A leading older people's organisation says Scotland’s hospitals and social care system must be supported “to get to grips” with a worrying trend in the number of people suffering a hip fracture – and fewer standards for their care being met.

Markedly more people sustained a hip fracture during 2022 than the year before, more of them spent longer in emergency departments and fewer received a speedy geriatric assessment.

The Scottish Hip Fracture Audit for 2022 shows the number of patients increased by 584, compared with 2021, to 8,380.

The data, published by Public Health Scotland shows the proportion of patients admitted to hospital within the four hour target fell by nearly half, from 61.2% in 2021 to 34.9% in 2022.

Four in every ten had to wait more than four hours from arriving in A&E to being admitted.

Age Scotland’s Interim Chief Executive, Katherine Crawford, says the Audit is published at a time when levels of frailty are reported to be increasing. She says some of the numbers are “shocking” and should prompt an urgent response:

“The situation for people with hip fractures is deteriorating across nearly all of the indicators and patients are spending longer than ever in hospital.

“The dramatic increase in the number of hip fractures last year is a real cause for concern. Compared with pre-pandemic levels, 1000 more people went to hospital with a fractured hip. We already knew that the pandemic has impacted mobility levels amongst older people and this uplift was predicted, but the scale of change is remarkable.

“Healthcare professionals have reported higher levels of frailty among patients. This could be a knock-on effect of the COVID-19 pandemic as prolonged lockdowns and isolation led to a loss of mobility, strength and flexibility among older people who spent weeks and months at home with limited options for physical activity.”

Ms Crawford says longer waits for assessment and lengthy hospital stays make it more difficult for people to recover, as they become deconditioned, lose muscle strength and balance.

She says the whole hip fracture pathway from admission to returning to the community needs to be prioritised:

"With outcomes getting poorer across all main indicators and no discernible fixes, it is vital that hospitals and social care are supported to get to grips with this worrying trend.

“There needs to be a robust falls prevention plan and there needs to be enough capacity in the system to treat people quickly. We must ensure there is adequate social care in the community so that people can leave hospital safely and promptly."

The Audit is made up of 12 different measures including the expectation that each patient should have commenced a Comprehensive Geriatric Assessment (CGA) by a specialist clinician trained in care of older people within three days after admission.

The data shows a slight reduction in the number of people for whom the CGA standard was met, from 88% to just below 85%.

Assessment by occupational therapy within three days of admission was at 81.8%, and 96.4% of patients received a physiotherapy assessment by the end of their second day in hospital.

Overall, hip fracture patients spent a day longer in hospital than they had in 2021.

Read more: Concern as COVID protections reduced; Doctors ‘deeply concerned’ for care homes over winter; First step toward Older People Commissioner.

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