OBJECTIVES: To determine the association between quality of hospital care, using selected Assessing Care of Vulnerable Elders (ACOVE) quality indicators, and short term outcomes for very old patients admitted for acute illnesses in a tertiary hospital. METHODS: This is a retrospective review of medical records of a random sample of all patients aged 80 years and above admitted to the Department of General Medicine and Department of Geriatric Medicine from 2005 to 2008, with an equal number of cases (750) selected for each year. The quality indicators selected were cognitive and functional assessment, discharge planning, delirium evaluation and treatment, mobilization, and aspiration precautions. If patients met the inclusion criteria for each specific quality indicator, they were assessed to determine if the process-of-care was carried out and documented. The outcomes of interest were inhospital mortality, 30-day mortality and hospital readmission within 15 days of discharge. RESULTS: From the review of 2,923 cases, the adherence for the quality indicators ranged from 33.8% for cognitive and functional assessment to 88.1% for discharge planning. In univariate analyses, adherence to delirium evaluation and treatment was associated with a reduction in inhospital (17.5% vs 26.1%, p=0.004) and 30-day mortality rates (22.6% vs 32.5%, p=0.002). Documentation of cognitive and functional assessment was associated with a reduction in inhospital (6.2% vs 16.2%, p<0.005) and 30-day mortality rates (10.3% vs 22.3%, p<0.005). The association between adherence to quality indicators and hospital readmission was not statistically significant. After adjustments using the biovariate probit regression, adherence to aspiration precautions was associated with lower inhospital mortality (rho=-0.128 (95% Confidence Interval: -0.233,-0.021). CONCLUSIONS: Adherence to selected process-of-care quality indicators was generally low. Adherence to aspiration precautions was the only quality indicator that had an impact on the short term outcome for elderly patients hospitalized for acute medical conditions.