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Improving hospital care for older people in acute care

Cabinet Secretary welcomes new report into management of frailty and delirium.

Health Secretary Shona Robison, welcomed the findings of a new report by Healthcare Improvement Scotland published yesterday that shows hospitals across Scotland are making important improvements in the care that older people receive.

The report details the impact of an improvement programme of work commissioned by the Scottish Government and run by Healthcare Improvement Scotland since 2012.

The programme focused on two critical areas identified as important in improving the care older people receive – frailty and delirium. Healthcare Improvement Scotland worked with health boards to develop various tools to improve identification and care for people with delirium, and improve care coordination for people with frailty in acute hospitals.

Data from individual boards highlighted in the report shows outcomes for patients are beginning to improve, including:

  • reduced mean length of stay from 22 days to 8 days in NHS Grampian
  • a 50% decrease in the average number of falls per month in two wards between January 2013 and January 2015 in NHS Greater Glasgow and Clyde
  • frailty screening in three wards in the surgical directorate at the Royal Infirmary of Edinburgh resulted in decreases in length of stay, falls and the number of complaints.

Health Secretary Shona Robison said:

“I’m pleased to see that Healthcare Improvement Scotland’s report has found real change in the management of frailty and delirium in older people in our hospitals. Credit should be given to the hard-working staff who have worked tirelessly to improve patient care.

“The latest report shows staff awareness and training increasing, and that results for patients are improving. There is still more that needs to be done to ensure that older people get the care they need and have a right to expect, but I’m encouraged that the dedication and commitment of staff is seeing results for patients.”

Ruth Glassborow, Director of Improvement for Healthcare Improvement Scotland, said:

“Our organisation is committed to driving improvements in healthcare and this report highlights the significant difference that this programme of work is making for older people admitted into hospital. We look forward to continuing to work with NHS boards to build on these achievements and ensuring that the learning and good practice is spread across Scotland. The results we’ve seen thus far are down to the hard work of NHS staff in these areas and their commitment to making care better for their patients.”

Notes To Editors


Over the 25 years to 2037, the proportion of over 65s in the population as a whole is projected to increase from 17% to 25%. In the same period, the number of people over 75 is expected to rise by 86%, with this group accounting for around 8% of the whole population. Older people usually have longer stays in hospital, higher mortality and rates of readmission, and they are more likely to be discharged to residential care.

In 2011, Scottish Government reiterated its commitment to improving older people’s acute care by announcing a programme of inspections of older people’s acute care by Healthcare Improvement Scotland in order to assess care, drive improvements where needed, and to provide public assurance that NHS Scotland treats older people with respect, compassion and dignity.

Healthcare Improvement Scotland has been leading a national programme of work with NHS board colleagues to improve older people’s acute care in NHS Scotland since April 2012.

The programme has focused initially on two critical areas:

  • frailty - ensuring older people in hospital identified with frailty receive comprehensive geriatric assessment (CGA) within 24 hours of admission
  • delirium - increasing early identification and management of delirium.

Delirium is an acute medical emergency that commonly affects older people admitted to hospital. It has potentially serious consequences, such as increased likelihood of admission to long term care and even increased mortality. The prevalence of delirium in people on medical wards in hospital is about 20% to 30%, and 10% to 50% of people having surgery develop delirium.

The decision to focus on these particular areas of care was informed by a review of literature, themes emerging from the Healthcare Improvement Scotland inspection of older people’s acute hospitals reports, and an extensive period of consultation with stakeholders.

Healthcare Improvement Scotland is a public body formed on the 1 April 2011. Its purpose is to support healthcare providers in Scotland to deliver high quality, evidence-based, safe, effective and person-centred care; and to scrutinise those services to provide public assurance about the quality and safety of that care. The organisation has the focus and key responsibility to help NHS Scotland and independent healthcare providers deliver high quality, evidence-based, safe, effective and person-centred care; and to scrutinise services to provide public assurance about the quality and safety of that care. Key components of the organisation include the Healthcare Environment Inspectorate (HEI), the Scottish Health Council, Scottish Medicines Consortium, the Scottish Health Technologies Group, the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Patient Safety Programme.

The report is available on the Healthcare Improvement Scotland website:


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