AimThis paper considers the challenges of delivering effective palliative care to older people with dementia and the possible strategies to overcome barriers to end-of-life care in these patients.

ObjectiveBioelectrical impedance vector analysis (BIVA) and phase angle (PA) have been shown previously to indicate relative nutritional status in patients. The aim of this study was to investigate the application of BIVA and PA assessments in a cohort of frail older hospital patients and compare these assessments with malnutrition risk screening by MUST (Malnutrition Universal Screening Tool), and the MNA-SF® (Mini-Nutritional Assessment-Short Form). MethodsSixty-nine patients (n = 44 men; n = 25 women; age 82.1 ± 7.6 y [range 62-96 y]; body mass index 25.8 ± 5.4 kg/m2 [range 16.6-45.1 kg/m2]) were recruited from hospital wards specializing in the care of frail older individuals from the United Kingdom. Bioelectrical impedance assessment was performed at 50 khz frequency, BIVA was performed using raw impedance data, PA was calculated, and data were compared against reference population groups. Patients were categorized by malnutrition risk by MUST and MNA-SF.

s u m m a r yBackground & aims: This cohort study aimed to investigate and compare the ability to predict malnutrition in a group of frail older hospital patients in the United Kingdom using the nutritional risk screening tools, MUST (malnutrition universal screening tool), MNA-SF Ò (mini nutritional assessment-short form) and bioelectrical impedance assessment (BIA) of body composition. Methods: MUST and MNA-SF was performed on 78 patients (49 males and 29 females, age: 82 y AE 7.9, body mass index (BMI): 25.5 kg/m 2 AE 5.4), categorised by nutritional risk, and statistical comparison and test reliability performed. BIA was performed in 66 patients and fat free mass (FFM), fat mass (FM) and body cell mass (BCM) and index values (kg/m 2 ) calculated and compared against reference values. Results: MUST scored 77% patients 'low risk', 9% 'medium risk' and 14% 'high risk', compared to MNA-SF categorisation: 9%, 46% and 45%, respectively (P < 0.000001). Reliability assessment found poor reliability between the screening tools (coefficient, r ¼ 0.4). Significant positive correlations were found between most variables (P < 0.05e<0.001); although females exhibited greater variation. FFM index analysis found 40% of males low/depleted, 21% borderline/at risk with 96% categorised by MNA-SF as either malnourished or at risk (MUST-35%). 29% males had low FM index and all appropriately classified by MNA-SF. 30% females had low FFM index or borderline, MNA-SF screening appropriately categorised 86% (compared to MUST-29%).Conclusions: This preliminary data may have significant clinical implications and highlights the potential ability of the MNA-SF and BIA to accurately assess malnutrition risk over MUST in frail older hospital patients.

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This article considers the role of palliative care in the management of patients with dementia. It aims to broaden the knowledge of nurses providing general care as well as specialist palliative and end of life care to patients with dementia in all settings. The article helps nurses to identify the characteristics of end-stage dementia and meet the associated challenges that this diagnosis poses. Nurses should then be in a better position to recognise and support patients and their families and ensure that palliative care is included in care planning for this group of patients.