Lower respiratory infections in nursing home residents with dementia: a tale of two countries.
OBJECTIVE
A focus on palliative care for residents with dementia is much more common in Dutch nursing homes than in the United States. We compared treatment and mortality in U.S. and Dutch nursing home residents with lower respiratory infections (LRI), which are often the immediate cause of death in dementia.


METHODS
We studied two prospective cohorts--a study of pneumonia (n = 706) conducted in 61 psychogeriatric nursing homes throughout the Netherlands and 701 subjects with likely dementia from a study of LRIs in 36 nursing homes in Missouri.


RESULTS
Nursing home residents with dementia were more often treated without antibiotics in the Netherlands (23%) than in Missouri (15%). Indicators of severe illness operate in opposite directions: more severe illness is associated with antibiotic treatment in the United States, but with palliative treatment without antibiotics in the Netherlands.


CONCLUSIONS
Our findings are consistent with others in indicating problems with transition to palliative care for U.S. nursing home residents with dementia.
Mehr
David R
DR
Department of Family and Community Medicine, University of Missouri-Columbia, M228 Medical Sciences Building, 1 Hospital Drive, Columbia, MO 65212, USA. Mehrd@health.missouri.edu
van der Steen
Jenny T
JT
Kruse
Robin L
RL
Ooms
Marcel E
ME
Rantz
Marilyn
M
Ribbe
Miel W
MW
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003704:Dementia / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008923:Missouri; D009426:Netherlands; D009735:Nursing Homes; D010166:Palliative Care; D011014:Pneumonia / Q000628:therapy*; D011446:Prospective Studies
D000900:Anti-Bacterial Agents