General Geriatrics - Draft

Overview

Geriatric (Care of the Elderly) medicine clinics are available in BNSSG at NBT and UHBW. However the way these clinics are arranged differs between the 2 trusts and this can cause confusion when trying to decide the best referral route for patients.

Before considering a general geriatrician referral please consider the following options first:

Referral to specialty clinics - Patients with specific symptoms should be initially investigated in primary care and then referred to the relevant specialty according the most likely underlying cause e.g. if cardiac condition suspected then refer to cardiology, if respiratory condition then refer to respiratory, if ENT condition the refer to ENT etc. Alternatively consider using relevant specialty advice and guidance services available on eRS.

Referral to Movement Disorder clinics - Patients with movement disorders or suspected Parkinson's disease can be referred to the available clinics in either trust depending on age (60 and over for UHBW, 70 and over for NBT). See the Parkinson's Disease page for details.

Referral to Bone Health for Older People clinics - Patients aged 75 and over with osteoporosis who require further assessment / secondary fracture prevention can be referred to Bone Health for Older People clinics which are available in either trust. See the Osteoporosis page for details.

Referral to Falls clinic - There are no specific falls clinics in BNSSG. Please see the Falls & Balance for advice on appropriate steps if a patient is having falls or is at risk of falls.

Referral to Dementia services - Patients with confirmed diagnosis or suspected diagnosis of dementia should be assessed initially in primary care and referred as appropriate. Please see the Dementia - Assessment & referral page for details.

Referral to Frailty MDTs - Patients with frailty requiring further multi-disciplinary assessment in the community can be referred to the community based Frailty MDTs - see the Frailty page for details.

Referral to RACOP clinics - Patients who are older and have complex co-morbidities who are deteriorating and particularly if they are at high risk of admission should be referred to RACOP clinics available at both trusts. Criteria and methods of accessing these clinics differ between the trusts. See the Rapid Assessment Clinic For Older People page for details.

Urgent/Same Day advice - If you wish to discuss a patient who needs same day advice or might need admission then there consider using community services or the NBT Geriatrician advice line - see the Frailty - Urgent Care or Urgent Community Response - Sirona pages for details.

Referral

NBT

There are no general geriatric clinics available via eRS at NBT. Please consider the options listed above or consider using the Geriatric medicine A and G service (for patients aged 65 and above) for 'advice on handling general medical problems in frail, older persons.'

UHBW

There is a general geriatric RAS clinic at UHBW. Please consider the options listed above initially before submitting a referral to this service. Referrals will be triaged by a consultant and will either be returned with advice or booked into the most appropriate clinic.

eRS directory of services for this clinic advise the following conditions are treated:

''Dizziness, Dizziness and giddiness, Dizziness on standing up, Vertigo, Drop attack, Falls, Falls caused by mecication, Finding of frequency falls, Recurrent falls, Giddiness, Impairment of balance, Difficulty balancing, Feels as though will fall, General unsteadiness, Unable to balance, Syncope, Blackout, Syncope and collapse, syncope symptom, Vasovagal syncope, Hypertensive disorder, Essential hypertension, Secondary hypertension, Acute confusion, Iron deficiency anaemia, Iron deficiency anaemia due to dietary causes, plummer vinson syndrome, Anaemia due to disturbance of haemoglobin synthesis, Anaemia of chronic disease, Megaloblastic anaemia due to folate deficiency, Combined B12 and folate deficiency anaemia, Folate deficiency anaemia drug induced, Megaloblastic anaemia due to vitamin B12 deficiency, Pernicious anaemia, Congenital deficiency of intrinsic factor, Vitamin B12 deficiency anaemia due to dietary causes, Chronic anaemia, Normocytic anaemia, Nutritional anaemia, non megloblastic anaemia associated with nutritional deficiency, C/O debility Malaise, Frailty, Delirium, General difficulty in moving, Cannot get about, has gone off legs, slow on legs, General health deterioration, Frail elderly, Diffuse lewy body disease, Reduced mobility, confined to chair, mobility poor, needs walking aid in home, restless legs, self-neglect, Undifferentiated illness, illness:found on floor, illness: off feet, illness: taken to bed, Undifferentiated illness: vague ill health,weight loss finding, abnormal weight loss, unexplained weight loss, recent weight loss.

Exclusions: For movement disorders (Parkinson's or related conditions) please refer to Movement Disorder clinic. For stroke related conditions please refer to TIA clinic. For dizziness in patients under 75 years please refer to ENT. For diagnosis of dementia please refer to dementia services.'

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.