A previous review described the literature outlining the characteristics and special needs of older people using accident and emergency (A&E) services, the service initiatives aimed at meeting these needs, and the implications of the findings for UK policy and practice. The review identified a lack of clear evidence to guide the development of specialist services for older people attending A&E. In particular it was noted that there was a deficit of work in the UK context. This seemed, in part at least, to be based on ambivalence about the legitimacy of developing specialist services in the emergency department for this group of patients, despite the large numbers of older people attending. However, the paper also noted encouraging trends and a move away from a preoccupation with whether or not older people were appropriate A&E attenders, to a consideration of how best to meet the particular needs of this group, that paralleled past developments of specialist services for children.