It has been said that the modern general hospital may contribute to the incidence of adverse outcomes for frail older people (Parker et al 2006). Unless older people have comprehensive, proactive assessment and are managed in an interdisciplinary and holistic way, they are at risk of delirium, functional decline, falls, medication associated problems, pressure sores, malnutrition and readmissions (Buchanan & Considine 2002). The hospital system should be tailored not only to meet these challenges but, more importantly, to avoid them. The purpose of this chapter is to explore some of the issues that may emerge during an acute hospitalisation of an older person. The issues to be discussed include iatrogenic adverse events, transition of care during hospitalisation, and the settings where care may be compromised. The chapter also provides examples of models of care and their application in acute care settings.