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Introduction and aims.– In the present research, we investigate the opinions on the administration of artificial nutrition (AN) and hydration (AH), compared to amedical treatment such as antibiotic therapy (AT), to patients with advanced dementia characterized by different expectancy of life. We also investigated the antecedents of these opinions, considering feelings, thoughts and behaviors related to death, opinions concerning palliative care and end-of-life issues, and individual characteristics. Participants and methods.– A questionnaire was administered to Italian physicians (n=288) and nurses (n=763). We analyzed the percentages of agreementwith the administration of treatments to patients with advanced dementia with expectancy of life of more than 6months, between 1 and 6months, and of less than 1month. Multivariate logistic regressions were performed with the aim of detecting the antecedents of these opinions. Results.– When expectancy of life is higher than 6months, agreement with the three types of treatment is similarly high (AN=82%; AH=87%; AT=86%). However, when expectancy of life is less than 1month, the agreement with providing AH was higher (73%) than that concerning AN (48%), while the percentage of agreement with the administration of AT was in between (61%). The analysis of the antecedents of agreement with the administration of these treatments showed the importance of factors such as emotional reactions to death, opinions concerning livingwill, respect for individual life, and formation in palliative care. Conclusions.– These findings suggest that AH is not conceived as an usual medical treatment, but is likely to be perceived as related to otherdimensions. Further results indicate that opinions concerning AN and AH are not only informed by scientific data, but are also related to cultural, ethical and psychological aspects.

Jean-Claude Monfort and colleagues (Jan 22, p 300) bring helpful attention to neglected aspects of elder abuse. Elder mistreatment in institutions is poorly catalogued, and is especially complex in consisting of both in stitutional abuse—towards all residents—and acts of elder abuse specifi cally towards a single resident. Monfort and colleagues’ Correspondence raises the further challenge of abuse by other residents, who, along with care staff , are recognised as the most common perpetrators of sexual abuse of nursing home residents. Most defi nitions of elder abuse are premised on their occurring within a relationship where there is an expectation of trust, and the precise nature of the relationship between residents, particularly when one or both might have cognitive impair ment, is not at all clear. More attention needs to be paid to developing techniques to prevent, detect, and manage resident-toresident abuse, and experienced care staff can provide helpful insights into how to develop these strategies. However, it would be important not to assume that only those with a past history of paedophilia are likely to be off enders, since vulnerability and inadequate vigilance about access might be more important factors than an agebased “gerontophilia”. Ad ditionally, we are as yet far from understanding how best to meet the sexual and emotional needs of residents in nursing homes. The expression of sexuality by nursing home residents often creates discomfort among care staff , and fresh thinking and multidisciplinary strategies are required to address the emotional and sexual wellbeing of older people in residential care.

Nursing home residents with diabetes have more complex care needs with higher levels of comorbidity, disability and cognitive impairment. We compared current practice in the 44 long-term residents in Peamount hospital with the standards recommended in the Diabetes UK "Good Clinical Practice Guidelines for Care Home Residents with Diabetes". Of 44 residents, 11 were diabetic. Residents did not have specific diabetes care plans. There were some elements of good practice with a low incidence of hypoglycaemia and in-house access to dietetics and chiropody. However, diabetes care was delivered on an ad-hoc basis without individualised care plans, documented glycaemic targets, or scheduled monitoring for complications and no formal screening for diabetes on admission. National and local policy to guide management of diabetes mellitus should be developed. There should be individualised diabetes care plans, clear policies for hypoglycaemia, hyperglycaemia and long-term diabetes complications, screening on admission and increased uptake of the national retinal screening and foot care programmes.

It is accepted that a lumbar puncture (LP) and cerebrospinal fluid (CSF) biomarker analysis support the routine diagnostic work-up for the differential diagnosis of dementia due to Alzheimer’s disease (AD) within certain patient cohorts1. These tests, which measure CSF protein concentrations of amyloid-β42 (Aβ42), total tau (t-tau) and phospho tau (p-tau), were recently validated, accredited and made available clinically for the first time in Ireland. A working group, comprising Irish clinical and scientific researchers, met to review a) the validation results; b) international consensus opinions, and c) research and clinical evidence as to the clinical utility of CSF biomarker analysis for AD dementia diagnosis. The outcome of this meeting was the formulation of a consensus statement paper for the benefit of health care professionals involved in the diagnosis and management of dementia to ensure appropriate use of these biomarker tests in clinical settings in Ireland.

Background Increased co-morbidities and physiological changes mean older patients may be at higher risk of adverse outcomes from certain imported illnesses. One of the most commonly diagnosed imported infections in returning travelers is malaria. Increasing age is strongly and independently associated with increasing morbidity and mortality from malaria. Delayed diagnosis leads to higher risks of poor clinical outcomes in older patients presenting with malaria. The objective of this study was to quantify malaria presentations in older patients as a percentage of total malaria presentations, compare length of hospital stay (LOS) between the older and younger cohort, and to describe medical co-morbidities, length of time to diagnosis and factors contributing to delayed diagnosis and increased LOS in the older cohort. Methods A retrospective cohort study was undertaken in two university hospitals of all patients aged 65 years or older presenting with malaria from 2002–2012. A national hospital inpatient database was used to identify patients of all ages with a discharge diagnosis of malaria over this ten year period, and quantify LOS in those aged

Background : Studies have demonstrated that a significant minority of older persons presenting to acute hospital services are cognitively impaired; however, the impact of dementia on long-term outcomes is less clear. Aim : To evaluate the prevalence of dementia, both formally diagnosed and hitherto unrecognised in a cohort of acutely unwell older adults, as well as its impact on both immediate outcomes (length of stay and in-hospital mortality) and 12-month outcomes including readmission, institutionalisation and death. Design : Prospective observational study. Methods : 190 patients aged 70 years and over, presenting to acute hospital services underwent a detailed health assessment including cognitive assessment (standardised Mini Mental State Examination, AD8 and Confusion Assessment Method for the Intensive Care Unit). Patients or informants were contacted directly 12 months later to compile 1-year outcome data. Dementia was defined as a score of 2 or more on the AD8 screening test. Results : Dementia was present in over one-third of patients (73/190). Of these patients, 36% (26/73) had a prior documented diagnosis of dementia with the remaining undiagnosed before presentation. The composite outcome of death or readmission to hospital within the following 12 months was more likely to occur in patients with dementia (73% (53/73) vs. 58% (68/117), P = 0.043). This finding persisted after controlling for age, gender, frailty status and medical comorbidities, including stroke and heart disease. Conclusion : A diagnosis of dementia confers an increased risk of either death or further admission within the following 12 months, highlighting the need for better cognitive screening in the acute setting, as well as targeted intervention such as comprehensive geriatric assessment.