Occurrence and treatment of suspected pneumonia in long-term care residents dying with advanced dementia.
OBJECTIVE
To describe the occurrence and management of suspected pneumonia in end-stage dementia and to identify factors associated with aggressiveness of antibiotic treatment.


METHODS
Retrospective cohort study.


METHODS
A 675-bed long-term-care facility in Boston, Massachusetts.


METHODS
Two hundred forty subjects aged 65 and older who died with advanced dementia between January 2001 and December 2003. Subjects who had suspected pneumonia during the last 6 months of life were identified.


METHODS
Independent variables included subject characteristics and features of suspected pneumonia episodes. These variables were obtained from medical records. Antibiotic treatment for each episode was determined. Multivariate analysis was used to identify independent variables associated with aggressiveness of treatment.


RESULTS
One hundred fifty-four (64%) subjects with advanced dementia experienced 229 suspected pneumonia episodes during the last 6 months of life. Within 30 days of death, 53% of subjects had suspected pneumonia. Antibiotic treatment for the 229 episodes was as follows: none, 9%; oral only, 37%; intramuscular, 25%; and intravenous, 29%. Factors independently associated with more-invasive therapy were lack of a do-not-hospitalize order (adjusted odds ratio (AOR) = 3.24, 95% confidence interval (CI) = 2.02-5.22), aspiration (AOR = 2.75, 95% CI = 1.44-5.26), primary language not English (AOR = 2.21, 95% CI = 1.17-4.15), and unstable vital signs (AOR = 2.02, 95% CI = 1.10-3.72).


CONCLUSIONS
Pneumonia is a common terminal event in advanced dementia for which many patients receive parenteral antibiotics. The aggressiveness of treatment is most strongly determined by advance care planning, the patient's cultural background, and clinical features of the suspected pneumonia episode.
Chen
Jen-Hau
JH
Hebrew SeniorLife, Research and Training Institute and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02131, USA. jhhchen@ha.mc.ntu.edu.tw
Lamberg
Jennifer L
JL
Chen
Yen-Ching
YC
Kiely
Dan K
DK
Page
John H
JH
Person
Carmel J
CJ
Mitchell
Susan L
SL
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003704:Dementia / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008134:Long-Term Care; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate
D000900:Anti-Bacterial Agents