title: Interventions Associated With the Management of Suspected Infections in Advanced Dementia.
abstract: BACKGROUND
  Nursing home (NH) residents with advanced dementia are commonly suspected of having infections. Most episodes are treated with antimicrobials, although evidence supporting bacterial infections is often lacking. The extent to which other interventions are used in managing suspected infections is unknown.
  
  
  OBJECTIVE
  To describe interventions used to manage suspected infections in advanced dementia and identify factors associated with greater intervention use.
  
  
  METHODS
  Residents with advanced dementia who experienced suspected infections in 35 Boston NHs were followed for 12 months. Data describing interventions used in managing each episode were ascertained, including blood draws, chest radiographs, procurement of urine samples, and hospital transfers. Resident and episode characteristics associated with greater intervention use were identified using mixed model regression.
  
  
  RESULTS
  A total of 240 residents experienced 496 suspected infections involving the following interventions: any, n = 360 (72.6%); hospital transfer, n = 51 (10.3%); blood draw, n = 215 (43.3%); chest radiograph, n = 120 (24.2%); and urine sample, n = 222 (44.8%). Factors associated with greater intervention use included black race (adjusted odds ratio [AOR] 3.19; 95% CI, 1.37-7.44); no do not hospitalize order (AOR, 1.83; 95% CI, 1.16-2.90); not on hospice (AOR, 5.41; 95% CI, 2.14-13.70); and suspected source being respiratory (AOR, 10.67; 95% CI, 4.99-22.80), urine (AOR, 15.79; 95% CI, 7.41-33.66) or fever of unknown source (AOR, 20.26; 95% CI, 8.42-48.73) vs. skin/soft tissue.
  
  
  CONCLUSIONS
  NH residents with advanced dementia frequently experience potentially burdensome interventions when suspected of having an infection. Advance directives to limit such interventions may be appropriate for residents whose goal of care is comfort.
authors.affiliation: University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Yates
authors.affiliation: Hebrew SeniorLife Institute for Aging Research, Boston, Massachusetts, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
authors.affiliation: Hebrew SeniorLife Institute for Aging Research, Boston, Massachusetts, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Habtemariam
authors.affiliation: Hebrew SeniorLife Institute for Aging Research, Boston, Massachusetts, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Alyssa B
authors.initials: AB
authors.lastname: Dufour
authors.affiliation: Hebrew SeniorLife Institute for Aging Research, Boston, Massachusetts, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. Electronic address: JaneGivens@hsl.harvard.edu.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Givens
mesh_terms: D000369:Aged, 80 and over; D001900:Boston / Q000453:epidemiology; D015897:Comorbidity; D003704:Dementia / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D016414:Resuscitation Orders
keywords: Nursing home; dementia; infection; palliative care