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The article discusses the importance of addressing the nutritional needs of older patients to prevent or mitigate malnutrition that may result in higher multimorbidity and mortality risks. It states that clinicians face the difficult task of assessing patients' views and the evidence on their acute illness or evolving long-term conditions when making decisions on their nutrition and hydration. Also noted is the need to consider palliative care for patients nearing the end of their lives.

Background Patients undergoing radiotherapy or chemoradiotherapy treatment for head and neck cancer have an increased risk of malnutrition, and may require enteral feeding via nasogastric or gastrostomy tube. The aim of this audit was to examine current enteral feeding practice, mortality, morbidity and 6-month outcome data of head and neck cancer patients receiving radical (chemo)radiotherapy at a regional cancer centre and to compare the results with a regional head and neck cancer gastrostomy audit. Methods A 2-year audit was conducted (2006-2008). Inclusion criteria were all adult patients diagnosed with squamous cell carcinoma of the head and neck, receiving radical radiotherapy or chemoradiotherapy treatment. The first-year data were collected retrospectively, and the second-year data were collected prospectively. Data were collected on all patients requiring enteral feeding with 6-month outcome data relating to route of nutrition. Results Approximately 14% ( n = 32/223) of patients were admitted for nasogastric feeding as a result of inadequate oral alimentation. On admission, 94% were at risk of refeeding syndrome, taking a mean (SD) of 11 (4.9) days to reach full nutritional requirements. Mean (SD) length of hospital stay was 13 (5.1) days. No major complications from nasogastric tube insertion were found. The mean (SD) length of nasogastric feeding was 72 (20.1) days with 89.6% managing full nutritional requirements orally at 6 months. Conclusions Patients requiring enteral feeding during treatment were fed via a nasogastric tube, rather than via a prophylactic gastrostomy tube. Compared with the regional gastrostomy audit results, our patients had a lower clinical risk/complication rate, with a greater proportion tolerating full oral intake at 6 months. Therefore, nasogastric feeding, rather than prophylactic gastrostomy tube feeding, could be a more appropriate method of enteral feeding in this patient group. [ABSTRACT FROM AUTHOR]

Background: The physiology and consequences of refeeding syndrome have long been recognised, although its management continues to be debated, despite the recommendations made by The National Institute for Health and Clinical Excellence (NICE) in their guideline 'Nutrition Support in Adults' (2006). The present study aims to assess current dietetic opinion and practice in this area, as well as whether the NICE recommendations have been adopted. Methods: An anonymous, self-completed Internet survey was designed investigating current practice and opinions on the NICE (2006) guidance on this subject. A link to the questionnaire was distributed with a covering letter via e-mail to the heads of department of National Health Service Trusts in the London region, UK, requesting that it be disseminated to all dietitians working with adults. After the closing date, all responses were collated and analysed. Results: The survey elicited a 30.8% response rate. Some 89.8% of respondents have read the NICE guidance on Nutrition Support in Adults (2006) and 66.9% have changed their practice regarding refeeding syndrome management as a result. Sixty-two percent do not wait for biochemistry to normalise before commencing nutrition. Ninety-two percent of respondents completed the mini case studies indicating that current practice is inconsistent among dietitians. Neither NICE criteria for recognising patients at risk of refeeding, nor the recommended starting rates are universally followed. Seventy-five percent continue to supplement electrolytes reactively. Conclusions: Although limited by a small sample size, the findings of the present study suggest that dietetic practice regarding refeeding syndrome management remains inconsistent with the recommendations made by NICE, although some aspects have been adopted. [ABSTRACT FROM AUTHOR]

Anorexia nervosa is an eating disorder with peak onset in adolescence, which carries the highest mortality rate of all psychiatric illnesses. It is commonly comorbid with other physical and mental health problems, yet training on management of people with eating disorders and working knowledge of clinicians working with underweight adolescents is inconsistent. This review of anorexia nervosa in adolescents provides an overview of the presentation, aetiology and treatment of this disorder, with a particular focus on the assessment and management of physical health risks, including refeeding syndrome.