[Decision making in frail patients with a hip fracture].

Background: When an older patient presents herself at the emergency department with a femur fracture different doctors are involved: the geriatrician, the orthopaedic or trauma- surgeon and the anaesthesiologist. Together they form an ad hoc team and are in charge of organising the best medical care for the patient.

Case Description: In this case description we present a patient with cardiovascular comorbidity and dementia.

Differences in nutritional status between very mild Alzheimer's disease patients and healthy controls.

Background: Studies on the systemic availability of nutrients and nutritional status in Alzheimer's disease (AD) are widely available, but the majority included patients in a moderate stage of AD.

Objective: This study compares the nutritional status between mild AD outpatients and healthy controls.

Methods: A subgroup of Dutch drug-naïve patients with mild AD (Mini-Mental State Examination (MMSE) ≥20) from the Souvenir II randomized controlled study (NTR1975) and a group of Dutch healthy controls were included.

Inclusion of frail elderly patients in clinical trials: solutions to the problems.

With the aging of the population, the interest in clinical trials concerning frail elderly patients has increased. Evidence-based practice for the elderly patient is difficult because elderly patients, especially the frail, are often excluded from clinical trials. To facilitate the participation of frail elderly patients in clinical trials, investigators should be more aware of possible barriers when setting up research.

Assessment and treatment of malnutrition in Dutch geriatric practice: consensus through a modified Delphi study.

Objective: scientific evidence regarding the optimal management of malnutrition in geriatric patients is scarce. Our aim was to develop a consensus statement for geriatric hospital practice concerning six elements: (i) definition of malnutrition, (ii) screening and assessment, (iii) treatment and monitoring, (iv) roles and responsibilities of involved health care professionals, (v) communication and coordination of care between hospital and community health care professionals, (vi) quality indicators for malnutrition management.

Design: a modified Delphi study.

[Health Council of the Netherlands underestimates interactions in undernutrition in the elderly].

The Health Council of the Netherlands has recently published a report on undernutrition in the elderly. Undernutrition is a huge problem associated with negative health outcomes, especially in the frail elderly. Although its review of the recent literature is useful, the report does not contribute anything to clinical practice.

Structured analyses of interventions to prevent delirium.

Background: Delirium is one of the most serious complications in hospitalized elderly, with incidences ranging from 3-56%. The objective of this meta-analysis was two-fold, first to investigate if interventions to prevent delirium are effective and second to explore which factors increase the effectiveness of these interventions.

Methods: An electronic search was carried out on articles published between January 1979 and July 2009.

[Presentation of illness in the elderly: a simple explanation for a complex problem].

Illness presentation in the elderly is often complex and atypical. This may cause negative health outcomes. In the standard medical model of diagnosis, there is a 1:1 correspondence between clinical signs and symptoms and a pathological disease process.

Cobalamin-binding proteins in normal and cobalamin-deficient older subjects.

Background: The causes of cobalamin (vitamin B(12)) deficiency in older people are only partly understood. We investigated the role of the cobalamin-binding proteins and tested the hypothesis that low saturated transcobalamin concentration is an early marker of cobalamin deficiency.

Methods: We measured saturated (holo) and unsaturated (apo) transcobalamin and haptocorrin concentrations in healthy middle-aged volunteers, healthy older volunteers, cobalamin-deficient older volunteers and cobalamin-deficient older patients.