In this cohort of hospitalized patients with advanced dementia, risk of receiving a new feeding tube is high, associated with African American ethnicity, and prior residence in a nursing home, and has no measurable influence on survival. With or without a feeding tube, these patients have a 50% six-month median mortality.

It was difficult for a palliative care research team to influence the care of advanced dementia patients in the acute hospital setting. When patients have advanced dementia, there may be unique barriers, including perceived prognostic uncertainty, difficulty assessing comfort level, and perceptions about tube feeding. There must be a reexamination of treatment approaches for this severely impaired group of patients. Further study should attempt to identify patients prior to the need for acute hospitalization so goals can be established when there is less urgency to make life and death decisions.

People with Asperger syndrome (AS) appear to have higher than expected rates of co-morbid psychiatric disorder. The main co-morbid diagnoses are anxiety disorders and depression, but eating disorders, obsessive compulsive disorder, substance abuse and bipolar affective disorder have all been reported. Cognitive Behaviour Therapy (CBT) is used effectively to treat these conditions, so could it be used in people who also have Asperger syndrome? This paper reviews important components and characteristics of cognitive behaviour therapy in relation to its use with people who have Asperger syndrome with reference to the relevant literature and to feedback from people with AS. The use of CBT in people with Asperger syndrome appears promising, but further work is needed to evaluate its effectiveness and to examine which particular aspects of therapy are helpful.

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Summary A pilot scheme was introduced in Manchester to provide additional social support to pregnant women at above average risk of giving birth to a low‐birthweight baby. The help of lay workers, known as family workers, was made available to eligible women. The effect on infant birthweight of offering the help of a family worker was assessed by a randomized controlled trial. No significant differences were observed between the experimental and control group, but on a number of grounds the interpretation of this finding is not straightforward, and further research is recommended.

Future efforts should be invested in prospective studies, including several years' post-discharge follow-up, to explore correlations with LOS and guide treatment decisions. PRACTITIONER MESSAGE: Inpatient treatment in specialist eating disorder units is associated with nutritional and psychological benefits in adults and adolescents. Treatment requiring legal detention or nasogastric feeding involves longer admission. Further research is needed to see whether benefits are lasting.

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Absence of functional surrogate decision-makers is a major barrier to research and clinical decision-making for hospitalized patients with advanced dementia.