The Health of Women and Girls: Health and Social Care Policy - Beyond the Women's Health Plan

4 The Health of Older Women

Older women who took part in the Focus Groups that informed Phase Two of the Women’s Health Plan told us they would like to see improved care and support for older women to ensure they are supported to live as well as possible through later life. Phase Two has a primary focus on ‘Optimising Future Health’ to support women and girls across the life course, so that their health in later life can be supported by prevention, early intervention, care and support. In particular, this includes new focus on brain health, bone health and pelvic floor health as well as building on existing ambitions around women’s heart health.

This section highlights some of the work happening across the Scottish Government supporting older women’s health, which will be augmented by the new actions in Phase Two of the Women’s Health Plan.

Dementia and Brain Health

It is estimated that up to 90,000 people in Scotland are living with dementia and that around 65% of them are women. Dementia is the leading cause of death for women in Scotland^[23]. Phase Two of the Women’s Health Plan includes action on Women’s Brain Health through the Brain Health and Dementia Risk Group, which will augment the work already happening on dementia in the Scottish Government.

Women who took part in focus groups with Age Scotland for the Women’s Health Plan, particularly participants in their 50s and 60s, raised brain health as an area which is important to them as they get older.

In addition, the impact of caring for someone with a condition such as dementia was discussed, including how this can affect their mental and physical health.

With the number of people living with dementia likely to increase by up to 50% by 2044, work is needed now to improve the experiences of women, to reduce the risk of dementia in later life and to consider how to support unpaid carers supporting people with dementia, who we know are most likely to be women.

As set out in the 10-year Dementia Strategy for Scotland and first 2-year Delivery Plan, the Scottish Government is committed to:

• Increase access to support following a diagnosis. That includes investment of £4.35m in 2025 to increase direct support to dementia community groups and settings across Scotland, and to continue efforts to increase the number of people who benefit from our commitment to 12 months’ Post-Diagnostic Support
• Build the understanding and evidence we need to make the changes necessary to improve people’s dementia experience. That includes working with research, academia and national partners to build a comprehensive understanding of who is providing them care and support (and the skills and education they need), enhancing the data we have on how many people are living with a diagnosis and accessing support, and commissioning evaluations on future service delivery
• Challenge people’s preconceptions of dementia. That includes a national Rethink Dementia campaign that saw up to 73% of those engaged commit to take action to continue to be there for those in their lives who have received a diagnosis, and how this can help them stay well for longer.
• Supporting people to take steps to improve their brain health – we are also responding to evidence that up to 45% of dementias can be prevented through addressing risk factors. We are committed to addressing these as part of the Population Health Framework and, on the back of an evaluation of a Brain Health Service & Clinic test site, will explore as part of a cross-policy group led by the CMO, how we can take forward actions to improve the population’s brain health. That will include establishing which dementia risk factors may be greater for women.

The particular needs of women will be taken account of, as all of this work is delivered, ensuring the impact on women is central to these interventions, including assessing and establishing the dementia risk factors which are more likely to affect them.

Bone Health

Work carried out by the Royal Osteoporosis Society (ROS) indicated that one in two women and one in five men over the age of 50 will break a bone as a result of osteoporosis. There are around 300,000 people in Scotland with osteoporosis, and around 44,000 fragility fractures occur every year. A broken bone in someone aged 50 or older can indicate osteoporosis, and taking a bone-strengthening treatment could reduce their risk of breaking a bone in the future by up to 50%. Public Health Scotland has identified extensive variation between Fracture Liaison Services across Scotland, which may negatively impact individuals’ care and outcomes and could lead to health inequalities. This is particularly important for women’s health, as women are disproportionately affected by osteoporosis and fragility fractures.

The Scottish Government therefore commissioned the Scottish Fracture Liaison Service Audit (SFLSA) in 2024, under the Scottish National Audit Programme (SNAP) governance process. This will create high-quality, standardised data and consistency across NHS Boards to identify and evaluate gaps in osteoporosis care, preventable harm, and drive improvements. It will support clinical decision-making and reduce health inequalities by ensuring the most appropriate treatments, interventions, support and services are provided at the right time to everyone who will benefit. This work supports the principles of realistic medicine by facilitating effective collaboration between clinicians, patients and others. As the audit develops, annual reports will be published to provide reliable data to support improvement work for Fracture Liaison Services across Scotland, which in turn will help to address the needs of women who are most at risk.

