.
  2. Silver Book: Training and education.
  3. Silver Book: Governance and research.
  4. Silver Book: References

Full Text Link


Conroy, S. (2012). Quality care for older people with urgent and emergency care needs (“The Silver Book”). London: Age UK; Association of Directors of Adult Social Services (ADASS); British Geriatrics Society (BGS), June 2012. 102p.

Note: For convenience, there is also an Executive Summary and a Short Version.

Guidance for Commissioning Integrated Urgent and Emergency Care: a “Whole System” Approach (RCGP)

Commissioners of urgent and emergency care services, in particular, may also be interested in:

Full Text Link (b)


Fernandes, A. (2011). Guidance for commissioning integrated urgent and emergency care: a ‘whole system’ approach. London: Royal College of General Practitioners (RCGP), 2011. 84p.

About Dementia and Elderly Care News

Dementia and Elderly Care News. Wolverhampton Medical Institute: WMI. (jh)
This entry was posted in Acute Hospitals, ADASS, Age UK, Commissioning, Community Care, Delirium, Depression, Falls, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Integrated Care, National, NHS, Nutrition, Pain, Patient Care Pathway, Physiotherapy, Quick Insights, RCN, Royal College of Physicians, Royal College of Psychiatrists, Standards, Systematic Reviews, UK, Universal Interest and tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

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