title: Discomfort in dementia patients dying from pneumonia and its relief by antibiotics.
abstract: Dementia patients frequently die after a pneumonia or prolonged intake problems. Maintaining comfort is a goal of palliative care in end-stage dementia. To compare discomfort in dementia patients dying after a pneumonia with patients dying after intake problems, and to assess associations with treatment, we combined 2 Dutch prospective studies. We selected 559 pneumonia patients and 166 patients with intake problems who had no pneumonia. Discomfort was observed with the Discomfort Scale - Dementia of Alzheimer Type (DS-DAT). Linear regression was performed with the dependent DS-DAT levels shortly before death in 314 patients who died within 2 weeks. Compared with discomfort in patients with intake problems, unadjusted and adjusted discomfort in patients with pneumonia was higher both at t 0 and before death. In adjusted analyses, antibiotic treatment (mostly oral) was associated with less discomfort before death (beta -1.1, CI -2.2 - -0.03), while invasive rehydration (received by only 8 patients) was associated with more discomfort (beta 3.5, CI 0.6 - 6.3). Death from pneumonia may cause great suffering in dementia patients. If confirmed in a study with different case mix and treatments, antibiotics may be used to decrease discomfort even when death is imminent.
authors.affiliation: Departments of Public and OccupationalHealth, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. j.vandersteen@vumc.nl
authors.forename: Jenny T
authors.initials: JT
authors.lastname: Van Der Steen
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.forename: Miel W
authors.initials: MW
authors.lastname: Ribbe
authors.forename: Gerrit
authors.initials: G
authors.lastname: Van Der Wal
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003704:Dementia / Q000150:complications* / Q000628:therapy; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D016014:Linear Models; D008297:Male; D009735:Nursing Homes; D018529:Nutritional Support; D059408:Pain Management; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods*; D011014:Pneumonia / Q000150:complications* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents