A comparison of changes in drug burden index between older inpatients who fell and people who have not fallen: A case-control study.

Objective: Older inpatients who fall are often frail, with multiple co-morbidities and polypharmacy. Although the causes of falls are multifactorial, sedating and delirium-inducing drugs increase that risk. The aims were to determine whether people who fell had a change in their sedative and anticholinergic medication burden during an admission compared to people who did not fall.

A broken neck: outcomes from conservative management of C2 fractures in older adults.

Aim: To describe the management, complications and functional outcomes of older patients who sustain fractures of the second cervical vertebra (C2).

Methods: Retrospective review of consecutive patients aged 65 years and older. All patients admitted with the clinical discharge code of S12.

Anticoagulant-related intracranial haemorrhage: time to anticoagulant reversal improving but still slower than thrombolysis for ischaemic stroke.

Aims: This study aims to determine whether door-to-needle times (DNT) for reversal of anticoagulant-associated intracerebral haemorrhage (ICH) (1) have improved over time, (2) differ between warfarin and dabigatran and (3) are comparable to ischaemic stroke (IS) thrombolysis DNT, and (4) whether reversal is monitored.

Methods: Retrospective review of all warfarin- and dabigatran-associated ICH presenting to Christchurch Hospital over a 15-year period. DNT data from 2013-2018 were compared between warfarin-related ICH (WRICH), dabigatran-related ICH (DRICH) and IS thrombolysis.

Polypharmacy in Palliative Care: Two Deprescribing Tools Compared with a Clinical Review.

Lack of guidance is highlighted as a barrier to deprescribing in palliative care. Two deprescribing tools exist, but with inclusion and exclusion criteria that limit utility. The tools have not previously been compared directly or used in an unselected palliative population.

Low-impact (compliant) flooring and staff injuries.

Introduction: Low impact flooring (LIF) has shown potential for reducing fall-related injuries for older people in residential care or hospital environments. However, the increased rolling resistance when moving equipment on these floors has raised concerns that staff injuries may increase.

Methods: LIF was trialled on one Older Persons Health ward for 2.

Implementing a 'Safe Recovery' fall prevention program: Refining intervention theory using realist methods.

Objectives: This research aimed to explain how the Safe Recovery Programme (SRP) may best work to reduce falls in older adults undergoing rehabilitation in four wards in an older person's health and rehabilitation service.

Methods: Qualitative realist methods were used, including surveys completed by patients and staff, and qualitative interviews or focus groups exploring views of patients, ward staff and SRP educators.

Results: Emphasising different types of information for patients with different pre-existing understandings may facilitate their responses to SRP messaging.

Inpatient healthcare-associated bloodstream infections in older people.

This retrospective study describes inpatient healthcare-associated bloodstream infections (HABSI) in older adults and explores whether urinary catheters (presence/insertion/removal) were related to HABSI events. One hundred and sixty-seven HABSI events were identified, predominantly (124, 74%) with Gram-negative bacteria. HABSI was attributed to a urinary source in 110 patients (66%), with over half (63, 57%) of these associated with urinary catheters.

Examining the Risks of Major Bleeding Events in Older People Using Antithrombotics.

Background: Real-world evidence for the safety of using antithrombotics in older people with multimorbidity is limited. We investigated the risks of gastrointestinal bleeding (GI-bleeding) and intracranial (IC-bleeding) associated with antithrombotics either as monotherapy, dual antiplatelet therapy (DAPT) or as triple therapy (TT) [DAPT plus anticoagulant] in older individuals aged 65 years and above.

Methods: We identified all individuals, 65 years and above, who had a first-time event of either IC- or GI-bleeding event from the hospital discharge data.

Readmissions to hospital in a frail older cohort receiving a community-based transitional care service.

Aims: To investigate frequency of and reasons for hospital readmission in a frail older cohort receiving a community-based, multidisciplinary, transitional care service.

Methods: A prospective cohort study with descriptive analysis of reasons for readmission in a cohort of frail older people discharged from hospital with the service. Measures of frailty, comorbidity, cognition, quality of life and function were recorded at discharge.

Telephone discharge support for frail, vulnerable older people discharged from hospital: Impact on readmission rates - Participant and general practitioner feedback.

Objective: To assess the use and acceptability to older participants and general practitioners (GPs) of telephone support postdischarge to reduce readmissions.

Methods: A prospective cohort study of older people after discharge from a specialist geriatric unit, and comparison with a previous cohort. Telephone follow-up calls were made fortnightly for three months.

Low-Impact Flooring: Does It Reduce Fall-Related Injuries?

Objectives: To compare fall rates and injuries from falls on low-impact flooring (LIF) compared with a standard vinyl flooring.

Design: Prospective, observational, nonrandomized controlled study.

Setting: Subacute Older Persons Health ward (N = 20 beds).

