Back to:
Social work & social care

About the standards

Ageing and frailty standards
Healthcare Improvement Scotland

These standards update and replace Healthcare Improvement Scotland’s Standards of Care for Older People in Hospital (2015). They apply in all settings where older people living with frailty receive health and social care. They provide a benchmark for progress towards nationally consistent integrated frailty services that put people and their rights at the centre.

Frailty

When a person is living with frailty, their body gradually loses its in-built reserves. This leaves them vulnerable to changes in their health or circumstances and makes it harder to recover from an injury, infection or illness.1 People with frailty may experience falls, immobility, delirium, incontinence and are more susceptible to side effects of medication.2, 3 As a person’s frailty increases, they may find it more difficult to live independently and require additional support and care.4 They are more likely to be admitted to hospital.5

Older people living with frailty are amongst the most vulnerable in our society. They can be at risk of harm if we do not understand and address their needs, or if our systems and services are inadequate, ineffective or poorly coordinated.3 Frailty is not an inevitable consequence of ageing. Coordinated multiagency care supports and enables people experiencing frailty to remain as independent as possible.6 If frailty, or likelihood of frailty, is identified early, it can sometimes be prevented, reversed or slowed down.7

Population to be covered by the standards

These standards are for people who are living with age-related frailty. Older people living with frailty are likely to benefit from integrated, multiagency planning and delivery of care.8

The United Nations defines an older person as someone above the age of 60. In the UK, 65 is traditionally used as the marker for the start of (chronological) older age. Biological ageing refers to the changes to a person’s body and mind that occur over time. While chronological age cannot be modified, biological ageing can be impacted by a range of factors. These include a person’s long-term health conditions, comorbidities, socioeconomic circumstances and lifestyle.3 A person’s biological age can better help predict how frailty may develop and impact them.9

Principles and aims

These standards promote positive, healthy and active ageing. In line with the principles of Realistic Medicine, the standards are underpinned by the following key principles:

  • services should have a focus on prevention and early intervention
  • people’s choices and what matters to them should be at the centre of discussions
  • interventions should be the least intrusive or restrictive possible.

The overall aim of these standards is to ensure national consistency in the quality of care that people receive. The standards aim to support national improvements towards integrated frailty services.

In meeting the standards, organisations will ensure that people:

  • have the care and support they need to maximise enjoyment of life
  • have choice, autonomy and ownership of their life
  • work in partnership to make decisions about their health and care based on what matters to them
  • experience a palliative care approach that helps them to live well with deteriorating health.

Policy context

These standards are underpinned by human rights and seek to provide better outcomes for older people with frailty. The United Nations Principles for Older Persons were adopted by the UN General Assembly (Resolution 46/91) on 16 December 1991. Governments are encouraged to incorporate human rights into their national programmes whenever possible. The 18 principles can be grouped under five themes: independence, participation, care, self-fulfillment and dignity.10

The ageing and frailty standards should be read alongside:

Implementation

The Healthcare Improvement Scotland Quality Management System (QMS) Framework supports health and social care organisations to apply a consistent and coordinated approach to the management of the quality of health and care services. By using standards as part of a quality management system, organisations can work in partnership to develop learning, plan improvement and understand their whole system. Central to this is the relationship between people, their care partners and organisations.

Healthcare Improvement Scotland (HIS) leads national improvement work focusing on frailty. In 2022, we published the findings of a 90-day learning cycle on frailty.25 This involved a scan of the published literature on frailty and interviews with people with lived experience as well as health and social care professionals specialising in frailty. The report described seven core components of an integrated frailty system.

Following this, the Focus on Frailty improvement and implementation programme was launched. The programme aims to improve the early identification and assessment of frailty with a view to improving access to person-centred and coordinated health and social care services. We also host a national frailty learning system with over 1,500 members. Through the learning system, members share practice examples, tools and resources relating to frailty improvement work.

The ageing and frailty standards will support the spread of person-centred approaches to care and support for people living with frailty. The standards will also support improvements to the early identification and assessment of frailty.

HIS may use these standards in a range of assurance and inspection activities. They may be used to review the quality and registration, where appropriate, of health and social care services.

 

Format of the standards

All HIS standards follow the same format. Each standard includes:

  • an overarching standard statement
  • a rationale explaining why the standard is important
  • a list of criteria describing what is needed to meet the standard
  • what the standard means if you are an older person living with frailty
  • what the standard means if you are a member of staff
  • what the standard means for organisations
  • examples of what meeting the standard looks like in practice.

Terminology

Wherever possible, we have used generic terminology that can be applied across all health and social care settings. The terms ‘people,’ ‘person’ or ‘individual’ are used within the criteria to refer to the person receiving care or support.

Care partner refers to any person or representative the individual wishes to be involved in their care. This may be a friend, neighbour, family member or other person who may provide informal help or support.

Unpaid carers provide or intend to provide care for an individual and their role is recognised under the Carers (Scotland) Act 2016.26

Staff refers to people who are employed to provide health and care support to an individual. It includes those defined in the Health and Care (Staffing) (Scotland) Act 2019.16

Palliative care is an approach that improves the quality of life of people who are living with one or more advanced or progressive health conditions. Palliative care prevents and relieves suffering through the early identification, assessment and management of pain and other problems–whether physical, mental health, social or spiritual.

Future care planning is about supporting adults and children, their families and carers, to think and plan ahead for changes in their life, health and care. It is an ongoing process that helps people talk about what matters to them in their lives, including if their health or care should change. Future care planning gives people opportunities to discuss realistic options for treatment and care. A personalised future care plan is recorded, shared and reviewed.

Organisation refers to all health and social care providers or services that support older people with frailty. This includes hospitals, primary care, community healthcare facilities, hospices, Hospital at Home services and care homes. It also includes independent health and social care providers.