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Treatment strategy and risk of functional decline and mortality after nursing-home acquired lower respiratory tract infection: two prospective studies in residents with dementia.
- Source :
-
International journal of geriatric psychiatry [Int J Geriatr Psychiatry] 2007 Oct; Vol. 22 (10), pp. 1013-9. - Publication Year :
- 2007
-
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.<br />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.<br />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.<br />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.<br /> (Copyright (c) 2007 John Wiley & Sons, Ltd.)
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 0885-6230
- Volume :
- 22
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- International journal of geriatric psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 17340655
- Full Text :
- https://doi.org/10.1002/gps.1782