Background: previous studies have indicated a prevalence of dementia in older admissions of ∼42% in a single London teaching hospital, and 21% in four Queensland hospitals. However, there is a lack of published data from any European country on the prevalence of dementia across hospitals and between patient groups.Objective: to determine the prevalence and associations of dementia in older patients admitted to acute hospitals in Ireland.Methods: six hundred and six patients aged ≥70 years were recruited on admission to six hospitals in Cork County. Screening consisted of Standardised Mini-Mental State Examination (SMMSE); patients with scores <27/30 had further assessment with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Final expert diagnosis was based on SMMSE, IQCODE and relevant medical and demographic history. Patients were screened for delirium and depression, and assessed for co-morbidity, functional ability and nutritional status.Results: of 598 older patients admitted to acute hospitals, 25% overall had dementia; with 29% in public hospitals. Prevalence varied between hospitals (P < 0.001); most common in rural hospitals and acute medical admissions. Only 35.6% of patients with dementia had a previous diagnosis. Patients with dementia were older and frailer, with higher co-morbidity, malnutrition and lower functional status (P < 0.001). Delirium was commonly superimposed on dementia (57%) on admission.Conclusion: dementia is common in older people admitted to acute hospitals, particularly in acute medical admissions, and rural hospitals, where services may be less available. Most dementia is not previously diagnosed, emphasising the necessity for cognitive assessment in older people on presentation to hospital.

These findings support the prioritisation of nutritional screening in clinical practice and public health policy, for all patients ≥70 on admission to hospital, and in particular for people with dementia, increased functional dependency and/or multi-morbidity, and those who are frail.

Purpose: This paper reports on results of a study to identify education needs of nurses in acute care environments regarding dementia care in Ireland. Method:As part of a multicentre study of dementia prevalence and in-hospital course, a survey was conducted with nurses (n = 151) in six acute hospitals in the south of Ireland. Data were analysed using descriptive statistics. Findings:Despite the availability of a national dementia education programme across all care services, 83% of acute hospital nursing staff perceived that they had insufficient training in dementia care, reflecting the known poor uptake of offered dementia education in acute hospitals. Over two thirds of nurses felt that education on dementia specific communication strategies was insufficient or unavailable. Nurses also reported insufficient knowledge with regard to pain assessment in patients with dementia, or alternatives to physical or chemical restraint. This lack of knowledge has implications for quality of care and may have consequences for safety of patients with dementia in acute hospitals in Ireland. Conclusion:With the expected growth in prevalence of dementia worldwide, more people with dementia will access acute hospital care. Education and training to improve dementia care needs to be prioritised in acute hospitals at senior level.

Malnutrition is common in older adults, and is associated with high healthcare costs and adverse outcomes, particularly in hospital settings (1,2) . The prevalence and correlates of malnutrition in hospitalised older adults are currently not clear; much of the existing research in this area is limited methodologically; studies are typically based on small samples and/or narrow populations (3,4) , exclude people with dementia (3,4) , are uni-centre (5) , and/or use tools not designed for use with older adults (5) . The present study addresses this gap, investigating the prevalence, correlates and outcomes of malnutrition in older adults on admission to hospital.In total, 606 (70+ years) older adults were included in a prospective cohort study across six hospitals in the Republic of Ireland. All elective and acute admissions to any speciality were eligible. Day-case admissions and those moribund on admission were excluded. All participants were clinically assessed for dementia on admission (see Timmons et al. (6) ). Socio-demographic and clinical data, including nutritional status (Mini-Nutritional Assessment -short form (7) , was collected within 36 hours of admission. Outcome data was collected prospectively on length of stay, in-hospital mortality and institutionalisation.The mean age was 79·7; 51 % were female; 29 % were elective admissions; 67 % were admitted to a medical specialty. Nutrition scores were available for 602/606; 37 % had a 'normal' status, 45 % were 'at-risk', and 18 % were 'malnourished'. Malnutrition was more common in females, acute admissions, older patients and those who were widowed/ separated. Dementia, functional dependency, comorbidity and frailty independently predicted a) malnutrition and b) being at-risk of malnutrition (p < ·001). Malnutrition was also associated with an increased length of stay (p < ·001), institutionalisation (p < 0·001) and in-hospital mortality (p < ·001).These findings support the prioritisation of nutritional screening in clinical practice and public health policy, for all ≥70 on admission to hospital, and in particular for people with dementia, increased functional dependency and/or multi-morbidity, and those who are frail.