Antibiotics and end-of-life in dementia patients
Antibiotics are frequently prescribed to patients with advanced dementia in nursing homes, which poses two potential ethical dilemmas, both in the treatment burden placed on patients at the end of life and the spread of antimicrobial resistance in the nursing home community, a research group reports.
Erika D'Agata, MD, MPH, of Boston's Beth Israel Deaconess Medical Center and Harvard Medical School, led a team that studied 214 residents with advanced dementia living in 21 nursing homes.1 Each patient was followed up, after an initial review, for up to 18 months. During that time, 99 of the residents died and, of those, 42 (42.4%) received antibiotics during the final two weeks before they died.
"The proportion of residents taking antimicrobials was seven times greater in the last two weeks of life compared with six to eight weeks before death," the authors wrote. Thirty of the 72 courses (41.7%) in the last two weeks of life were administered intravenously rather than by mouth, a method that may be uncomfortable for patients with advanced dementia.
"This extensive use of antimicrobials and pattern of antimicrobial management in advanced dementia raises concerns not only with respect to individual treatment burden near the end of life, but also with respect to the development and spread of antimicrobial resistance in the nursing home setting," the authors wrote. The results support "the development of programs and guidelines designed to reduce the use of antimicrobial agents in advanced dementia."
Reference
1. D'Agata E, Mitchell SL. Patterns of antimicrobial use among nursing home residents with advanced dementia Arch Intern Med 2008; 168:357-362.
Antibiotics are frequently prescribed to patients with advanced dementia in nursing homes, which poses two potential ethical dilemmas, both in the treatment burden placed on patients at the end of life and the spread of antimicrobial resistance in the nursing home community, a research group reports.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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