Emergency room geriatric assessment--urgent, important or both?

Most Western health services are seeking to reduce reliance onsecondarycareserviceswhereappropriate,whilstexpanding primary care services [1, 2]. Much of the focus has been on the care of older people, predominantly those deemed to be frail, as this population tend to have greater health needs than younger populations. Methods to achieve this ‘transfer of care’ include an increased focus on managing long-term conditions, development of community-based comprehensive geriatric services and a focus on older patients with functional decline presenting as emergencies. With such services, it is crucial that appropriate patients arereferredtotheappropriateserviceattheappropriatetime. There is a perception that emergency physicians might not be best placed to make accurate rapid assessments of frail older people with complex comorbidities and polypharmacy, especially those who present non-specifically and have additional social needs [3]. As detailed in the article by Ngian et al. [4], various models of medical care have evolved to provide urgent comprehensive geriatric assessment (CGA), including mobile geriatric teams and nurse led teams. Several trialsthathavefocussedonfrailolderpeoplebeingdischarged from the acute setting have included use of a screening tool toidentifysuitablepatientsandthendeliveringCGAtothem