Elderly Patient
118 General Medical Emergencies
2 Refer a patient with a pigmented lesion with any major sign urgently to the
dermatology team.
3 Also refer a patient with a pigmented lesion and a minor sign, although <50%
will have a melanoma.
4 Remember that the most common sites for melanoma are on the back and on
the legs.ELDERLY PATIENT
1 An increasing number of patients over the age of 75 years attend the ED and
pose unique problems of t heir own.
2 These problems begin in the waiting area, where old people may become
frightened or confused due to their inability to see, hear or move easily, and
understand instructions.
3 Always consider all of the following factors before discharging an elderly
patient:
(i) Can the patient walk safely with or without a stick?
(ii) Can the patient understand new or existing medication?
(iii) Can the patient get home safely and easily?
(iv) Once home, can the patient cope with dressing, washing, using
the toilet, shopping, cooking, cleaning or relaxing?
(v) Can relatives or friends cope any more?
4 Do not discharge the patient without seeking help from the following people,
if any factor above is present. Keep the patient in overnight to facilitate
arrangements, when there is any doubt:
(i) General practitioner:
(a) the key person to coordinate the care of the patient at home
(b) always contact by fax as well as by letter.
(ii) ‘Hospital in the Home’, or ‘Hospital in the Nursing Home’
service.
(iii) District or community nursing service.
(iv) Social worker (hospital- or community-based), who can offer:
(a) home help
(b) ‘meals on wheels’
(c) lunch and recreational clubs
(d) voluntary visiting services
(e) laundry service
(f) chiropody service
(g) home adaptation service
(h) emergency accommodation.
(v) Domiciliary physiotherapist or occupational therapist.