Iterative expert panel meetings with review of the relevant evidence were used to generate a set of indicators to assess the quality of the process of care, rather than outcomes. RAND researchers postulate that these QIs represent minimal care rather than optimal care for the vulnerable elderly population, and are meant to assess and ultimately improve the quality of care. The resulting set consists of explicitly phrased IF-THEN clinical rules with comprehensive coverage of general medical and geriatric conditions, including comorbidities. These rules are intended to evaluate, by means of gauging adherence to the rules, the extent to which the care being delivered meets minimal standards of quality. The following is an example of an ACOVE indicator : “IF a vulnerable elder reports a history of two or more falls in the previous year, THEN there should be documentation of a basic fall history within three months of the report. ACOVE-1 represents the first original set of QIs. The second phase of ACOVE aimed at evaluating various interventions in primary care practices in order to improve care, but the QI set was not changed. The ACOVE-3 QI set is an updated and expanded set of QIs including five new conditions: COPD, colorectal cancer, breast cancer, sleep disorders, and benign prostatic hypertrophy. Because ACOVE QIs or adaptations thereof have been used for over a decade for the assessment of quality of care. This paper reviews the PR-171 studies that assessed the quality of care for elderly patients using ACOVE QIs in order to evaluate the state of the quality of care for the reported conditions. In this systematic review we described the results of 17 research papers using the ACOVE quality indicators to assess the quality of care. The assessment of care was performed in a variety of care settings, in several different elderly patient populations and for multiple conditions. Due to this heterogeneity and the fact that the studies used different subsets of the ACOVE QIs or adaptations thereof, the results of the studies cannot be directly compared and hence a quantitative meta-analysis is not justified. However, considering that many studies assessed the quality of care for multiple conditions simultaneously and 50% of the QIs had a pass rate below 50%; some general conclusions can be drawn about areas to which improvement initiatives should be focused. An overall conclusion is that there is much room for care improvement for the elderly population. Individual studies have already shown the need for greater focus on elderly care. This finding is supported by our review. Based on the included studies the overall quality scores for dementia, depression, osteoporosis and osteoarthritis were notably low. In addition to the conditions above, hypertension, ischemic heart disease, pressure ulcer, pain management, falls and urinary incontinence scored below 50% at the QI level. In the interest of maintaining a good quality of life for elderly patients it is very important to treat geriatric conditions, and it may even be unethical to ignore this need. Although care for many conditions showed deficiencies, geriatric conditions like dementia and falls seem to show greater deficiencies than others.