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Emergency department management of older people living with frailty: a guide for emergency practitioners
  1. Vera M Hogervorst1,2,
  2. Bianca M Buurman2,
  3. Annemarieke De Jonghe1,
  4. James David van Oppen3,4,
  5. Christian Hans Nickel5,
  6. Jacinta Lucke6,
  7. Laura C Blomaard7,
  8. Arjun Thaur8,
  9. Simon P Mooijaart7,
  10. Jay Banerjee3,9,
  11. James Wallace10,
  12. Bas de Groot11,
  13. Simon Paul Conroy3
  1. 1 Department of Geriatric Medicine, Tergooi Hospital, Hilversum, The Netherlands
  2. 2 Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
  3. 3 Department of Health Sciences, University of Leicester, Leicester, UK
  4. 4 Emergency & Specialist Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
  5. 5 Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
  6. 6 Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
  7. 7 Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
  8. 8 Department of Emergency Medicine, Guy's and Saint Thomas' NHS Foundation Trust, London, London, UK
  9. 9 Department of Emergency Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
  10. 10 Department of Emergency Medicine, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
  11. 11 Department of Emergency Medicine, Leids Universitair Medisch Centrum, Leiden, The Netherlands
  1. Correspondence to Vera M Hogervorst, Department of Geriatric Medicine, Tergooi Hospital, Hilversum, The Netherlands; vhogervorst{at}


Emergency Departments (EDs) are increasingly seeing more seriously unwell older people living with frailty. In the context of limited resources and increasing demand it’s the ED practitioner’s challenge to unpick this constellation of physical, psychological, functional and social issues.To properly assess older people living with frailty at the ED it is crucial to use an holistic approach. This consists of triage with algorithms sensitive to the higher risk of older people living with frailty, a frailty assessment, and an assessment with the help of the principles of Comprehensive Geriatric Assessment. Multi-disciplinary care, a tailor-made treatment plan, based on what the person values most, will help the ED practitioner to deliver appropriate and valuable care during the ED stay, but also in transition from hospital to home.

  • geriatrics
  • acute care
  • assessment
  • emergency department

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  • Handling editor Mary Dawood

  • Twitter @J_vanOppen, @APOPLeiden ; @BlomaardLC, @jmwallace84

  • Contributors VMH, BMB, ADJ and SPC made substantial contributions to the conception and design of the work. VMH did the drafting and revisions. All authors reviewed the article and made contributions to the final version of the article. BMB and SPC did the final approval of the version to be published. All authors had full access to all the data in the study and take responsibility for the integrity and accuracy of the data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JB reports personal fees from NHS Elect, England, personal fees from Jay Banerjee Consultancy Ltd, outside the submitted work; and I am the Chair of the Frailty/ Older Person’s Special Interest Group for the Royal College of Emergency Medicine, UK. SPC reports grants from National Institute of Health Research, UK, outside the submitted work. All other authors have nothing to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.