This article is protected by copyright. All rights reserved. Research issues in Elderly patients: gaps in knowledge and suggested directions. 1 Robert Walker 1 , Robert G Fassett 2 and Rachael L Morton 3 1 Professor of Medicine, Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand 2 Director of Renal Research, Royal Brisbane and Women’s Hospital, Herston, QLD 3 School of Public Health, University of Sydney, NSW Concentration of research is recommended in the following areas: • Prospective studies of the appropriateness, relevance, timing and sustainability of dialysis in elderly patients • Health related quality of life (HRQoL) in older patients choosing not to dialyse and in those choosing to dialyse with comparison to a matched population without renal disease • Methods of communication of prognosis and factors affecting decision making • Models of care – comparative studies to delineate how best to deliver renal supportive care • Treatment preferences amongst indigenous patients • Symptom control, focussing on those areas specific to the needs of renal patients There has been an increase of over 400% in the number of elderly and very elderly patients on dialysis in Australia and New Zealand over the past 2 decades (1). This rapid increase has generated considerable debate resulting in wide variation in attitude towards referral and acceptance of elderly patients for dialysis (2-4). One major reason for this is that there is uncertainty about the outcome from dialysis treatment in this population (5). If conservative management is shown to be an important and valid option with similar outcomes to dialysis, then this can be appropriately discussed with the individual and their family/whanau (Maori - extended family) without this being considered as rationing, or limiting health resources. Current studies suggest poor maintenance of functional capacity and high mortality in nursing home patients accepted for dialysis in the USA (6), and a retrospective study suggests outcomes are much the same on dialysis or with conservative care if aged >75 with greater than two comorbidities(5). 1. Prospective studies are required to address the appropriateness, relevance, timeliness, and the sustainability (both with respect to quality as well as quantity) of dialysis in the elderly. Providing information as to preferred options by this group related to their expectations and perceived quality of life will immediately influence delivery of healthcare. The provision of dialysis, preferably in a home setting or low level self care satellite units closer to the individuals’ residences, may allow better integration with primary and community care. Evidence is required to disentangle survival alone versus quality of life with respect to the provision of renal replacement therapy and renal supportive care. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/nep.12084 Accepted Article