Table 2.

Summary of reports and guidance on elderly emergency surgery

Year	Title, reference	Publishing body	Key recommendations or findings
1999	Extremes of age10	NCEPOD	Failings in perioperative management of elderly patients Poor intravenous fluid management Lack of multidisciplinary teams and senior clinician involvement
2001	National Service Framework for Older People2	Department of Health, UK	Outlines the quality standards for organizations delivering care to older people in the UK Equality of access to and provision of care for older people
2009	Ageism and age discrimination in secondary health care in the UK60	Department of Health and Centre for Policy on Ageing	Highlighted inequality for older people in both perceived and actual access to health care and treatment within the NHS
2010	An age old problem1	NCEPOD	44% of elderly patients admitted to surgical specialties; there was room for improvement in care 6% received care that was less than satisfactory
2010	Falling standards, broken promises. National audit of falls and bone health in older people61	Royal College of Physicians, UK	One-third of hip fracture patients did not receive adequate pain relief within an hour of arriving in hospital Inadequate attention to pressure area care in the first 4 hours and early prescription of intravenous fluids was lacking in many cases
2011	The management of hip fractures in adults16	NICE	Recommended the use of integrated multidisciplinary geriatric care and to focus on osteoporosis management, polypharmacy, frailty management, and prevention and assessment of falls
2011	High-risk surgical patient17	ASGBI	Elderly patients at particular risk of complications, including death Improved care would come by improving the identification of patients at risk and ensuring early access to definitive treatment by a trained specialist Rapid and appropriate escalation of care to higher dependency wards (ie, intensive care unit) was also recommended as a means of improving outcome
2012	Silver Book: quality care for older people with urgent and emergency care needs62	British Geriatric Society	Focuses on the first 24 hours of care Specifically highlights multidisciplinary working
2012	Access all ages: assessing the impact of age on access to surgical treatment11	RCSEng, Age UK, and MHP Health Mandate	25 Recommendations focusing on six key areas: 1. Informing and communicating with patients to encourage them to seek help and take part in decisions about their treatment and care 2. Improving the evidence base to further our understanding of the impact of age on surgical decision making. 3. Developing guidance to promote age equality in surgical care 4. Delivering the most appropriate care by improving models of working and developing guidance for clinicians 5. Measuring progress and tackling underperformance 6. Delivering high-quality commissioning for older people
2014	National Hip Fracture Database Annual Report63	Falls and Fragility Fractures Audit Programme	One of the key elements is “best practice tariff” for surgery within 48 hours Target was achieved for 70.6% in the 2012–2013 report and slightly increased to 71.7% for 2013 Range in hospital performance is dramatic, with some sites reporting just 13% of patients having surgery within 36 hours and yet some hospitals reporting rates of 91%
2014	Perioperative care of the elderly guidelines48	AAGBI	Highlights the ageing population and the challenges elderly patients place on the NHS Outlines specific considerations regarding perioperative management; recommends a multidisciplinary approach with the role of geriatricians in the assessment and ongoing care of the elderly emergency patients

Abbreviations: AAGBI, Association of Anaesthetists of Great Britain and Ireland; ASGBI, Association of Surgeons of Great Britain and Ireland; NCEPOD, National Confidential Enquiry into Patient Outcome and Death; NICE, National Institute for Health and Care Excellence; NHS, National Health Service; RCSEng: Royal College of Surgeons of England.