Audit of anticholinergic medication changes in older hospitalised patients using the Anticholinergic Drug Scale.

Background/aim: In patients discharged from an Older Person's Health hospital, we assessed (i) the prevalence of anticholinergic medications (ACM) in this study population and (ii) changes in anticholinergic drug burden during admission using the Anticholinergic Drug Scale (ADS).

Methods: Cases were identified between September 2010 and January 2011 using discharge coding data. Clinical notes were reviewed to determine which regular oral medications were commenced, altered or ceased during admission with their respective ADS level.

'Real-world' haemorrhagic rates for warfarin and dabigatran using population-level data in New Zealand.

Background: Anticoagulants such as warfarin and dabigatran can significantly reduce the risk of stroke in individuals with atrial fibrillation that may lead to increased risk of bleeding, especially in older people. Evidence for bleeding risks with anticoagulants within the context of doses, multimorbidity and impaired renal function in real world setting is lacking. Therefore we aimed to assess and compare real world bleeding risks with warfarin and dabigatran.

Introduction of the Pill Pruner to acute medical care: a simple medication guide to control polypharmacy.

Aim: To assess the effect of a simple medication guide (the Pill Pruner) on the number of regular medications taken by older patients following medical admission.

Methods: In July 2009, following introduction of the Pill Pruner, we audited 500 consecutive older patients, recording the number of regular medications being taken on admission and discharge. Safety data included 90-day mortality and readmission rates.

Impacts of the emergency mass evacuation of the elderly from residential care facilities after the 2011 Christchurch earthquake.

Objective: The 2011 earthquake that devastated Christchurch, New Zealand, led to the closure and evacuation of 7 residential care facilities and the partial evacuation of 2 more. Altogether, 516 elderly persons were evacuated. The emergent nature of the disaster was unexpected and largely unplanned for.

Classification of falls in stroke rehabilitation--not all falls are the same.

Objective: To develop a practical taxonomy of falls and to determine whether these different fall groups have different outcomes.

Design: Descriptive study examining patient characteristics at the time of each fall and iterative development of falls taxonomy.

Setting: An inpatient stroke rehabilitation ward.

Telerehabilitation to improve outcomes for people with stroke: study protocol for a randomised controlled trial.

Background: In New Zealand, around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained. Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities. However, on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of resources and geographical location.

Warfarin-related intracerebral haemorrhage: better outcomes when reversal includes prothrombin complex concentrates.

Background: Warfarin-related intracerebral haemorrhage (WRICH) has high mortality. Haematoma expansion is prolonged in WRICH and independently predicts worse outcomes. Guidelines recommend prompt reversal of the warfarin coagulopathy, but evidence of benefit is lacking.

Perceived factors which shape decision-making around the time of residential care admission in older adults: a qualitative study.

Aim: To understand the perceived factors that shape decision-making around the time of residential care admission in older people.

Method: Two qualitative methods (telephone interviews at intervals post discharge from geriatric inpatient care and face-to-face interviews with older people and their family carers) were used as part of a multiphase mixed methods study of a cohort of 144 older people discharged from medical wards in a subacute assessment, treatment and rehabilitation facility.

Results: Key topics and themes were derived from interviews: the role of the informal carer and other community supports, attitudes to decision-making and loneliness were key aspects of social context.

Fall and fracture rates following a change from carpet to vinyl floor coverings in a geriatric rehabilitation hospital. A longitudinal, observational study.

Objective: To investigate whether changing from 5 mm thick carpet tiles to vinyl on a concrete subfloor would alter fall or fracture rates.

Design: Longitudinal, observational study.

Setting: Six wards (129 beds) of a geriatric rehabilitation hospital.

Resource usage and outcomes in a facilitated discharge service in Christchurch, New Zealand.

Aim: To describe the type and level of support provided by a facilitated discharge team to frail older patients discharging from a 113-bed elderly rehabilitation hospital and the outcomes achieved.

Method: Prospective data detailing reasons for referral, services provided and retrospective data on outcomes, were obtained to 90 days post discharge on visits to new patients during 21/2/08 to 15/7/08.

Results: Seventy-four patients (mean age 82, 58% female) were included.

Acute medical admissions for older people from residential care facilities: are they appropriate?

Aim: Acute medical admissions are increasing and potentially avoidable admissions (PAA) from residential care facilities (RCF) have been blamed. Estimates for the proportion of PAA from RCFs vary enormously in the literature. This study aimed to prospectively determine the level of PAA to a New Zealand hospital.

Stroke discharges from a rehabilitation unit: 1-year and 5-year domicile outcomes. Function is important.

Background: Stroke units save lives, reduce disability and increase the chances of the person returning to their own home. Following the introduction of a stroke rehabilitation unit, we assessed the durability of stroke discharges over a 1-year period and predictors of early 'failed' home discharges. Stability of discharge domicile and survival over 5 years was also reviewed.