Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2010 Jul 12;170(13):1102-7.
doi: 10.1001/archinternmed.2010.181.

Survival and comfort after treatment of pneumonia in advanced dementia

Jane L Givens  1 , Richard N Jones, Michele L Shaffer, Dan K Kiely, Susan L Mitchell
Affiliations
Comparative Study

Survival and comfort after treatment of pneumonia in advanced dementia

Jane L Givens et al. Arch Intern Med. .

Erratum in

  • Arch Intern Med. 2011 Feb 14;171(3):217

Abstract

Background: Pneumonia is common among patients with advanced dementia, especially toward the end of life. Whether antimicrobial treatment improves survival or comfort is not well understood. The objective of this study was to examine the effect of antimicrobial treatment for suspected pneumonia on survival and comfort in patients with advanced dementia.

Methods: From 2003 to 2009, data were prospectively collected from 323 nursing home residents with advanced dementia in 22 facilities in the area of Boston, Massachusetts. Each resident was followed up for as long as 18 months or until death. All suspected pneumonia episodes were ascertained, and antimicrobial treatment for each episode was categorized as none, oral only, intramuscular only, or intravenous (or hospitalization). Multivariable methods were used to adjust for differences among episodes in each treatment group. The main outcome measures were survival and comfort (scored according to the Symptom Management at End-of-Life in Dementia scale) after suspected pneumonia episodes.

Results: Residents experienced 225 suspected pneumonia episodes, which were treated with antimicrobial agents as follows: none, 8.9%; oral only, 55.1%, intramuscular, 15.6%, and intravenous (or hospitalization), 20.4%. After multivariable adjustment, all antimicrobial treatments improved survival after pneumonia compared with no treatment: oral (adjusted hazard ratio [AHR], 0.20; 95% confidence interval [CI], 0.10-0.37), intramuscular (AHR, 0.26; 95% CI, 0.12-0.57), and intravenous (or hospitalization) (AHR, 0.20; 95% CI, 0.09-0.42). After multivariable adjustment, residents receiving any form of antimicrobial treatment for pneumonia had lower scores on the Symptom Management at End-of-Life in Dementia scale (worse comfort) compared with untreated residents.

Conclusion: Antimicrobial treatment of suspected pneumonia episodes is associated with prolonged survival but not with improved comfort in nursing home residents with advanced dementia.

PubMed Disclaimer

Figures

Figure
Figure
Survival after suspected pneumonia episode, by treatment: no antimicrobial agents, oral antimicrobial agents, intramuscular antimicrobial agents, and intravenous antimicrobial agents or hospitalization. Adjusted for age, sex, race, functional status (Bedford Alzheimer Nursing Severity Subscale), suspected aspiration, congestive heart failure, hospice referral, chest radiograph obtained, do-not-hospitalize order, and unstable vital signs.
See this image and copyright information in PMC

Comment in

References

    1. Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA. Alzheimer disease in the US population: prevalence estimates using the 2000 census. Arch Neurol. 2003;60(8):1119–1122. - PubMed
    1. Mitchell SL, Teno JM, Miller SC, Mor V. A national study of the location of death for older persons with dementia. J Am Geriatr Soc. 2005;53(2):299–305. - PubMed
    1. Chen JH, Lamberg JL, Chen YC, et al. Occurrence and treatment of suspected pneumonia in long-term care residents dying with advanced dementia. J Am Geriatr Soc. 2006;54(2):290–295. - PubMed
    1. Beard CM, Kokmen E, Sigler C, Smith GE, Petterson T, O’Brien PC. Cause of death in Alzheimer’s disease. Ann Epidemiol. 1996;6(3):195–200. - PubMed
    1. Thomas BM, Starr JM, Whalley LJ. Death certification in treated cases of pre-senile Alzheimer’s disease and vascular dementia in Scotland. Age Ageing. 1997;26(5):401–406. - PubMed

Publication types

MeSH terms

Substances