A study published in the Archives of
Internal Medicine stated that using of antibiotics to thwart
pneumonia, a common illness contracted in late-stage dementia, has a
capacity to prolong patient's lives on an average of nine months. But
the study also found that patients experience increased pain,
depression, anxiety, and agitation from the treatment.
Dementia patients in nursing homes are routinely given antibiotics
to treat pneumonia. And according to the study there is a dire need to re-educate nursing homes on
how to treat these patients.
There are approximately 5 million Americans diagnosed with
dementia. This number is anticipated to more than double over a
couple of decades as baby boomers age. The findings may spark a
debate about how much is too much when it comes to treatment at the
end of life. The researchers concluded that the study should lead
care-givers to stop the practice of automatically giving antibiotics
for pneumonia to dementia patients, and instead consult with family
members of the patients first.
The study's lead author, Dr. Jane L. Givens, an assistant
scientist at the Institute for Aging Research of Hebrew Senior Life
said, ?Over one-third of patients with advanced dementia have
pneumonia in the last three months of life, and 42 percent of those
patients will be on antibiotics in the last two weeks of life,??
According to Dr. Givens the goal of their research was not to
recommend for one treatment or another, but to provide the best
evidence for families to make decisions. Dr. Givens is a geriatrician
who regularly encounters the dilemma of how to care for patients with
advance dementia with pneumonia at the facility's nursing home. She
said her team embarked upon its six-year study because there was
barely sufficient science about the benefits and risks of antibiotic
treatment for families to understand.
Dr Givens and her team tracked 323 nursing home residents with
advanced dementia, for her study, in 22 long-term care facilities in
Greater Boston between 2003 and 2009. It was revealed that the large
majority of the patients, around 91% of them, received antibiotics
for episodes of pneumonia. Fifty-five percent of these patients were
orally treated with the medication, but around 20% received more
aggressive treatment, with hospitalization or antibiotics given
intravenously.
Based on their observation of patient's agitation, restlessness,
moaning, and other behaviors that might indicate discomfort and pain,
found that patients who didn't receive any antibiotic treatments
showed the highest levels of comfort. As the aggressiveness of care
accelerates, comfort levels were progressively lower.
Some reasons for patients with advance dementia contracting
pneumonia are: a). They usually lose their capacity to swallow which
results to food getting lodged in their lungs causing infection. b).
Their immune system may be impaired.
Unfortunately, and almost often, families do not receive the
information they need to make an informed choice about treatment,
said Paul Raia, vice president of clinical services for the
Massachusetts and New Hampshire Alzheimer?s Association. Raia stays
in nursing homes training staff regarding proper medication and
behavior management techniques for dementia patients, and he said
discussing with families about treatment choices often don?t happen
because agitated workers are worried about the legal consequences of
their actions
It is best if families discuss en-of-life care wishes before
members are incapacitated, and to appoint a health care proxy to
make treatment decisions should they later become unable to care for
themselves. This is what the organization tries to encourage.
According to the 2008 Dartmouth Atlas of Health Care, in the
United States, billions of dollars are spent each year on intensive
treatments for geriatric patients in the last six months of their
lives. The Atlas found that more than 80 percent of patients wish to
avoid hospitalization and intensive care during their final days, but
those wishes are often upset by other factors.
Alice Bonner, a nurse practitioner who spent 20 years in nursing
homes and is now the state?s top nursing home regulator said the
Massachusetts Department of Public Health, the one that regulates
nursing homes, has been collaborating with the industry to improve
staff training, so they are able to engage in knowledgeable
discussions with families about treatment options.