Delays in transferring patients from A&E departments to orthopaedic wards and moving them to operating theatres appear to be growing, with a smaller proportion treated in line with targets compared to five years ago.
An audit led by clinicians found just 16% of patients reached wards within the two-hour window recommended by national guidelines, down from 28% in 2008.
It also revealed almost 30% of patients had no cognitive assessment while in hospital though the median age of sufferers was 82.
Doug Anthoney, campaigns officer for charity Age Scotland, said the wide variation in the quality of care was "unacceptable".
Mr Anthoney said: "It beggars belief that incidence of formal cognitive assessments, which the audit recommends for every patient, ranges between 6% and 100%. The scarcity of geriatric services available to hip fracture patients in some hospitals is also worrying, with fewer than half receiving routine geriatric assessment. With our population rapidly ageing, incidence of hip fracture is likely to increase so it's imperative that health boards act now to ensure that best practices become the norm across the country."
More than 6000 patients are admitted to hospitals every year with hip fractures. The ambulance service recently revealed the number of calls relating to falls in homes and care homes rose from 31,369 in 2011-12 to 33,604 in 2012-13, an increase of 7.1%.
Between December last year and March a new investigation looked at how well hospitals were meeting guidelines and good practice protocols for hip fracture patients.
The percentage of patients transferred from A&E to orthopaedic wards within four hours was down to 82% compared to 96% in 2008 and the report says "it is not acceptable to have frail, elderly patients waiting more than four hours in the emergency department unless indicated for essential medical interventions."
In addition 92% of patients who were fit enough received surgery within 48 hours of admission - a time window associated with fewer complications and shorter hospital stays. In 2008 performance was 98%.
The audit found 10% of patients were not given an early warning score assessing the risk to their life when they arrived in hospital. Performance varied with more than 50% having no score recorded in the Borders, but all patients having a score in Forth Valley. Cognitive assessments were conducted on all Glasgow Royal Infirmary patients but on less than 25% at the Royal Alexandra Hospital in Paisley.
Across Scotland more than 40% of patients received no form of geriatric assessment while in hospital. Glasgow's Victoria Infirmary had one of the best rates and Inverclyde Royal one of the lowest.
Graeme Holt, clinical lead for the audit and an orthopaedic surgeon, said the standard of care was high but admitted there were areas where it could be improved.
A Scottish Government spokesman said: "We are working with the NHS to ensure all areas can continue to learn from growing examples of good practice."