From April 2017, the Older People in Acute Care programme joined with the SPSP Acute Adult programme to form the Acute Care Portfolio.

The vast majority of people in hospital are over the age of 65 and growing numbers of frail older people are admitted to hospital, often as an emergency. The number of emergency admissions to hospital among those aged 85 and over is rising and older people usually have longer stays in hospital, higher mortality, higher rates of re-admission and are more likely to be discharged to long-term care. Multiple morbidity and cognitive impairment increase with age and while age alone is not a predictor of frailty or delirium increasing age, long term conditions and acute illness all impact on the likelihood of an individual becoming frail or developing a delirium.

Two critical areas of focus for improvement work in the care of older people in acute care care are the identification and immediate management for older people with frailty and/or delirium.


Frailty at the Front Door Collaborative

There is compelling evidence to support the benefits of early and effective comprehensive geriatric assessment, reablement and intermediate care for people living with frailty. However, optimal outcomes are only achieved when community health and social care services and hospital systems are fully aligned, well-coordinated, and care and support are attuned to the specific needs of people living with frailty.

The aim of this collaborative is to improve the processes of identifying frailty and coordinating care to deliver better experiences and outcomes for people living with frailty. While this specific work is focused on the front door of acute care, it is driven by an approach that recognises the importance of thinking about flow across the whole system. Getting the care pathway right for older people and people living with frailty in acute care has a wider impact on the whole system.

The 5 sites taking part in this collaborative programme, which runs from December 2017 – May 2019 are:

  1. Greater Glasgow and Clyde – Queen Elizabeth University Hospital
  2. Dumfries and Galloway - Dumfries and Galloway Royal Infirmary
  3. Forth Valley – Forth Valley Royal Hospital
  4. Lanarkshire –Monklands Hospital
  5. Lothian – St John’s Hospital

The collaborative aims to work in synergy with the ihub’s Living Well in Communities portfolio, Scottish Government’s National Unscheduled Care Team and Integration Authorities to support improvements across the pathway. Taking this integrated approach to improvement will maximise opportunities to improve quality, experience and flow while contributing to the aims of the Health and Social Care Delivery Plan.

Driver Diagram

Frailty driver diagram, change package and measurement plan



Healthcare Improvement Scotland worked with the Scottish Delirium Association and others to design, develop and test a delirium bundle to support staff with the early identification and management of delirium in caring for older people in the acute care setting.

Please view the Delirium Toolkit

This section of the website is under review. For more information, please contact the team on hcis.acutecare@nhs.net.