1. Treatment strategy and risk of functional decline and mortality after nursing-home acquired lower respiratory tract infection: two prospective studies in residents with dementia.
- Author
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van der Steen JT, Mehr DR, Kruse RL, Ribbe MW, and van der Wal G
- Subjects
- Aged, Aged, 80 and over, Cohort Studies, Cross Infection mortality, Drug Administration Routes, Female, Homes for the Aged, Humans, Male, Nursing Homes, Pneumonia etiology, Pneumonia mortality, Prospective Studies, Treatment Outcome, Activities of Daily Living, Anti-Bacterial Agents therapeutic use, Cross Infection drug therapy, Dementia complications, Pneumonia drug therapy
- Abstract
Background: Although lower respiratory tract infections (LRI) cause considerable morbidity and mortality among nursing home residents with dementia, the effects of care and treatment are largely unknown. Few large prospective studies have been conducted., Methods: We pooled data from two large prospective cohort studies in 61 Dutch nursing homes and 36 nursing homes in the state of Missouri, United States. We included 551 US residents and 381 Dutch residents with dementia and LRI. Main outcome measures were 3-month mortality and decline in activities of daily living (ADL) function after 3 months compared with pre-illness status. Using multivariable multinomial logistic regression to control for confounding, we assessed associations of restraint use and antibiotic type (oral compared with parenteral), with outcomes of lower respiratory tract infection (LRI). Survival without ADL decline was the reference category., Results: After multivariable adjustment, restraint use was associated with ADL decline (OR 1.9, 95% CI 1.1-3.3). Oral antibiotics were not associated with 3-month mortality (OR 0.83; 95% CI 0.56-1.2). Severe dementia was the strongest independent predictor of decline; mortality was most strongly associated with male gender., Conclusions: Among Dutch and US nursing home residents with dementia and LRI, restrained residents suffered more decline. Parenteral antibiotic treatment was not associated with better outcome in residents at low to moderate risk of mortality. Aggressive treatment strategies may provide little benefit for the majority of nursing home residents with dementia and LRI., (Copyright (c) 2007 John Wiley & Sons, Ltd.)
- Published
- 2007
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