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. 2015 Jun;63(6):1084-90.
doi: 10.1111/jgs.13435. Epub 2015 Jun 1.

Healthcare Proxy Awareness of Suspected Infections in Nursing Home Residents with Advanced Dementia

Jane L Givens  1   2 , Sara Spinella  3 , Claire K Ankuda  4 , Erika D'Agata  2 , Michele L Shaffer  5 , Daniel Habtemariam  1 , Susan L Mitchell  1   2
Affiliations

Healthcare Proxy Awareness of Suspected Infections in Nursing Home Residents with Advanced Dementia

Jane L Givens et al. J Am Geriatr Soc. 2015 Jun.

Abstract

Objectives: To determine healthcare proxy involvement in decision-making regarding infections in individuals with advanced dementia.

Design: Prospective cohort study.

Setting: Thirty-five Boston-area nursing homes (NHs).

Participants: NH residents with advanced dementia and their proxies (N = 362).

Measurements: Charts were abstracted monthly (up to 12 months) for documentation of suspected infections and provider-proxy discussions for each episode. Proxies were interviewed within 8 weeks of the infection to determine their awareness and decision-making involvement. Factors associated with proxy awareness and discussion documentation were identified.

Results: There were 496 suspected infections; proxies were reached for interview for 395 (80%). Proxy-provider discussions were documented for 207 (52%) episodes, yet proxies were aware of only 156 (39%). Proxies participated in decision-making for 89 (57%) episodes of which they were aware. Proxy awareness was associated with antimicrobial use (adjusted odds ratio (AOR) = 3.43, 95% confidence interval (CI) = 1.94-6.05), hospital transfer (AOR = 3.00, 95% CI = 1.19-7.53), infection within 30 days of death (AOR = 3.32, 95% CI = 1.54-7.18), and fewer days between infection and study interview (AOR = 2.71, 95% CI = 1.63-4.51). Discussion documentation was associated with the resident residing in a dementia special care unit (AOR = 1.71, 95% CI = 1.04-2.80), the resident not on hospice (AOR = 3.25, 95% CI = 1.31-8.02), more provider visits (AOR = 1.71, 95% CI = 1.07-2.75), proxy visits of more than 7 h/wk (AOR = 1.93, 95% CI = 1.02-3.67), and episode within 30 days of death (AOR = 3.99, 95% CI = 1.98-8.02).

Conclusion: Proxies are unaware of and do not participate in decision-making for most suspected infections that NH residents with advanced dementia experience. Proxy awareness of episodes and documentation of provider-proxy discussions are not congruent.

Keywords: dementia; nursing home; surrogate decision-making.

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Conflict of interest statement

Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Dr. Erika D’Agata is a Member of Data Safety Monitoring Board of Cubist Pharmaceuticals.

Figures

Figure 1
Figure 1
Proxy Awareness of Suspected Infections and Involvement in Decision Making for a Cohort of Nursing Home Residents with Advanced Dementia (N=362 residents)
Figure 2
Figure 2
Proxy awareness and nursing home (NH) documentation of discussion with proxy regarding suspected infections among residents with advanced dementia (N=395). Diagram represents infections with NH documentation only (A) (N=102), both NH documentation and proxy awareness, (B) (N=105), proxy awareness only (C) (N=51), and neither (D) (N=137).
See this image and copyright information in PMC

References

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