Frailty

Healthcare Improvement Scotland (HIS) is currently working to reduce inpatient falls through its Scottish Patient Safety Programme (SPSP) Adults in Hospital (previously Acute Adult) initiative, which includes an evidence-based Falls Reduction Change Package that has practical tools, driver diagrams, and quality improvement methods that can be tailored for local contexts. Informed by SPSP, several of the measures included in the Excellence in Care programme’s Care Assurance and Improvement Resource (CAIR) dashboard are explicitly related to the safety of patients, such as falls rates and pressure ulcers, whilst other indicators of care quality are indirectly associated with patient safety and experience of the healthcare system more broadly.

Alongside this, the Scottish Government is making progress in delivering specialist frailty services across emergency departments. Healthcare Improvement Scotland set out in a report the implementation of frailty services across Scotland, following the commitment in the NHS Scotland Operational Improvement Plan to deliver access to specialised frailty teams in every core Emergency Department by Summer 2025. The report confirms strong progress with over half of sites testing, implementing or embedding these services, and the remainder actively developing locally designed approaches.

HIS highlights that while implementation is at different stages, all hospitals now have some level of frailty service in place, supported by temporary solutions until full units are established. This means older women and others experiencing frailty can access specialist assessment and care from the moment they arrive, improving outcomes and reducing unnecessary admissions.

The Scottish Government remains committed to ensuring full delivery of the frailty model across all boards. This includes direct referral pathways from GPs and the Scottish Ambulance Service, and expansion of Hospital at Home services, so that women receive the right care in the right place. These actions provide assurance that progress is being made and that interim measures are safeguarding access to specialist support while permanent units are embedded. Frailty pathways help older women return home sooner, prevent hospital-related harms, and support independence.

Unpaid Care

"…one of the things that led to my health being impacted was my role as an unpaid carer". - BHF Focus Group, Participant 4BHF Focus Groups, Participant 2.

It is estimated that around 700,000 to 800,000 people in Scotland are unpaid carers, the majority of whom are women. Overall, 59% of carers in Scotland are women.^[24]

People are more likely to be providing unpaid care in their later working years – especially women. A quarter (25%) of women aged 45-64 provided unpaid care in 2019-2023 combined. This represents a large and skilled portion of the workforce. This means that women are disproportionally affected emotionally, financially and physically due to their caring role.

Providing unpaid care is a barrier to older women looking after their own health and wellbeing^[25]. Women have described how unpaid caring responsibilities have mean that they “do not have the time, money or mental capacity to prioritise their own health and wellbeing”^[26].

“I don’t get to be sick – I’m mum and gran and wife to a disabled husband. There’s no one to look after them, nevermind me” -Focus Group participant, Age Scotland. [Age 60 to 65, urban area]

The nature of some caring roles can lead to increased risks to the carer’s health and wellbeing. There are a number of reasons that can give rise to this, including insufficient support for the unpaid carer, a lack of trauma-informed support from services, a lack of breaks and economic and social isolation. This can also lead to poorer outcomes for the person who is being cared for.

The Scottish Government estimates unpaid care is currently saving Scotland £12.8 billion per year in social care costs, plus £320 million in health care costs – a total saving of £13.1 billion per year^[27].

Supporting carers to enter or stay in work brings vital benefits to carers, employers and the economy. The impact of women reducing hours, not taking or applying for promotions, or leaving the labour market altogether in order to provide unpaid care contributes towards Scotland’s gender pay gap.

The Scottish Government’s National Carers Strategy specifically considers the importance of all employers being positive about carers in the workforce, and sets out our intentions regarding carers and employment at Chapter 4. This includes our commitment to fund and promote the Carer Positive employer accreditation scheme.

The Carer Positive scheme aims to tackle inequalities and remove barriers that people face in the labour market, recognising the impact of caring responsibilities on women. There are now more than half a million employees working in 292 Carer Positive organisations across Scotland (October 2025).

The Care Reform (Scotland) Act, passed in June 2025, introduces the right to breaks for unpaid carers. It makes changes to the Carers (Scotland) Act 2016 to create a right to personalised short breaks support for carers who require them. Once these changes come into force they will place new duties on local authorities to determine whether a carer is able to take ‘sufficient breaks’ from their caring role; and if not, to provide support to enable this.