title: Treatment of nursing home residents with dementia and lower respiratory tract infection in the United States and The Netherlands: an ocean apart.
abstract: OBJECTIVE
  To compare treatment of nursing home residents with dementia and lower respiratory tract infection (LRI) in Missouri and the Netherlands.
  
  
  METHODS
  Two separate but simultaneous prospective cohort studies.
  
  
  METHODS
  Nursing homes in Missouri (n=36) and the Netherlands (n=61).
  
  
  METHODS
  Selected residents (701 from Missouri and 551 from the Netherlands) diagnosed with LRI and dementia.
  
  
  METHODS
  Treatment, dementia severity, symptoms and signs of LRI, and general health condition were recorded at the time of diagnosis of LRI. Death was monitored at follow-up. Treatment and mortality, stratified for dementia severity, are reported.
  
  
  RESULTS
  Treatment of nursing home-acquired LRI in Missouri residents involved a larger number of antibiotics, more frequent hospitalization, and greater use of intravenous antibiotics and rehydration therapy than in Dutch residents of equal dementia severity. Furthermore, for Missouri residents, intensive interventions were more often provided irrespective of severe dementia. By contrast, in both countries, treatments to relieve symptoms of LRI were provided for only a minority of residents. Dutch mortality rates were higher overall.
  
  
  CONCLUSIONS
  Care for U.S. nursing home residents with LRI and dementia is more aggressive than care for Dutch residents, particularly in residents with severe dementia. These results are relevant to the debate on optimal care in relation to curative or palliative treatment goals.
authors.affiliation: Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, The Netherlands. j.vandersteen@vumc.nl
authors.forename: Jenny T
authors.initials: JT
authors.lastname: van der Steen
authors.forename: Robin L
authors.initials: RL
authors.lastname: Kruse
authors.forename: Marcel E
authors.initials: ME
authors.lastname: Ooms
authors.forename: Miel W
authors.initials: MW
authors.lastname: Ribbe
authors.forename: Gerrit
authors.initials: G
authors.lastname: van der Wal
authors.forename: Lawrence L
authors.initials: LL
authors.lastname: Heintz
authors.forename: David R
authors.initials: DR
authors.lastname: Mehr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015331:Cohort Studies; D003422:Critical Care; D003627:Data Interpretation, Statistical; D003704:Dementia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008923:Missouri; D009426:Netherlands; D009735:Nursing Homes; D010166:Palliative Care; D011014:Pneumonia / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents