The proportion of people who are very old is growing fastest. There are currently three million people over 80, and this number is expected to almost double by 2030 1.

Older people are also more likely to use health services. In one hospital, a recent one-day census of patients in medical beds found the average age was 82 years old, with 10 per cent of the patients over 90 2

Advancing age is also associated with frailty – a useful term that describes the state of ‘limited functional reserve’ or ‘failure to integrate responses in the face of stress’ 3

Frail older people are likely to have multiple co-morbidities, polypharmacy, sensory and cognitive impairment – all of which are associated with an increased incidence of healthcare-associated harm 4.

The effect of this harm is likely to be more severe since a characteristic of frailty is that relatively small injuries can result in devastating physiological, social or functional effects. Adverse events in older people include the geriatric syndromes such as falls, delirium, and pressure ulcers.5

This complexity means that there are unique challenges in designing safe systems of care for frail older people. Our resources include position papers on care pathways, safer medicines management and maintaining and improving community care for frail older people.

The Kings Fund. The care of frail older people with complex needs: Time for a revolution. London, 2012: Kings Fund.
Tadd W, Hillman A, Calnan S et al. Dignity in Practice: An exploration of the care of older adults in acute NHS Trusts. 2011; Southampton: NIHR-SDO
Sari AB, Cracknell A, Sheldon TA. Incidence, preventability and consequences of adverse events in older people: results of a retrospective case-note review. Age Ageing 2008;37(3):265-9.
Thomas EJ, Brennan TA. Incidence and types of preventable adverse events in elderly patients: population based review of medical records. British Medical Journal 2000;320(7237):741-4.
Tsilimingras D, Rosen AK, Berlowitz DR. Patient safety in geriatrics: a call for action. J Gerontol A Biol Sci Med Sci 2003;58(9):M813-9.

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