AimThe management of severely agitated elderly patients is not easy, and limited guidelines are available to assist practitioners. At a Sydney hospital, an Aggression Response Team (ART) comprising clinical and security staff can be alerted when a staff member has safety concerns. Our aims were to describe the patient population referred for ART calls, reasons for and interventions during ART calls, and complications following them.MethodsPatients 65 years and older referred for ART calls in the emergency department or wards during 2014 were identified using the Incident Information Management System database and medical records were reviewed. Demographic and clinical data were collected.ResultsOf 43 elderly patients with ART calls, 30 had repeat ART calls. Thirty-one patients (72%) had underlying dementia, and 22 (51%) were agitated at the time of admission. The main reasons for ART calls were wandering and physical aggression. Pharmacological sedation was used in 88% of the ART calls, with a range of psychotropics, doses, and routes of administration, including intravenous (19%) and, most commonly, midazolam (53%). Complications were documented in 14% of cases where sedation was used.ConclusionWe observed a high frequency of pharmacological sedation among the severely agitated elderly, with significant variance in the choice and dose of sedation and a high rate of complications arising from sedation, which may be an underestimate given the lack of post-sedation monitoring. We recommend the development of guidelines on the management of behavioral emergency in the elderly patients, including de-escalation strategies and standardized psychotropic guidelines.

Between 1979 and 2006, there were 610 deaths recorded as due to meningococcal disease in Australia. Mortality rates per capita consistently increased on average by 6% per annum between 1979 and 2002, but then fell significantly in 2003, coinciding with the introduction of the meningococcal C conjugate vaccine. In 2002, the mortality rate was 0.24 per 100,000. In the 4 years since, it fell progressively to 0.06 per 100,000. Since the introduction of conjugate Hib and pneumococcal vaccines, meningococcal disease has emerged as the number 1 infectious cause of death in children but conjugate meningococcal C vaccine appears to have greatly reduced total meningococcal disease deaths.

Objective To gain insights into the experience and challenges faced by Australasian geriatricians who have recently made the transition from advanced trainee to consultant. Methods An interpretative exploratory qualitative study. Geriatricians with five or less years of experience as consultants were recruited by email. Data were collected through semi‐structured interviews, with themes identified through open axial coding. Results Respondents (n = 20) experienced a transition period in which they adjusted to the roles of final decision‐maker and manager. Respondents felt relatively confident with their clinical skills, but under‐prepared for non‐clinical roles associated with becoming a consultant. Most respondents described challenges with career planning. Support networks were considered critical. Conclusions This is the first study in Australasia exploring the transition from trainee to consultant geriatrician. Training programs should endeavour to create “consultant‐like roles” during advanced training and address non‐clinical competencies. Participants perceived that there should be more emphasis on career planning and mentorship.

Objective To describe patterns of emergency department (ED) presentations and predictors of 30-day mortality in patients referred from a residential aged care facility (RACF). Methods A retrospective analysis of linked state-wide emergency, inpatient and death data from 136 public ED hospitals in New South Wales, Australia. Data were collected from the NSW Emergency Department Data Collection database, the NSW Admitted Patient Data Collection database and the NSW Registry of Births, Deaths and Marriages. All patients aged ≥65 years presenting to the ED from a RACF between January 2017 and July 2018 were included. ED diagnosis categories, re-admission rates within 30 days and 30-day all-cause mortality were measured. Results In total, 43 248 presentations were identified. The most common ED diagnosis categories were: injury (26.48%), respiratory conditions (14.12%) and cardiovascular conditions (10.74%). Prolonged ED length of stay was associated with higher adjusted hazard ratios for 30-day all-cause mortality after adjustments for age Charlson Comorbidity Index, triage category and diagnosis category (HR 1.10 95% CI 1.05–1.14 P < 0.001). Conclusions A large proportion of ED presentations from RACFs were for injuries associated with falls and chest infections. There was a range of both high- and low-urgency presentations. Both the 30-day mortality and re-admission rates were high. Predictors of increased mortality included prolonged length of stay in the ED and re-admission within 30 days. The findings are useful in informing discussion around improving access to care in RACFs and coordination of healthcare providers in this cohort.