Information
For patients with frailty, dementia or delirium, admission to hospital can be detrimental to both physical and mental health. Patients lose 10% of their body mass per week on bed rest or with minimal activity as is common in hospital. In addition, change of environment can worsen cognitive and behavioural issues in those with dementia or delirium. For some patients, admission to hospital is still the most appropriate course of action but this document outlines a range of community-based services that provide assessment for frail elderly and offer alternatives to admission or alternative admission pathways for suitable patients.
Frailty Assessment
Across Lothian, it is recommended you use the Rockwood Clinical Frailty Scale in all Medicine of the Elderly referrals and your clinical practice.
Please see this PDF on all referral pathways for MOE patients in Midlothian.
Where referral forms are mentioned these can be found under the Resources and Links section of this page.
Who to refer:
- Falls, frailty syndromes including dizziness
- Weight loss in frail older patients i.e. clinical frailty score >4
- Multiple/complex symptoms in frail
- Single symptom suggestive of malignancy if frail (consider if single organ specialty referral more appropriate especially if clinical frailty score <4)
Who not to refer:
- Iron deficiency anaemia (single issue) – should be referred to GI
- Memory loss only – should be referred to Midlothian Older People’s Mental Health Team: https://apps.nhslothian.scot/refhelp/guidelines/mentalhealthadult/older-peoples-mental-health/olderpeoplesmentalhealthmidlothian/
- Incontinence – consider continence nurse / DN referral
- End of life support – palliative care team unless require community bed in which case please refer via Midlothian Patient Flow Team (see above)
ALL the above do not preclude the referral being appropriate – clinical judgment is required. We are more than happy to discuss referrals/give advice.
