Poster Presentation Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2026

Safety in focus: Building a statewide hospital framework for dementia‑related aggression (#213)

Frederick Graham 1 2 3 , Elizabeth Whiting 4 5 , Madeline Downey 6 , Laureen Hines 7 , Ruth E Hubbard 1 2
  1. Princess Alexandra Hospital, Greenslopes, QLD, Australia
  2. The Australian Frailty Network, The University of Queensland, Brisbane , QLD, Australia
  3. The School of Nursing , Queensland University of Technology, Brisbane, QLD, Australia
  4. Geriatric and General Medicine, Th ePrince Charles Hospital , Brisbane, Qld, Australia
  5. The University of Queensland, Brisbane, QLD, AUS
  6. Subacute Care Unit, Older Person Subacute and Rehabilitation , Cairns and Hinterland Hospital and Health Service, Brisbane, Queesland, Australia
  7. Health Improvement Unit , Clinical Excellence Queensland, Queensland Health, Brisbane , Qld, Australia

Aims: To develop a hospital-wide model-of-care for managing violence in patients with dementia and delirium and assess statewide service capability against this framework.

Methods: A multi-stage, mixed-methods design. Phase 1 involved a SAC1-informed literature appraisal and review of two exemplar hospitals. Findings from three hospital-service SAC1-investigations of assault-related deaths in Australian hospitals underscored the serious risks that violence in older patients pose to safety and care quality. They identified a predominantly dispersed-care approach across hospitals, placing patients according to available bed locations rather than behavioural severity, clinical complexity, or risk, resulting in unsafe care, patient-to-nurse violence, increased length-of-stay, antipsychotics and restraints, perpetuating cyclical patient deterioration with symptom intractability. This informed initial framework development. Phase 2 comprised iterative co-design workshops, stakeholder engagement, and structured environmental scans across 23-hospitals. Phase 3 refined the framework through expert workshops and consumer input. Phase 4 developed weighted service capability rubrics spanning workforce, care processes, and infrastructure. Phase 5 applied these capability standards to 23-hospitals, producing a statewide heat map and gap analysis.

Results: A hospital-wide model-of-care framework was endorsed statewide. Its three-tiered severity stratification requires specific infrastructure: Specialist Units, Cohorting and Consultation Liaison. While nine hospitals met minimum-or-above capability standards, modest, site-specific infrastructure investments for the remainder could ensure minimum standards statewide.  

Conclusion: Addressing critical system-level gaps in hospital dementia care, this statewide endorsed model-of-care framework represents a systemic shift away from dispersed generalist care, toward safer, consistent, specialised care. Ready for service-level evaluation, the framework usefully directs statewide planning, service capability, and hospital redesign.