Information
For patients with frailty, dementia or delirium, avoidable 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 patient’s admission to hospital is still the most appropriate course of action but this document outlines alternatives sources of support and treatment available to prevent this where possible.
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.
JH & JB 26/6/26
Please see this PDF on all referral pathways for MOE patients in East Lothian
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 older patients
- Single symptom suggestive of malignancy if frail (consider if single organ specialty referral more appropriate especially if clinical frailty score <4)
- Possible Parkinson’s disease (please state this in the referral)
UPDATE JUNE 2026 RE MOE-LED IV THERAPIES (blood transfusions and IV therapy): These services are not currently able to be offered at ELCH. East Lothian patients requiring this service should be escalated to RIE if required
(Please note this will not affect those already having treatment delivered from Haematology in the IV therapies satellite unit, or those where the treatment is arranged via their GI consultant directly with endoscopy)
For MOE Advice and OPD in East Lothian the pathways are:
FOR ADVICE ONLY: East Lothian Community Hospital >> Geriatric Medicine >> Geriatric Medicine Advice
FOR OUTPATIENT APPPOINTMENT: East Lothian Community Hospital >> Geriatric Medicine >> Basic Sign Referral
Who not to refer:
- Iron deficiency anaemia (single issue) – should be referred to GI
- Memory loss only – should be referred to East Lothian Older People’s Mental Health Team (SCI Gateway: Mental Health >> East Lothian – Psychiatry of Old Age >> LI Psychiatry of Old Age EL)
- Persistent vertigo with suspicion of BPPV or vestibular neuritis, consider if patient could be managed via the physiotherapy vestibular pathway: East Lothian Vestibular Pathway
- Incontinence – consider Continence team / DN referral
- End of life support – please see the Palliative Care team page for details of referral, unless require a Community Bed at ELCH, in which case please see the ELCH Lothian HBCCC referrals (ELCH Ward 1) page.
ALL the above do not preclude the referral being appropriate – clinical judgment is required. We are more than happy to discuss referrals/give advice.
