An epidemic outbreak of Mesoamerican Nephropathy in Nicaragua linked to nickel toxicity

For over 20 years, researchers have tried to solve the medical mystery behind Mesoamerican Nephropathy, a form of chronic kidney disease that has caused more than 50,000 deaths in coastal South America. Now, researchers present the strongest evidence to date on the cause of the disease in one of the worst-hit hotspots in the region, Nicaragua, using an unlikely source, the toenails of individuals with the disease.

Delirium in older adults

Delirium is a serious and common syndrome characterized by acute deterioration of mental status. Patients show attentional deficits and commonly also altered levels of arousal and psychotic features. Detection can be assisted through use of validated tools such as the 4AT. Delirium is associated with multiple adverse outcomes including patient and carer distress, increased length of hospital stay, risk of future dementia, new institutionalization and death. Old age, dementia and frailty are the main predisposing factors, but there are a number of modifiable risk factors that are important within hospital environments.

Diagnosis and management of dementia in older people

Dementia is a leading cause of morbidity and death in the UK. Diagnostic criteria exist for the different aetiologies and subtypes. Alzheimer’s disease is the most common type and there is evidence of benefit from acetylcholinesterase inhibitors for some people living with Alzheimer’s disease. Care for people living with dementia in hospital and in the community needs improvement. Non-pharmacological means of managing distress people living with dementia should be prioritized over the use of antipsychotic and sedative medications, and greater focus on symptom management towards the end of life is required.

Parkinson’s disease in older people

The prevalence of Parkinson’s disease (PD) increases with age. Caring for people with this condition frequently requires it to be considered within a wider context of both health and social factors. Diagnosis is made eliciting the hallmark motor signs, which can be confounded by signs from other co-morbidities such as depression, arthritis and cognitive impairment. The disease can be divided into four stages – diagnostic, maintenance, complex and palliative – reflecting an individual’s needs. Alternative approaches include the Braak, and Hoehn and Yahr, stagings, using pathophysiological and clinical features, respectively.

Elder abuse and adult safeguarding

This article defines elder abuse and describes its main categories. Risk factors and predictive indicators are discussed to help professionals identify older individuals who could be vulnerable. The adult safeguarding procedure, as defined by the UK Care Act 2014, is outlined, alongside the importance of a multidisciplinary approach to, as well as shared responsibility for, older adults at risk.

Practical advice for prescribing in old age

Optimizing drug therapy is an essential part of caring for older people. Prescribing in this group has unique challenges because of high interindividual variability in pharmacological response and homeostatic mechanisms, and the fact that frailty, rather than age, predicts physiological responses to external stimuli. The effects of drugs and how they are handled by the body change with increasing age. With decreasing life expectancy, drugs used for secondary prevention might not be appropriate, particularly where their adverse effects impair quality of life.