Impact of Special Care Unit for Patients with Advanced Alzheimer's Disease on Patients' Discomfort and Costs

Volicer, Ladislav; Collard, Ann F.; Hurley, Ann C.; Bishop, Christine E.; Kern, Donald C.; Karon, Sarita L.

doi:10.1111/j.1532-5415.1994.tb06856.x

Cited by 129 publications

(88 citation statements)

References 23 publications

(42 reference statements)

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“…For residents with advanced dementia, who are facing a high 6-month mortality and the frequent necessity of restraints to prevent removal of intravenous lines, the benefi t of such aggressive care has been increasingly questioned. 3,26,[35][36][37][38][39] Our fi ndings lend further support to this position because aggressive care appeared to offer little survival benefi t in the 3 months after lower respiratory tract illness. Previous analysis of Missouri LRI Study data found no difference in 1-month mortality between residents fi rst treated in the nursing home or the hospital, after adjusting for illness severity and probability of hospitalization.…”

Section: Discussionsupporting

confidence: 52%

Antibiotic Treatment and Survival of Nursing Home Patients With Lower Respiratory Tract Infection: A Cross-National Analysis

Kruse

Mehr²,

Steen³

et al. 2005

The Annals of Family Medicine

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PURPOSE Although lower respiratory tract infections are a leading cause of death in frail elderly patients, few studies have compared treatments and outcomes. We assessed the effects of different antibiotic treatment strategies on survival of elderly nursing home residents with lower respiratory tract infections in the United States and the Netherlands, where treatment approaches are quite different. METHODSWe combined data from 2 prospective cohort studies of lower respiratory tract infections conducted in 36 nursing homes in the United States and 61 in the Netherlands. We included residents whose infections were treated with antibiotics: 806 in the United States and 415 in the Netherlands. Outcome measures were 1-month and 3-month mortality. We used logistic regression to adjust for differing illness severity.RESULTS Dutch residents had higher mortality than US residents (28.1% vs 15.1% at 1 month, respectively; P <.001). After adjusting for illness severity with logistic regression, the differences between the Dutch and US populations were not significant (odds ratio 1.34; 95% confi dence interval, 0.94-1.90). Predicted mortality was overestimated for more severely ill US residents at 1 month but not at 3 months. No antibiotic regimen was consistently associated with increased or decreased mortality. CONCLUSION Despite differences in illness severity and treatment, adjusted mortality did not differ between the 2 countries. Although we cannot exclude a short-term survival benefi t from more aggressive treatment in the United States, differences in baseline health appear prognostically more important than the type of antibiotic treatment.

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Section: Discussionsupporting

confidence: 52%

Antibiotic Treatment and Survival of Nursing Home Patients With Lower Respiratory Tract Infection: A Cross-National Analysis

Kruse

Mehr²,

Steen³

et al. 2005

The Annals of Family Medicine

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“…In the DSCU, discomfort was lower and mortality was higher. There were fewer hospitalizations and costs were lower [106].…”

Section: Research Trends In Dementia At the End Of Lifementioning

confidence: 99%

“…Prospective observational [60,89,91,95,102,106,108] and intervention studies [33,86,87,101,103,104,110] provide the best evidence on how to improve care and 14 have been completed or are ongoing (Table 1). However, most studies have been small, retrospective, or both.…”

Section: Research Trends In Dementia At the End Of Lifementioning

confidence: 99%

Dying with Dementia: What We Know after More than a Decade of Research

Steen

2010

JAD

224

177

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Abstract. Death with dementia is increasingly common. Although prognostication is difficult, it is an incurable life-limiting illness for which palliative care for the patient is often appropriate. Dementia patients are otherwise at risk of overtreatment with burdensome and possibly non-beneficial interventions and undertreatment of symptoms. Although recent studies indicate encouraging trends of improved palliative care, little evidence supports effectiveness of specific treatments. As of January 2010, at least 45 studies, almost all performed after 2000, have reported on treatment, comfort, symptom burden, and families' satisfaction with care. Over half (25; 56%) of these studies were in US settings, and most were small or retrospective. Few randomized trials and prospective observational studies have been performed so far, but several promising studies have been completed recently or are underway in various countries. Guidelines for care and treatment, still mostly consensus-based, support the benefits of advance care planning, continuity of care, and family and practitioner education. Assessment tools for pain, prognosis, and family evaluations of care have been developed and some have been shown to be effective in clinical practice. With increasing numbers of well-designed, large-scale studies, research in the next decade may result in better evidence-based guidelines and practice.

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“…One uncontrolled trial was done in a single nursing home and compared a palliative-care approach with traditional longterm care management for persons with severe dementia. By incorporating a pain-management component, the palliative-care approach led to decreased discomfort scores, fewer transfers to acute care, and lower costs [37]. Use of the Assessment of Discomfort in Dementia (ADD) protocol, a systematic approach to pain assessment and management for nurses, ameliorated discomfort behaviors in 84 percent of enrolled residents in a convenience sample of 143 residents [38].…”

Section: Best Practices In Pain Management In Persons With Dementiamentioning

confidence: 99%

Cognitive impairment and pain management: Review of issues and challenges

Buffum

Hutt²,

Chang³

et al. 2007

JRRD

102

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Abstract-The assessment and treatment of pain in persons with cognitive impairments pose unique challenges. Disorders affecting cognition include neurodegenerative, vascular, toxic, anoxic, and infectious processes. Persons with memory, language, and speech deficits and consciousness alterations are often unable to communicate clearly about their pain and discomfort. Past research has documented that persons with cognitive impairments, particularly dementia, are less likely to ask for and receive analgesics. This article provides an overview of the assessment, treatment, and management of pain in adults with cognitive impairments. We review types of cognitive impairment; recent work specific to best practices for pain management in patients with dementia, including assessmenttool development and pharmacological treatment; challenges in patients with delirium and in medical intensive care and palliative care settings; and directions for future research.

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Impact of Special Care Unit for Patients with Advanced Alzheimer's Disease on Patients' Discomfort and Costs

Abstract: These results suggest that management of patients with advanced DAT on a DSCU using a palliative care philosophy may result in less patient discomfort and lower costs than management on a TLTC.

Cited by 129 publications

References 23 publications

Antibiotic Treatment and Survival of Nursing Home Patients With Lower Respiratory Tract Infection: A Cross-National Analysis

Antibiotic Treatment and Survival of Nursing Home Patients With Lower Respiratory Tract Infection: A Cross-National Analysis

Dying with Dementia: What We Know after More than a Decade of Research

Cognitive impairment and pain management: Review of issues and challenges

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