Secondary Care Referrals to a Tertiary Physician-Led Memory Clinic: Patient Characteristics & Service Planning Implications

Introduction

National guidance mandates delirium/cognitive screening for all older hospital patients (aged >65 years) with onward referral to memory services for suspected dementia. However, barriers between hospital and community services may impact this pathway. The Oxford University Hospitals physician/geriatrician-led memory clinic takes “internal” referrals directly from local secondary care services as well as from GPs. We determined the characteristics of this memory clinic population including referral route and degree of multimorbidity.

Methods

In a retrospective study of patients attending the Memory Clinic for the first time in 2019-2026, proportions of internal versus external referrals were compared. In a sample of patients attending in 2021-2022, internally vs externally referred patients were compared for diagnosis, number of medications (as a proxy for multimorbidity), Montreal Cognitive Assessment (MoCA) score and Clinical Frailty Scale (CFS). 

Results 

The proportion of referrals received internally increased over time; χ2(df=4, n=345)=40.3; p<0.001. Internal referrals rose from 5.1% in 2019-2020 to 66.7% in 2025-2026.

Among 106 new patients seen in 2021-2022, 60 (56.6%) had dementia diagnosed (of which 41.7% AD, 11.7% vascular, 46.7% other) and 37 (34.9%) had MCI. Findings were similar irrespective of referral source. Internal referrals had greater comorbidity as indicated by number of medications (mean/SD=6.8/3.6 vs 5.1/3.0, p=0.01) and a trend towards worse cognition (mean/SD MoCA=16/6.4 vs 18/5.9 p=0.08) and higher frailty (mean/SD CFS=5.0/1.3 vs 4.5/1.5, p=0.1). 

Conclusion
The proportion of patients referred to our clinic directly from secondary care services with suspected MCI/dementia has increased more than 10 fold in recent years. Notably, patients referred directly from secondary care are more multimorbid with possible worse cognition and greater frailty than those from primary care. Embedding of front-door delirium and frailty screening in hospitals has implications for memory clinic services; greater capacity and capability will be required to manage increasing numbers of multimorbid, complex patients.