Hebrew SeniorLife researcher finds

February 25, 2008

An article co-authored by Susan L. Mitchell, M.D., M.P.H., of Hebrew SeniorLife's Institute for Aging Research reports that nursing home residents with advanced dementia are frequently prescribed antibiotic medications, especially during the two weeks before death. This practice raises concerns about the end-of-life care of individual patients dying with advanced dementia, as well as the emergence of antimicrobial resistance. The paper appears in the February 25 issue of the Archives of Internal Medicine.

"The extensive antibiotic use demonstrated in this study is concerning given the lack of demonstrable benefits and the potential burdens of treatment in this terminally ill population for whom the goal of care is often palliation," write study authors Susan L. Mitchell, M.D., M.P.H., of Hebrew SeniorLife's Institute for Aging Research, and Erika D'Agata, M.D., M.P.H., of Beth Israel Deaconess Medical Center. "Moreover, we believe that the widespread use of antibiotics in advanced dementia may pose a potential public health risk through the emergence of antibiotic resistance."

Nearly 70 percent of the 5 million Americans with dementia--a progressive decline in cognitive function due to damage or disease in the brain beyond what is expected in normal aging--will live in a nursing home during the final stage of their disease. Recurrent infections and fevers typically occur during this stage; therefore, nursing home residents with advanced dementia are at high risk for exposure to antibiotic medications. Exposure to drugs, however, can lead to the emergence of antibiotic-resistant bacteria, which are associated with higher mortality rates and more frequent and prolonged hospitalizations.

The researchers followed 241 residents with advanced dementia from 21 Boston-area nursing homes who were recruited for a study called Choices, Attitudes and Strategies for Care of Advanced Dementia at End-of-Life (CASCADE), a five year study funded by the National Institutes of Health. The primary goal of the CASCADE study is to describe the multiple facets of the end-of-life experience for nursing home dementia patients and their families. As one component of this larger study, the use of antimicrobial medications (drugs that kill or inhibit the growth of bacteria) among these residents every 3 months for 18 months or until their death.

More than 66 percent of residents with advanced dementia received at least one course of antibiotic therapy during an average of 322 days of follow-up. Among the 99 residents who died during the observation period, nearly 52 percent received at least one course of antibiotics within eight weeks of death, and 42% received antibiotics during the 2 weeks prior to death. As subjects approached death, the number of antibiotic therapy courses increased significantly.

This is the first comprehensive study to describe the quantity, type and pattern of antibiotics prescribed for advanced dementia patients. Earlier studies focused on the treatment of specific infections, such as pneumonia, or studied residents in only a single institution.

"Despite these differences," the researchers say, "our study corroborates that antimicrobial agents are commonly prescribed in advanced dementia and extends these findings by a marked increase in antimicrobial use as death becomes imminent."

In an accompanying editorial, two epidemiologists from Tel Aviv Medical Center in Israel argue that physicians must "consider every decision to use antibiotics in this population as we would decisions regarding other treatment modalities, including resuscitation and major surgery." That is, physicians must determine if using these medications for specific patients justifies the risk placed on others by antimicrobial resistance. "We must challenge the assumptions that it is always acceptable to treat bacterial infection with antibiotics, and that deliberation is required only in the event that one wishes not to treat."

Drs. Mitchell and D'Agata say their findings are a "first step" toward a better understanding of the public health risks posed by antibiotic resistance and that the development of programs and guidelines to reduce the use of antimicrobial agents in advanced dementia is warranted.
-end-
Scientists at the Institute for Aging Research conduct rigorous medical and social studies, leading the way in developing strategies for maximizing individuals' strength, vigor and physical well-being, as well as their cognitive and functional independence, in late life. Hebrew SeniorLife is a 100+-year-old organization committed to maximizing quality of life of seniors through an integrated network of housing, health care, research and teaching programs, serving more than 4,000 seniors annually in the Greater Boston area.

Hebrew SeniorLife Institute for Aging Research

Related Dementia Articles from Brightsurf:

The danger of Z-drugs for dementia patients
Strong sleeping pills known as 'Z-drugs' are linked with an increased risk of falls, fractures and stroke among people with dementia, according to new research.

The long road to dementia
Alzheimer's disease develops over decades. It begins with a fatal chain reaction in which masses of misfolded beta-amyloid proteins are produced that in the end literally flood the brain.

Why people with dementia go missing
People with dementia are more likely to go missing in areas where road networks are dense, complicated and disordered - according to new research from the University of East Anglia.

PTSD may double risk of dementia
People who have experienced post-traumatic stress disorder (PTSD) are up to twice as likely to develop dementia later in life, according to a new study by UCL researchers, published in the British Journal of Psychiatry.

Dementia education
School-based dementia education could deliver much needed empathy and understanding for older generations as new research from the University of South Australia shows it can significantly improve dementia knowledge and awareness among younger generations.

Building dementia friendly churches
A project to help church communities become more 'dementia friendly' has had a significant impact across the country.

A "feeling" for dementia?
A research team led by the DZNE concludes that personal perception can be an important indicator for the early detection of Alzheimer's disease.

New biomarker for dementia diagnosis
Medical researchers in the UK and Australia have identified a new marker which could support the search for novel preventative and therapeutic treatments for dementia.

Digital solutions for dementia care
Telehealth delivery of dementia care in the home can be as effective as face-to-face home visit services if carers and recipients take advantage of the technologies available, Australian researchers say.

Despite a marked reduction in the prevalence of dementia, the number of people with dementia is set to double by 2050 according to new Alzheimer Europe report
Today, at a European Parliament lunch debate, Alzheimer Europe launched a new report presenting the findings of its collaborative analysis of recent prevalence studies and setting out updated prevalence rates for dementia in Europe.

Read More: Dementia News and Dementia Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.