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Background: Little is known about doctors' decision-making patterns when using Advance Care Directives (ACDs), particularly for older patients in Australia and New Zealand. Aims:To determine the level of agreement among Australian and New Zealand doctors' decisions when using ACDs to guide treatment decisions for older patients. To evaluate factors that may affect decision-making including doctors' demographics, vignette complexity and Advance Care Directive (ACD) content.Methods: In December 2016-January 2017, a survey was distributed to doctors working within one tertiary hospital network in Melbourne and to doctors registered with the Australian and New Zealand Society of Geriatric Medicine. The survey comprised of three vignettes (1, 2, 3) presented with deidentified versions of genuine ACDs (A and B) volunteered by community members via a tertiary hospital ACD service.Results: Five hundred and sixty doctors submitted completed surveys. The level of agreement between doctors when using ACDs varied by vignette complexity, ACD content, doctor speciality (P = 0.006 vignette 1 ACD A, P = 0.04 vignette 1 ACD B, P = 0.04 vignette 2 ACD A, P = 0.04 vignette 3 ACD B) and doctor seniority (P = 0.04 vignette 1 ACD A, P < 0.0001 vignette 2 ACD A). Australian and New Zealand doctors are infrequently exposed to ACDs in their work, 30% did not know the legal status of ACDs and majority of the cohort requested more education on ACDs. Conclusion:Despite the presence of an ACD, the level of agreement on treatment decisions for older patients when using ACDs varies by vignette complexity, ACD content, speciality and seniority of doctors.

Background: Falls risk assessment tools are used in hospital inpatient settings to identify pa-tients at increased risk of falls (which may be related to muscle loss/sarcopenia) to guide and target interventions for falls prevention. In 2022, Western Health, Melbourne, Australia, intro-duced a new falls risk assessment tool, the Western Health St. Thomas’ Risk Assessment Tool (WH-STRATIFY), a modified version of The Northern Hospital’s risk tool (TNH-STRATIFY), which replaced the Peninsula Health Risk Screening Tool (PH-FRAT). Aims: To determine the predictive accuracy of three falls risk assessment tools (PH-FRAT, TNH-STRATIFY and WH-STRATIFY) on admission to Geriatric Evaluation Management (GEM) units. Method: A retrospective observational study was conducted on four GEM units. Data was col-lected on 54 consecutive patients who fell during admission and 62 randomly sampled patients who did not fall between December 2020 and June 2021. Participants were scored against three falls risk assessment tools. The event rate Youden (Youden IndexER) indices were calculated and compared using default and optimal cut points to determine which tool was most accurate for predicting falls. Results: Using default cut points to compare falls assessment tools, TNH-STRATIFY had the highest predictive accuracy (Youden IndexER = 0.20, 95% confidence interval CI = 0.07, 0.34). The PH-FRAT (Youden IndexER = 0.01 and 95% CI = -0.04, 0.05) and WH-STRATIFY (Youden IndexER = 0.00 and 95% CI = -0.04, 0.03) were statistically equivalent and not predictive of falls compared to TNH-STRATIFY. When calculated optimal cut points were applied, predictive accuracy im-proved for PH-FRAT (Cut point 17, Youden IndexER = 0.14 and 95% CI = 0.01, 0.29) and WH-STRATIFY (Cut point 7, Youden IndexER = 0.18 and 95% CI = 0.00, 0.35). Overall, all tools had low predictive accuracy for falls. Conclusion: TNH-STRATIFY had the highest predictive accuracy for falls. The predictive accu-racy of WH-STRATIFY improved and was significant when the calculated optimal cut point was applied. The optimal cut points of falls risk assessment tools should be determined and validated in different clinical settings to optimise local predictive accuracy, enabling targeted falls risk mitigation strategies and resource allocation.

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BackgroundCaring for those at the end of their lives is an increasing component of work for Intensive Care Units (ICUs). Limited research is available about patients specifically admitted to ICU with the aim of providing end of life care.AimTo define epidemiology of patients admitted to ICU for consideration of organ donation or palliative care and identify factors associated with outcome.MethodsRetrospective analysis of data from the Australian and New Zealand Intensive Care Society Adult Patient Database between 2007 and 2011.ResultsBetween 2007 and 2011, there were 1428 admissions to ICU for palliative care and 343 for consideration of organ donation (0.4% of the total 445 381 ICU admissions). Mortality was 87% and 93% respectively, compared with 9% in patients admitted for active management. 122 patients were discharged home alive. Median length of ICU stay was 17 h (IQR 6–39) in the palliative care group, 24 h (IQR 14–42) in the potential organ donation group, compared with 42 h (IQR 22–86) in patients admitted for active management. The most common diagnosis was intra-cerebral haemorrhage. A diagnosis of gastrointestinal cancer (OR 12.3, 95% CI 2.3 to 62.9, p=0.002) and planned admission following elective surgery (OR 4.3, 95% CI 2.6 to 7.2), p<0.001) were independently associated with being discharged home alive.DiscussionAdmission to ICU for palliative care or consideration of organ donation is uncommon and most patients die. Functional status of survivors remains unknown.ConclusionMore work is required to better identify patients who might survive, and assess needs and functional outcomes.