1. Interface geriatrics Simon Conroy

2. Why this is important Evidence-based, educational solutions –For frail older people Integrated whole systems perspective –‘Team without walls’ Holistic, generalist approach –Interdisciplinary team working

3. What we did… Vertically integrated services for frail older people Focussed comprehensive geriatric assessment, including social care –At and across the interfaces; –Coordinated and communicated Horizontal integration (ED and GER) Whole system, collaborative leadership

4. Why we did it Screening and intervening does not work –MRC trial of multidimensional assessment (1995- 1998) –UK Evercare evaluation –Screening for falls risk in primary care Screening tools insufficiently precise, interventions not sufficiently effective and not cost-effective.

5. 28% of attendances = older people 21 st century urgent care 73% of bed-days = older people

6. Frail older person in crisis Intermediate care Bed-based rehabilitation/ reablement Specialist care In-patient CGA Liaison SPA – clinical discussion MDT Triage Trajectory Transfer EFU/ FOPAL

7. ED performance 2010-13: people 85+

8. Summary Urgent care = older people Whole system solutions required –Vertically integrated –Holistic & interdisciplinary –Underpinned by robust communication and cooperation