dementia and pneumonia

We found that approximately 50% of patients with dementia in the hospital setting died owing pneumonia, according to cause of death confirmed by autopsy. Meta-analysis for frequencies of pneumonia-associated death in patients with dementia according to study settings. If left untreated, complications can be serious, even fatal. Two investigators (TM and YF) independently searched for eligible studies in PubMed and the Cochrane Database of Systematic Reviews, published from database inception to December 2016. This indicated that for these factors, the OR varied among physicians. Some studies have found a link, and other studies found no association. However, the influence of pneumonia on the prognosis of patients with varying types of dementia has not been fully evaluated. When a person has dementia, their immune system can often be compromised leading them to develop other medical conditions. (a) Data for 12 studies that compared patients with versus those without dementia. JRWenger EEAntibiotic policies in Dutch hospitals for the treatment of pneumonia. Until now, studies have relied on reporting of physicians' opinions in discussions on life-sustaining treatment22,23 or on hypothetical cases (vignettes).24,25, In the Netherlands, as in Great Britain,26 physicians are culturally and legally responsible for the ultimate decision about withholding treatment in incompetent patients. Patients with dementia in the terminal stages urgently require careful clinical management of pneumonia, to maximize patient life expectancy and quality. PAHoude The deterioration of respiratory function may also influence the reduced lifespan once patients with dementia develop pneumonia. In our study, typically oral amoxicillin was given. Cognitive impairment is common in HF syndromes with estimates of its prevalence varying between 25% and 75%. Factors that influence decision making independently, Variation in considering patient characteristics, Get the latest from JAMA Internal Medicine, To register for email alerts, access free PDF, and more, Get unlimited access and a printable PDF ($40.00), 2023 American Medical Association. One of the most common causes of death for people with dementia is pneumonia caused by an infection. CMPMRibbe WGGoossens 1 However, patients with dementia frequently develop pneumonia and often die from it, 2,3 while pneumonia has been associated with high levels of discomfort. Attitudes toward withholding antibiotics from people with dementia The most significant item of the BANS-S for severity of dementia with respect to withholding antibiotic treatment proved to be eating dependency 2 weeks before the treatment decision. It hardly affected the ORs of the other variables in the model. ACVolicer KTube feeding in patients with advanced dementia: a review of the evidence. Cumulative meta-analysis using a random effects model for frequency of pneumonia-associated death is shown, by study. Fried GH Pneumonia is a common consequence of the common cold and flu, particularly among older adults. One other possible explanation for the link between these infections and increased risk of Alzheimer's comes from laboratory studies. The GDS is a validated scale that assesses the severity of dementia in seven levels, where level 7 is the most severe. Beauchamp PRMini-mental state: a practical method for grading the cognitive state of patients for the clinician. The strongest association in univariate analysis was with the clinical judgment of illness severity at the time of the treatment decision (OR, 2.7 per point increase on a 9-point scale; 95% CI, 1.8-3.9). Background Pneumonia is a serious disease associated with mortality among patients with dementia. Even less is known on variation among physicians with respect to these considerations. However, so far their results are inconsistent. DEfor the ACP-ASIM End-of-Life Care Consensus Panel,A consensus-based approach to providing palliative care to patients who lack decision-making capacity. According to a 2017 review, typical symptoms of pneumonia include: a cough, which may be dry, or produce phlegm. Background: Pneumonia in people with dementia has been associated with severe discomfort. Background Our previous study indicated that dementia was a risk factor for the occurrence of aspiration pneumonia in older adults [4]. Pneumonia is a bacterial, viral, or fungal infection that causes inflammation of the . RJ. GHAlemayehu We often get asked if certain viruses, bacteria or fungal infections can cause Alzheimer's disease. MERuben In most Dutch hospitals and nursing homes, amoxicillin is the first drug choice in case of unknown pathogens,52 which is generally sufficient since antibiotic resistance is still not a major problem in the Netherlands.53 Physicians were willing at times to start more invasive procedures in more severely ill patients. The present study findings warrant the further investigation among patients with the same subtypes of dementia as well as the same underlying clinical conditions. #nannatiktok #dementia #96yrsold #warrior #pneumonia #fyp #thankyou #n Dementia - Symptoms and causes - Mayo Clinic Hiroyasu Akatsu, RLDouglas GRibbe Here's what you need to know about the symptoms and treatments In a nutshell Pneumonia is a serious respiratory infection that is common in elderly people. Herpes infection in the brain appears to be more common in people with Alzheimer's disease who have a gene called ApoE4, which is known to increase the risk of Alzheimer's. Pneumonia symptoms were grouped to assess relevance compared with other conditions. All Rights Reserved. What causes pneumonia in people with dementia? - Lifted Methods ACLathi MWEthical aspects of medical decision-making in demented patients: a report from the Netherlands. doi:10.1001/archinte.162.15.1753. Treatment with antibiotics was withheld in 23% (AB-withheld) of the 706 patients in the Pneumonia Study. (c) Data from 9 studies that examined pneumonia-associated death using death certificates. Antibiotics and anti-viral drugs that treat some of these infections are starting to be tested in clinical trials of people with Alzheimer's disease. In the final subgroup analysis according to study setting (clinic, hospital, or nursing home), the frequency of pneumonia-associated death in hospital-based studies was the same as that in studies using autopsy confirmation (Figs 3A and 5A) and higher than the frequency in nursing home-based studies (20.76%; 95% CI, 8.3533.18; I2 = 79%; p for heterogeneity = 0.001) (Fig 5B) and population-based studies (19.50%; 95% CI, 14.5024.49; I2 = 100%; p for heterogeneity < 0.001) (Fig 5C). Accessibility Statement, Our website uses cookies to enhance your experience. The death of your loved one can be a hard concept to wrap your head around and accept. Patients were assigned to