There is growing evidence that some models of integrated health and social care for older people can result in improved outcomes, patient satisfaction and cost savings. Current arrangements, however, do not serve vulnerable frail older people with complex needs well. Improving safety for this group should aim to reduce the unpredictability which characterises so much of their care1.
Integrated care frameworks
Care pathways – specified in detail and in advance – can improve the quality and reduce the variation of care for frail older people. Frameworks of integrated care for the elderly: a systematic review, created for the Canadian Policy Research Networks, examines best practice in this area through a comparative review of four frameworks. It identifies four interventions which contribute to a successful pathway for integrated care for older people.
Acute care for older people
Most patients over 85 go to hospital because of an emergency1 and acute medical teams may not have the capacity to undertake the holistic assessments required to identify and manage the complex needs of these patients. As part of a three part series on improving acute care, the Acute care toolkit: acute medical care for frail older people from the Royal College of Physicians, England, provides guidance on providing high quality assessment of older patients in an acute setting.
Continuity of care
Continuity of care is important for all patients, but is particularly key for the frail older person who is likely to have multiple medications and co-morbidities, longer lengths of stay in hospital and, for patients with dementia, may not be able to provide information about themselves to healthcare staff.  Continuity of care for older hospital patients from The King’s Fund examines this problem in detail, including barriers to continuity of care and strategies for improving how continuity is delivered.

Cornwell J. The care of frail older people with complex needs: time for a revolution. London: The King’s Fund, 2012.

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