Survival and Comfort After Treatment of Pneumonia in Advanced Dementia

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Abstract
An estimated 5 million Americans have dementia, a number that is expected to increase to 13 million by 2030.1 Nursing homes (NHs) play an important role in their end-of-life care, as 70% will die in this setting.2 Infections, particularly pneumonia, are common in individuals with advanced dementia.3-7 Nursing home residents with end-stage dementia who develop pneumonia are often treated with antimicrobial agents, and many are hospitalized.3,6,8-11 However, the benefits of antimicrobial treatment are not well established in this population, and there is substantial variation in practice.10,11 Current literature provides limited and contrasting information on the ability of antimicrobial agents to affect 2 important treatment goals in advanced dementia: survival12,13 and comfort.14,15 Furthermore, prior work is limited by a lack of randomized designs, and some observational studies have not adjusted for factors that are associated with the likelihood of receiving treatment.12-15