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Dementia and End of Life Care |
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From EurekAlert! - Breaking News: An article co-authored by Susan L. Mitchell, M.D., M.P.H., of Hebrew SeniorLife's Institute for Aging Research reports that nursing home residents with advanced dementia are frequently prescribed antibiotic medications, especially during the two weeks before death. This practice raises concerns about the end-of-life care of individual patients dying with advanced dementia, as well as the emergence of antimicrobial resistance. Nearly 70 percent of the 5 million Americans with dementia---a progressive decline in cognitive function due to damage or disease in the brain beyond what is expected in normal aging---will live in a nursing home during the final stage of their disease. Recurrent infections and fevers typically occur during this stage; therefore, nursing home residents with advanced dementia are at high risk for exposure to antibiotic medications. Exposure to drugs, however, can lead to the emergence of antibiotic-resistant bacteria, which are associated with higher mortality rates and more frequent and prolonged hospitalizations. The researchers followed 241 residents with advanced dementia from 21 Boston-area nursing homes who were recruited for a study called Choices, Attitudes and Strategies for Care of Advanced Dementia at End-of-Life (CASCADE), a five year study funded by the National Institutes of Health. As one component of this larger study, the use of antimicrobial medications (drugs that kill or inhibit the growth of bacteria) among these residents every 3 months for 18 months or until their death. Among the 99 residents who died during the observation period, nearly 52 percent received at least one course of antibiotics within eight weeks of death, and 42% received antibiotics during the 2 weeks prior to death. Earlier studies focused on the treatment of specific infections, such as pneumonia, or studied residents in only a single institution.
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