Search

A study on elderly inmates of nursing homes who died within one year of joining the nursing home is presented. The effect of chronic ailments and other diseases on their mortality is examined.

Severe dementia and adverse outcomes of nursing home-acquired pneumonia: evidence for mediation by functional and pathophysiological decline.

This article evaluates the operation of health care system in terms of its meeting the demands and needs of the older persons in the Netherlands. Data show that about 8% of the older population live in the residential or nursing homes.

Dementia is a process arising from neurological impairment and social psychological pressures. The conditions if left untreated can aggravate into malignant social psychology like infantilization, stigmatization, ignoring etc. A study is presented to show that snoezelen, a method of stimulating the senses of light, sound, smell and taste of the elderly dementia patients inhibits the progress of the dementia.

The treatment of nursing home residents in Missouri and Netherlands is compared to examine dementia and lower respiratory tract infection (LRI). Results indicate more aggressive care for US nursing home residents with LRI and dementia as compared to care for Dutch residents.

Research indicates that dementia patients with pneumonia suffer substantially regardless of whether or not they are treated with antibiotics, and implications for symptomatic treatment are discussed. Studies were conducted on 662 demented nursing home patients in the Netherlands, 77% of whom were given antibiotics and 23% whom were not.

Using a guideline for decision-making Summary points * We have developed a guideline to help physicians to decide whether to forgo curative treatment of pneumonia in patients with dementia who [...]

Non-treatment decisions concerning demented patients are complex: in addition to issues concerning the health of patients, ethical and legal issues are involved. This paper describes a method for the development of a guideline that clarifies the steps to be taken in the decision making process whether to forgo curative treatment of pneumonia in psychogeriatric nursing home patients. The method of development consisted of seven steps. Step 1 was a literature study from which ethical, juridical and medical factors concerning the patient's health and prognosis were identified. In step 2, a questionnaire was sent to 26 nursing home physicians to determine the relative importance of these factors in clinical practice. In a meeting of nine experienced physicians (step 3), the factors identified in step 2 were confirmed by most of these professionals. To prevent the final guideline being too directive, a concept guideline that included ethical and legal aspects was designed in the form of a 'checklist of considerations' (step 4). Experts in the fields of nursing home medicine, ethics and law reviewed and commented on the concept guideline (step 5). The accordingly adapted 'checklist of considerations' was tested in a pilot study (step 6), after which all experts endorsed the checklist (step 7). The resulting 'checklist of considerations' structures the decision making process according to three primary domains: medical aspects, patient's autonomy, and patient's best interest (see annex at end of paper). (Journal of Medical Ethics 2000;26:114-120) Keywords: Decision making; medical futility; patient advocacy; pneumonia; practice guidelines; nursing homes, Introduction Physicians involved in the care of elderly patients with a limited life expectancy are often confronted with the dilemma of whether treatment should be given or should be considered [...]