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-There is little evidence to support tube feeding in advanced dementia although it is still frequently used in acute hospital settings. Patients present with complex problems and are often unable to make decisions about their healthcare needs. Multidisciplinary teams may be challenged by the difficult ethical decisions they are required to make in the best interests of their patients. This paper guides decision making in the management of patients with dementia and dysphagia in the acute hospital setting. A structured approach to information gathering, assessment and management is outlined with practical application of recent published guidelines and research evidence, which ensures appropriate individualised care. KEY WORDS: acute care, dementia, dysphagia IntroductionGrowing numbers of patients with dementia and dysphagia are being admitted to acute medical wards with complex problems including reversible or transient medical conditions, acute stroke or other neurological aetiologies. Some patients may be approaching the end of their disease process and may present a diagnostic challenge.Current practice in the area of dysphagia and dementia is variable, with the use of artificial feeding, nasogastric (NG) tubes, percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG) frequently being used without adequate consideration of the suitability of such procedures. Clinicians should be aware that there is little evidence to support tube feeding in advanced dementia. The National Institute for Health and Clinical Excellence (NICE) guideline on dementia advises that tube feeding should only be considered where dysphagia is a transient phenomenon and that artificial feeding should not generally be used in people with severe dementia. 1Other recent publications help guide the decision-making process. 2,3 Dementia and dysphagia in acute hospital careSwallowing problems may be caused by dementia or by other factors. Physical illness or metabolic upset may lead to acute confusional state in cognitively intact older people and those with dementia. 4 Symptoms usually resolve once the acute illness has been treated. Acute confusion can impact on feeding and swallowing due to the decrease in functional skills and conscious level. It is well recognised that a decrease in swallowing efficiency and reserve in older people can result in dysphagia when acute physical illness is present. 5 Certain medications have a detrimental effect on swallowing. Antipsychotics may cause Parkinsonism and dystonia. 6 Antidepressants and benzodiazepines may cause drowsiness while other medications may lead to a dry mouth.It is important to recognise and treat depression in dementia as significant improvement in mood and function is possible. Depression may lead to a range of problems including lack of appetite, reduced motivation to eat or feed oneself, abnormal ideation about food, for example that it is poison, or anxiety about eating and swallowing. In severe depression the person may have stopped eating al...

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A close scrutiny of the pattern of aggregate expenditure recorded in the Australian national accounts reveals it was the behaviour of exports and imports, and not increased fiscal activity, that was primarily responsible for offsetting the fall in private investment due to the Global Financial Crisis. The examination of a broad set of national income and employment indicators suggests that the Australian economy most likely did not avoid a recession, even though it was a relatively mild one by past standards.