Occurrence and Treatment of Suspected Pneumonia in Long‐Term Care Residents Dying with Advanced Dementia

Abstract

Pneumonia is a common terminal event in advanced dementia for which many patients receive parenteral antibiotics. The aggressiveness of treatment is most strongly determined by advance care planning, the patient's cultural background, and clinical features of the suspected pneumonia episode.

End of life care for community dwelling older people with dementia: an integrated review

“…The presence of an advance care plan and perceptions of a patient's quality of life may affect carers' decision making about interventions to prolong life. However, the review demonstrated how contextual factors such as level of education, rural or urban settings and nationality all influence individuals' responses to decision making about place of care and interventions at the end of life (Caron et al, 2005a(Caron et al, , 2005bChen et al, 2006;Gessert et al, 2006). Very few studies have engaged with how carers interact with professionals in the decision-making process, nor have they described what is required for effective communication (Caron et al, 2005b) even though it is clear that how physicians resolve and negotiate patient and family preferences regarding care appears to directly influence patient outcomes (Helton et al, 2006).…”

The Clinical Course of Advanced Dementia

“…Survival was poor after the onset of these complications. 7,11,12,26 These findings can be used to inform families and care providers that infections and eating problems should be expected and that their occurrence often indicates that the end of life is near. Families and providers should also understand that although these complications may be harbingers or even precipitants of death, as they are in other terminal diseases (e.g., the acquired immunodeficiency syndrome, cancer, and emphysema), it is the major illness, in this case dementia, that is the underlying cause of death.…”

“…Our current understanding of end-stage dementia is based on findings from retrospective studies, [3][4][5][6][7] cross-sectional studies, 8 or investigations of hospitalized patients. [9][10][11][12] The clinical course of advanced dementia has not been described in a rigorous, prospective manner.…”

Vulnerable long-term psychiatric inpatients need screening for physicalhealth problems: An audit of regular hospital statistics and clinical files

“…2,[14][15][16][17] Acute respiratory tract infections also take their toll in psychiatric patients: Patients with advanced dementia in long-term care often get pneumonia in the last six months of life (64% prevalence) and it is often a terminal event. 3 Surprisingly, when patients with dementia were compared prospectively to patients without dementia in nursing homes, those with dementia were found to have lower overall rates of infection and lower mortality rates. 18 Falls are another physical health concern in long-term psychiatric patients.…”

“…[1][2][3][4][5] For psychiatric in-patients, and in particular for long-term psychiatric in-patients, the challenge of maintaining physical health often relates to inadequate monitoring of their physical problems by the treating team. 1 On the other hand, inadequate self-report by the patients themselves of physical symptoms -which might be a function of psychosis or cognitive impairment -might also contribute to poor physical health maintenance.…”