title: Dementia severity, decline and improvement after a lower respiratory tract infection.
abstract: OBJECTIVE
  To assess decline and improvement in functional characteristics, cognition and restraint use after a lower respiratory tract infection (LRI) and describe variation by dementia severity.
  
  
  METHODS
  Two prospective cohort studies.
  
  
  METHODS
  Nursing homes in the Netherlands and in Missouri, USA.
  
  
  METHODS
  227 Dutch and 396 Missouri nursing home residents with dementia and LRI who were treated with antibiotics.
  
  
  METHODS
  We compared functional characteristics (Activities of Daily Living [ADL], bedfast status, pressure ulcers, incontinence), cognition and restraint use 3 months after an LRI with status 1 to 2 weeks before diagnosis.
  
  
  RESULTS
  Residents with LRI frequently declined on all measures, but many also improved, including those with severe dementia. On the measures where residents could still decline further, residents with severe dementia showed higher variability than residents with less severe dementia. This was most obvious for bedfast status and restraint use.
  
  
  CONCLUSIONS
  Compared with less severely demented residents, residents with severe dementia showed more decline on measures where they still had room for change. However, on these measures, residents with severe dementia also improved more often. LRI does not necessarily lead to deterioration even in individuals with severe dementia.
authors.affiliation: VU University Medical Center, EMGO Institute, Department of Nursing Home Medicine, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. j.vandersteen@vumc.nl
authors.forename: J T
authors.initials: JT
authors.lastname: van der Steen
authors.forename: R L
authors.initials: RL
authors.lastname: Kruse
authors.forename: D R
authors.initials: DR
authors.lastname: Mehr
authors.forename: M W
authors.initials: MW
authors.lastname: Ribbe
authors.forename: G
authors.initials: G
authors.lastname: van der Wal
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003704:Dementia / Q000150:complications / Q000523:psychology* / Q000628:therapy; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D009426:Netherlands; D009735:Nursing Homes; D010166:Palliative Care; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000523:psychology*; D012720:Severity of Illness Index; D013997:Time Factors; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents