Older People in Acute Care Improvement Programme


With the number of older people increasing in our population, the need to ensure that they receive appropriate care in our healthcare system also increases.Our ‘Improving Care for Older People in Acute Care’ workstream is a two-year programme to improve the care for older people in acute care. This work complements the scrutiny programme currently taking place to identify strengths and areas for improvements across hospitals in NHS Scotland.

Background to our work

This workstream focuses on 2 key areas:

  • care co-ordination – focused on identification and immediate management of frailty
  • cognitive Impairment – focused on identification and immediate management of delirium.

Here’s more information on these key areas:

Frailty and Delirium


By identifying frail patients on admission to acute care, our aim is that those patients receive timely comprehensive geriatric assessment and input from a specialist team on the day of admission. Our programme focuses on this because evidence shows that appropriate and timely screening:

  • assessment reduces length of stay in hospital,
  • improves patient experience.


Older people and people with dementia, severe illness or a hip fracture are more at risk of delirium. We have developed a care bundle for identifying and caring for people with delirium and it is being piloted within NHS boards in Scotland.

Delirium is a medical emergency and carries a high level of 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. Evidence shows that people who have delirium may need to:

  • stay longer in hospital or in critical care,
  • have an increased incidence of dementia,
  • have more hospital-acquired complications, such as falls and pressure sores,
  • be more likely to need to be admitted to long-term care if they are in hospital,
  • be more likely to die.

Taking a collaborative approach to improving care

Working together is the key to improving care for older people. This workstream engages with healthcare teams from acute hospitals across Scotland, coming together for a series of events and webex calls to:

  • introduce new tools for testing locally with the aim of improving screening for frailty and improving the early management of delirium
  • share experience, expertise and examples of good practice in improving care for older people
  • build capacity and capability for improvement
  • support local improvement work.

Older People In Acute Care Improvement Programme resources