Pneumonia in Nursing Home Patients With Advanced Dementia: Decisions, Intravenous Rehydration Therapy, and Discomfort

The American Journal of Hospice & Palliative Care
Jenny T van der SteenEnd of Life Observatory–Prospective Study on DEmentia Patients Care (EoLO-PSODEC) Research Group

Abstract

Comfort may be an appropriate goal in advanced dementia. Longitudinal studies on physician decision-making and discomfort assessed by direct observation are rare, and intravenous rehydration therapy is controversial. To assess treatment decisions and discomfort in patients with advanced dementia and pneumonia and to compare by intravenous rehydration therapy, we used data from the observational multicenter Italian End of Life Observatory-Prospective Study On DEmentia patients Care. We analyzed 109 episodes of pneumonia, which involved decisions in 77 nursing home patients with Functional Assessment Staging Tool stage 7. We assessed decisions, decision-making, and treatments every fortnight. Trained observers assessed discomfort with the Discomfort Scale-Dementia Alzheimer Type (DS-DAT). Most decisions referred to treatment with antibiotics (90%; 98 of 109) and intravenous rehydration therapy (53%; 58 of 109), but hospitalization was rare (1%). Selecting decisions with antibiotics, with rehydration therapy, the prognosis was more frequently <15 days (34% vs 5% without rehydration therapy; P = .001), and a goal to reduce symptoms/suffering was more common (96% vs 74%; P = .005) while there was no difference in striving for life p...Continue Reading

References

Jan 1, 1992·International Psychogeriatrics·S G Sclan, B Reisberg
Oct 1, 1992·Research in Nursing & Health·A C HurleyL Volicer
Sep 1, 1993·ANS. Advances in Nursing Science·A C HurleyL Volicer
Aug 3, 2002·Archives of Internal Medicine·Jenny T van der SteenGerrit van der Wal
Oct 9, 2002·Journal of the American Geriatrics Society·Jenny T van der SteenMiel W Ribbe
Aug 10, 2005·Archives of Internal Medicine·H Roeline W PasmanGerrit van der Wal
Feb 21, 2006·Journal of Pain and Symptom Management·Guido MiccinesiUNKNOWN EURELD Consortium
Jul 4, 2007·Journal of Pain and Symptom Management·Hilde M BuitingUNKNOWN EURELD-Consortium
Sep 4, 2008·Journal of Advanced Nursing·Carolina Dello RussoFranco Toscani
Sep 16, 2008·Journal of Palliative Medicine·Paola Di GiulioPatrizia Spadin
Dec 10, 2008·Scandinavian Journal of Infectious Diseases·Jenny T Van Der SteenBregje D Onwuteaka-Philipsen
Oct 16, 2009·The New England Journal of Medicine·Susan L MitchellMary Beth Hamel
Jul 14, 2010·Archives of Internal Medicine·Jane L GivensSusan L Mitchell
Sep 18, 2010·Journal of Alzheimer's Disease : JAD·Jenny T van der Steen
Apr 1, 2011·Journal of the American Medical Directors Association·Jenny T van der SteenLadislav Volicer
Dec 14, 2012·Journal of Palliative Medicine·Franco ToscaniUNKNOWN End of Life Observatory-Prospective Study on Dementia Patients Care Research Group
Jul 6, 2013·Palliative Medicine·Jenny T van der SteenUNKNOWN European Association for Palliative Care (EAPC)
Feb 24, 2015·Journal of the American Medical Directors Association·Sandra M Lima Ribeiro, John E Morley
Apr 7, 2015·Journal of the American Medical Directors Association·Franco ToscaniUNKNOWN End of Life Observatory-Prospective Study on DEmentia Patients Care EoLO-PSODEC Research Group
Apr 22, 2015·Journal of Medical Ethics·Sandra Martins PereiraBregje D Onwuteaka-Philipsen
Jun 3, 2015·Journal of the American Geriatrics Society·Jane L GivensSusan L Mitchell
Jun 28, 2015·Journal of the American Medical Directors Association·Cari Levy
Sep 28, 2015·Journal of the American Medical Directors Association·Tessa van der MaadenRaymond T C M Koopmans
Jan 4, 2017·Journal of the American Medical Directors Association·Jenny T van der SteenLadislav Volicer

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Citations

Jan 21, 2020·International Journal of Nursing Knowledge·Su Jung LeeSung Ok Chang
Sep 17, 2020·Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America·Catherine C CohenPatricia W Stone
Feb 13, 2019·Current Opinion in Oncology·Filipa Macedo, Nuno Bonito
Nov 12, 2020·Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America·Alexandre R MarraEli N Perencevich
Dec 2, 2020·BMJ Supportive & Palliative Care·Jack FairweatherR Andrew Seaton
May 1, 2021·Geriatrics·Shelley A SternbergJenny T van der Steen
Sep 3, 2020·Journal of the American Medical Directors Association·Meera TandanChristopher J Wretman

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Methods Mentioned

BETA
sedation

Software Mentioned

PneuMonitor
Functional Assessment Staging Tool
EoLO PSODEC

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An antifungal, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis, cryptococcal meningitis, and others. Discover the latest research on antifungals here.