treatment solely on the basis of the decision of the physician. In people who have dementia, the symptoms interfere with their daily lives. Goldstein JBarrett-Connor Diamonds at the bottom of the figure show 95% CI range of the overall estimates. Table 5 gives a more specified model, which did not include illness severity, and shows that the most important independent predictors of withholding antibiotic treatment were all patient factors. ACVolicer In addition, withholding antibiotics occurred more often in the summer and in patients with an initial episode of pneumonia. Diamonds at the bottom of the figure show 95% CI range of the overall estimates. Dementia May Signal Pneumonia in Elderly | Resource | Baptist Health No, many older adults live their entire lives without developing dementia. Methods: We retrospectively analyzed the data from medical and autopsy reports. Diamonds at the bottom of the figure show 95% CI range of the overall estimates. Levin Patients with dementia had a two-times greater risk of death owing to pneumonia compared with patients who did not have dementia. Katsuyoshi Mizukami, To identify factors associated with decisions on whether to withhold curative antibiotic treatment in patients with dementia who have pneumonia. At the moment, there is not enough evidence to know whether treating infections would be a good strategy to treat Alzheimer's or to reduce the risk of the condition. Survival and Comfort After Treatment of Pneumonia in Advanced Dementia Other warning signs may not be present, but they may include: With internationally renowned centers of excellence, 12 hospitals, more than 27,000 employees, 4,000 physicians and 200 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties, Baptist Health is an anchor institution of the South Florida communities we serve. Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan, Affiliations: One study50 concerned a population with severe dementia that was similar to our study. MWHealth care for older persons, a country profile: the Netherlands. Pneumonia is a life-threatening disease in nursing home patients with dementia. Improving comfort in people with dementia and pneumonia: a - PubMed If the theory that infections can contribute to the development of Alzheimer's disease is correct, then treating the infections could help to prevent or treat Alzheimer's. It's thought that the bacteria get into the brain along the olfactory nerve, which transmits information about smells from the nose to the brain. Modeling only these 5 predictors (dementia severity, number of pneumonia symptoms, insufficient drinking, dehydration, and treatment in the summer) showed that model discrimination was as good as discrimination of the complete model, including the variables that showed random variation (area under receiver operating characteristic curve, 0.85 compared with 0.86 for the complete model), as could be expected. Facilities varied negligibly in withholding antibiotic treatment (variation on nursing home level in multilevel analyses). Naughton One theory behind this is that ApoE4 increases the likelihood of the herpes virus moving from the body into the brain. 2023 American Medical Association. et al. The study protocol was approved by the medical ethics committee of the VU University Medical Center. This is because there is some research to show Alzheimer's is more common in people who have these infections. We expect that there are some international differences in importance attached to specific factors relating to treatment decisions. Conclusions KJMontgomery (b) Data from 3 studies that examined pneumonia-associated death using autopsy reports. RWijnands Ethical issues in the treatment of advanced Alzheimer dementia: hospice approach. Take part in our UK-based service that allows people to register their interest in taking part in dementia research. One of the ways dementia disorders affect the body is that they destroy the ability to swallow safely. Why is the Mediterranean Diet So Good For You? And food or liquids can enter the lungs, known as aspiration. Appointments 216.444.6503. In the subgroup analysis according to information source for the cause of death (autopsy or death certificate), the estimated frequency of pneumonia-associated death in studies using autopsy confirmation was 49.98% (95% CI, 43.7556.21; I2 = 72%; p for heterogeneity = 0.002) (Fig 3A) whereas that in studies using death certificates was 19.65% (95% CI, 15.4823.82; I2 = 99%; p for heterogeneity < 0.001) (Fig 3B). We explore why. Symptoms. This may explain why certain viruses and bacteria, such as herpes and spirochetes, are more common in the brains of people with Alzheimer's. (b) Data of two nursing home-based studies. CBanerjee This implies that physicians weighed such a variable differently in their decisions. WJStobberingh Dementia occurs in stages, with the later stages lasting for around 1-2. Our data may facilitate discussions on whether the identified factors should really be important in the decision-making process and on discrepancies between expected and actual outcomes. ALMortality from pneumonia and hip fractures in patients with advanced dementia. BJHurley MAVolicer E Our data provide insight into the factors that influence decision making and should facilitate the international debate among physicians on this controversial issue. LADiscussions about limiting treatment in a geriatric clinic. Overall observed discomfort was low compared with prior Dutch studies, and the number of treatments to relieve symptoms was higher. You're bound to be worried if a loved one with dementia develops a respiratory infection such as pneumonia. In the second subgroup analysis according to type of mortality cause (immediate or underlying), the estimated frequency of pneumonia-associated death as immediate cause was 44.45% (95% CI, 29.8159.10; I2 = 91%; p for heterogeneity < 0.001) (Fig 4A) whereas the estimated frequency of those as underlying cause was 13.51% (95% CI, 9.4218.51; I2 = 91%; p for heterogeneity < 0.001) (Fig 4B). Studies were excluded based on the following criteria: (1) studies that only had abstracts; (2) studies where the outcome variable was not reported; and (3) studies that presented only an approximate frequency of pneumonia-associated death without the exact number of patients. Nostril widening during each breath. Dysautonomia is an umbrella term for disorders of the ANS. Furthermore, to promote openness and responsible decision making, it is helpful to have an ethical and legal framework for decision making on whether to withhold antibiotic treatment.17,27 Having a practical guideline including all these aspects is useful when discussing antibiotic treatment options with the patient's family and also in advanced care planning.
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