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.

Eighty-nine patients were studied; 47 in the MAU group and 42 in the non-MAU group. The MAU cohort was significantly older (84.1 ± 7.9 years v. 80.4 ± 7.8 years, respectively, P=0.03); and had shorter ED LOS (4.9 ± 3.0h v. 6.5 ± 2.8h, P=0.012). Overall hospital LOS did not differ except for patients with 'cellulitis', (5.7 ± 4.9 days for MAU cohort v. 14.8 ± 6.8 days for non-MAU cohort, P=0.022). There was no significant difference in mortality, readmission rate or discharge destination. Conclusions. The MAU can be an effective service model for older patients. More research is required to confirm this and to define the key elements that are essential for its effectiveness.

Objectives: To examine the perceptions of practising aged care physicians with respect to bereavement care. Method: A questionnaire survey was sent to 427 Consultant Geriatricians and Advanced Trainees in Geriatric Medicine. Results: Ninety eight percent of respondents believed it was important to provide bereavement care for patients and their families. Fifty six percent did not feel it was their role to provide this support. For those who provided bereavement care (33%), most used a combination of hospital and community based resources. Fifty nine percent of respondents believed that they had inadequate training in bereavement care. Seventy one percent of respondents were not aware of resources available to fellow colleagues experiencing difficulties coping with the death of a patient. Conclusions: Aged care physicians differ in their approaches to bereavement care. Aged care physicians may need further education in bereavement care.