title: Advanced dementia: opinions of physicians and nurses about antibiotic therapy, artificial hydration and nutrition in patients with different life expectancies.
abstract: OBJECTIVE
  The aim of the present study was to investigate the proportion of physicians and nurses who agree with the administration of antibiotic therapy (AT), artificial hydration (AH), and artificial nutrition (AN) in patients with advanced dementia and different life expectancies. Furthermore, we aimed at analyzing the correlates of the opinion according to which medical treatments should no longer be given to advanced dementia patients once their life expectancy falls.
  
  
  METHODS
  End-of-life decisions and opinions were measured with a questionnaire that was sent to geriatric units, hospices and nursing homes in three different regions of Italy. Multivariate logistic regressions were carried out to ascertain the correlates of the agreement with the administration of AH, AT or AN.
  
  
  RESULTS
  When the patient's life expectancy was 1-6 months, 83% of respondents agreed with AH, 79% with AT and 71% with AN. When the life expectancy was less than 1 month, a large proportion of respondents still agreed with AH and AT (73% and 61%), whereas less than one in two respondents (48%) agreed with AN.
  
  
  CONCLUSIONS
  The findings of the present study showed that AN creates more ethical dilemmas in the clinical management of end of life than other treatments, such as AH or AT. Opinions on whether or not these practices are appropriate at the end of life were related with feelings, thoughts and ethical issues that played a different part for physicians and nurses. Geriatr Gerontol Int 2017; 17: 487-493.
authors.affiliation: Geriatrics Division, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Pengo
authors.affiliation: Geriatrics Division, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Zurlo
authors.affiliation: Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Voci
authors.affiliation: Geriatrics Division, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Valentini
authors.affiliation: Geriatrics Division, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: De Zaiacomo
authors.affiliation: Internal Medicine Division, Macerata Hospital, Padova, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Catarini
authors.affiliation: Geriatrics Division, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Iasevoli
authors.affiliation: Aging Section, Institute of Neurosciences, Italian Research Council, Padova, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Maggi
authors.affiliation: Lanza Foundation, Padova, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Pegoraro
authors.affiliation: Geriatrics Division, Department of Medicine, University of Padova, Padova, Italy.|Aging Section, Institute of Neurosciences, Italian Research Council, Padova, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Manzato
authors.affiliation: Geriatrics Division, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Giantin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making / Q000941:ethics*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004750:Enteral Nutrition; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007558:Italy; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D010819:Physician's Role; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics*
chemical_list: D000900:Anti-Bacterial Agents
keywords: advanced dementia; antibiotic therapy; artificial hydration; artificial nutrition; end of life