Does Hospitalization Impact Survival After Lower Respiratory Infection in Nursing Home Residents?

Kruse, Robin L.; Mehr, David R.; Boles, Keith E.; Lave, Judith R.; Binder, Ellen F.; Madsen, Richard; D’Agostino, Ralph B.

doi:10.1097/01.mlr.0000135828.95415.b1

Cited by 77 publications

(55 citation statements)

References 32 publications

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“…Previous analysis of Missouri LRI Study data found no difference in 1-month mortality between residents fi rst treated in the nursing home or the hospital, after adjusting for illness severity and probability of hospitalization. 40 The study' s main limitation is the universal problem with observational studies-we were unable to assure adequate control for confounding. Across levels of illness severity and between the 2 countries, residents received very different therapies, making it diffi cult to compare outcomes.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Treatment and Survival of Nursing Home Patients With Lower Respiratory Tract Infection: A Cross-National Analysis

Kruse

Mehr²,

Steen³

et al. 2005

The Annals of Family Medicine

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PURPOSE Although lower respiratory tract infections are a leading cause of death in frail elderly patients, few studies have compared treatments and outcomes. We assessed the effects of different antibiotic treatment strategies on survival of elderly nursing home residents with lower respiratory tract infections in the United States and the Netherlands, where treatment approaches are quite different. METHODSWe combined data from 2 prospective cohort studies of lower respiratory tract infections conducted in 36 nursing homes in the United States and 61 in the Netherlands. We included residents whose infections were treated with antibiotics: 806 in the United States and 415 in the Netherlands. Outcome measures were 1-month and 3-month mortality. We used logistic regression to adjust for differing illness severity.RESULTS Dutch residents had higher mortality than US residents (28.1% vs 15.1% at 1 month, respectively; P <.001). After adjusting for illness severity with logistic regression, the differences between the Dutch and US populations were not significant (odds ratio 1.34; 95% confi dence interval, 0.94-1.90). Predicted mortality was overestimated for more severely ill US residents at 1 month but not at 3 months. No antibiotic regimen was consistently associated with increased or decreased mortality. CONCLUSION Despite differences in illness severity and treatment, adjusted mortality did not differ between the 2 countries. Although we cannot exclude a short-term survival benefi t from more aggressive treatment in the United States, differences in baseline health appear prognostically more important than the type of antibiotic treatment.

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Section: Discussionmentioning

confidence: 99%

Antibiotic Treatment and Survival of Nursing Home Patients With Lower Respiratory Tract Infection: A Cross-National Analysis

Kruse

Mehr²,

Steen³

et al. 2005

The Annals of Family Medicine

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“…A potential reason for this could be that those in later stages of AD forgo hospitalization in lieu of home care or care provided at the nursing home. Research suggests that certain common acute conditions, such as pneumonia, can be treated with the same efficacy and at reduced costs in the nursing home than in the hospital [29,30]. The potential benefits of hospitalization may outweigh its burdens for patient's whose primary goal of care remains life prolongation, but comfort if often considered the priority of care in the final stages of AD [31].…”

Section: Discussionmentioning

confidence: 99%

Predictors of hospitalization and institutionalization in Medicaid patient populations with Alzheimer’s Disease

Adrienne¹,

Daniel²,

Terri³

et al. 2013

AAD

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“…Researchers examined associations between treatment and outcome in frequently occurring treatment dilemmas, such as withholding antibiotics in patients with fever [30] or pneumonia [31], intake problems [32], and in hospitalization decisions [70,71].…”

Section: Research Trends In Dementia At the End Of Lifementioning

confidence: 99%

Dying with Dementia: What We Know after More than a Decade of Research

Steen

2010

JAD

225

177

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Abstract. Death with dementia is increasingly common. Although prognostication is difficult, it is an incurable life-limiting illness for which palliative care for the patient is often appropriate. Dementia patients are otherwise at risk of overtreatment with burdensome and possibly non-beneficial interventions and undertreatment of symptoms. Although recent studies indicate encouraging trends of improved palliative care, little evidence supports effectiveness of specific treatments. As of January 2010, at least 45 studies, almost all performed after 2000, have reported on treatment, comfort, symptom burden, and families' satisfaction with care. Over half (25; 56%) of these studies were in US settings, and most were small or retrospective. Few randomized trials and prospective observational studies have been performed so far, but several promising studies have been completed recently or are underway in various countries. Guidelines for care and treatment, still mostly consensus-based, support the benefits of advance care planning, continuity of care, and family and practitioner education. Assessment tools for pain, prognosis, and family evaluations of care have been developed and some have been shown to be effective in clinical practice. With increasing numbers of well-designed, large-scale studies, research in the next decade may result in better evidence-based guidelines and practice.

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Does Hospitalization Impact Survival After Lower Respiratory Infection in Nursing Home Residents?

Cited by 77 publications

References 32 publications

Antibiotic Treatment and Survival of Nursing Home Patients With Lower Respiratory Tract Infection: A Cross-National Analysis

Antibiotic Treatment and Survival of Nursing Home Patients With Lower Respiratory Tract Infection: A Cross-National Analysis

Predictors of hospitalization and institutionalization in Medicaid patient populations with Alzheimer’s Disease

Dying with Dementia: What We Know after More than a Decade of Research

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