Predictors of mortality for lower respiratory infections in nursing home residents with dementia were validated transnationally

Int J Geriat Psychiatry

Helton

Ribbe

2009

Self Cite

Section: Discussionmentioning

confidence: 99%

Prognosis is important in decisionmaking in Dutch nursing home patients with dementia and pneumonia

Int J Geriat Psychiatry

Helton

Ribbe

2009

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“…Unfortunately, current risk scores [13,14,175] identify patients at low risk of dying (i.e., less than 5% or 10%), but rarely or never provide estimates for those at high (80% or 90%) risk of death. Clinical impact studies examining effects on decisions, patients or family outcomes are still rare in palliative and dementia care settings [176].…”

Section: Toolsmentioning

confidence: 99%

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

2010

JAD

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225

177

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.

“…We used a previously derived model to calculate mortality risk (Van der Steen et al, 2006a) and selected the highest quintile of estimated 14-day mortality risk (n ¼ 187; probability ranged from 0.241-0.773).…”

Section: Methodsmentioning

confidence: 99%

“…Lower respiratory tract infections (LRI), including pneumonia, are the leading cause of mortality in dementia patients (Naughton and Mylotte, 2000;Mehr et al, 2001; Van der Steen et al, 2005, 2006a. Among survivors, LRIs may accelerate functional decline (Sands et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Treatment strategy and risk of functional decline and mortality after nursing‐home acquired lower respiratory tract infection: two prospective studies in residents with dementia

Int J Geriat Psychiatry

Mehr

Kruse

et al. 2007

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SUMMARYBackground Although lower respiratory tract infections (LRI) cause considerable morbidity and mortality among nursing home residents with dementia, the effects of care and treatment are largely unknown. Few large prospective studies have been conducted. Methods We pooled data from two large prospective cohort studies in 61 Dutch nursing homes and 36 nursing homes in the state of Missouri, United States. We included 551 US residents and 381 Dutch residents with dementia and LRI. Main outcome measures were 3-month mortality and decline in activities of daily living (ADL) function after 3 months compared with pre-illness status. Using multivariable multinomial logistic regression to control for confounding, we assessed associations of restraint use and antibiotic type (oral compared with parenteral), with outcomes of lower respiratory tract infection (LRI). Survival without ADL decline was the reference category. Results After multivariable adjustment, restraint use was associated with ADL decline (OR 1.9, 95% CI 1.1-3.3). Oral antibiotics were not associated with 3-month mortality (OR 0.83; 95% CI 0.56-1.2). Severe dementia was the strongest independent predictor of decline; mortality was most strongly associated with male gender. Conclusions Among Dutch and US nursing home residents with dementia and LRI, restrained residents suffered more decline. Parenteral antibiotic treatment was not associated with better outcome in residents at low to moderate risk of mortality. Aggressive treatment strategies may provide little benefit for the majority of nursing home residents with dementia and LRI.