Winter deaths in Scotland reached their highest level for 15 years last year, new figures have revealed.
Data from the National Records of Scotland show there were 22,011 deaths registered in the four months between December 2014 and March 2015.
The number is up from 18,675 the previous season and the highest since the winter of 1999/00, when there was a high level of flu activity.
Winter 2013/14 had the lowest recorded level of deaths for 64 years.
Statisticians said last winter had a “relatively low level of influenza activity but a seasonal increase in mortality that was unusually high for the 21st century”.
The seasonal increase in mortality, or the number of “additional” deaths compared with the average for the two adjacent four-month periods, was 4,060 in winter 2014/15, up from 1,600 the previous cold season.
Of these, 1,940 were in the 85-plus age group, with a further 1,240 among those aged 75 to 84.
Scotland’s chief medical officer Catherine Calderwood urged older people and those with underlying health conditions to take up free flu vaccinations.
She said: “Last winter was a challenging one with deaths being caused by a number of conditions including respiratory and circulatory diseases.
“We have also heard from NHS health boards of more, sicker, patients arriving at hospital, which possibly reflects the growing number of elderly people living in Scotland with multiple health problems.
“While in many cases of winter mortality influenza will not be the main cause of death, it can aggravate underlying long-term conditions, which may have had a significant impact on the sick and elderly last winter.
“This is why it is crucial that those with underlying health conditions, those who are pregnant or are older than 65 receive their free flu vaccination.”
Tim Ellis, chief executive of the National Records of Scotland, said: “Unfortunately, last winter had an unusually high seasonal increase, when compared with the previous 14 winters.
“Looking at our figures, which go back to 1951/52, the long-term trend has clearly been downward. Despite the latest winter’s unusually high figure, the five-year moving average (which smooths out much of the year-to-year fluctuation) is at its second lowest ever level.
“There is no single cause of additional deaths in winter. Very few are caused by hypothermia and only a small proportion by influenza.
“The underlying causes of most of the additional deaths include respiratory and circulatory diseases (such as pneumonia, coronary heart disease and stroke), dementia, and Parkinson’s, Alzheimer’s and other degenerative diseases.”