Navigation Links
Hebrew SeniorLife researcher finds
Date:2/25/2008

An article co-authored by Susan L. Mitchell, M.D., M.P.H., of Hebrew SeniorLifes Institute for Aging Research reports that nursing home residents with advanced dementia are frequently prescribed antibiotic medications, especially during the two weeks before death. This practice raises concerns about the end-of-life care of individual patients dying with advanced dementia, as well as the emergence of antimicrobial resistance. The paper appears in the February 25 issue of the Archives of Internal Medicine.

The extensive antibiotic use demonstrated in this study is concerning given the lack of demonstrable benefits and the potential burdens of treatment in this terminally ill population for whom the goal of care is often palliation, write study authors Susan L. Mitchell, M.D., M.P.H., of Hebrew SeniorLifes Institute for Aging Research, and Erika DAgata, M.D., M.P.H., of Beth Israel Deaconess Medical Center. Moreover, we believe that the widespread use of antibiotics in advanced dementia may pose a potential public health risk through the emergence of antibiotic resistance.

Nearly 70 percent of the 5 million Americans with dementiaa progressive decline in cognitive function due to damage or disease in the brain beyond what is expected in normal agingwill live in a nursing home during the final stage of their disease. Recurrent infections and fevers typically occur during this stage; therefore, nursing home residents with advanced dementia are at high risk for exposure to antibiotic medications. Exposure to drugs, however, can lead to the emergence of antibiotic-resistant bacteria, which are associated with higher mortality rates and more frequent and prolonged hospitalizations.

The researchers followed 241 residents with advanced dementia from 21 Boston-area nursing homes who were recruited for a study called Choices, Attitudes and Strategies for Care of Advanced Dementia at End-of-Life (CASCADE), a five year study funded by the National Institutes of Health. The primary goal of the CASCADE study is to describe the multiple facets of the end-of-life experience for nursing home dementia patients and their families. As one component of this larger study, the use of antimicrobial medications (drugs that kill or inhibit the growth of bacteria) among these residents every 3 months for 18 months or until their death.

More than 66 percent of residents with advanced dementia received at least one course of antibiotic therapy during an average of 322 days of follow-up. Among the 99 residents who died during the observation period, nearly 52 percent received at least one course of antibiotics within eight weeks of death, and 42% received antibiotics during the 2 weeks prior to death. As subjects approached death, the number of antibiotic therapy courses increased significantly.

This is the first comprehensive study to describe the quantity, type and pattern of antibiotics prescribed for advanced dementia patients. Earlier studies focused on the treatment of specific infections, such as pneumonia, or studied residents in only a single institution.

Despite these differences, the researchers say, our study corroborates that antimicrobial agents are commonly prescribed in advanced dementia and extends these findings by a marked increase in antimicrobial use as death becomes imminent.

In an accompanying editorial, two epidemiologists from Tel Aviv Medical Center in Israel argue that physicians must consider every decision to use antibiotics in this population as we would decisions regarding other treatment modalities, including resuscitation and major surgery. That is, physicians must determine if using these medications for specific patients justifies the risk placed on others by antimicrobial resistance. We must challenge the assumptions that it is always acceptable to treat bacterial infection with antibiotics, and that deliberation is required only in the event that one wishes not to treat.

Drs. Mitchell and DAgata say their findings are a first step toward a better understanding of the public health risks posed by antibiotic resistance and that the development of programs and guidelines to reduce the use of antimicrobial agents in advanced dementia is warranted.


'/>"/>

Contact: Jennifer Davis
jdavis@hrca.harvard.edu
617-363-8384
Hebrew SeniorLife Institute for Aging Research
Source:Eurekalert

Related medicine news :

1. 2 Hebrew University scientists awarded Wolf Prizes
2. Stanford researchers find culprit in aging muscles that heal poorly
3. Children of depressed moms do better when dad is involved, SLU researcher finds
4. UCLA researchers identify markers that may predict diabetes in still-healthy people
5. Mayo Clinic researchers discover new diagnostic test for detecting infection in prosthetic joints
6. Bipolar disorder relapses halved by Melbourne researchers
7. Cell that triggers symptoms in allergy attacks can also limit damage, Stanford researchers find
8. High and mighty: first common height gene identified by researchers behind obesity gene finding
9. Researchers estimate about 9 percent of US children age 8 to 15 meet criteria for having ADHD
10. Majority of 2.4 Million U.S. Children With ADHD Not Diagnosed or Consistently Treated, According to New Gold Standard Study by Cincinnati Childrens Researchers
11. Researchers develop long-lasting growth hormone
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/24/2017)... ... February 24, 2017 , ... Indiana Fiber Network (IFN) President and CEO Kelly ... Dyer started as the Chairman of the Management Committee when IFN was originally ... including the recruitment of investor/owners and development of the business plan. He became ...
(Date:2/24/2017)... ... 24, 2017 , ... Rosica Communications, a national PR ... media relations, social media, content marketing and SEO, is now offering direct, social ... intuitive marketing automation platform. , Rosica will now offer the platform to its ...
(Date:2/24/2017)... ... February 24, 2017 , ... Castle Farms, the ... Military Wedding Giveaway, with the winning couple announced on Feb. 14, 2017, on ... donated from local vendors: A Matter of Taste, Ryan Rousseau Enterprises, A Touch ...
(Date:2/23/2017)... ... 2017 , ... On February 22, 2017 the U.S. Department ... withdraw previous guidance issued by the Obama Administration requiring schools to treat transgender ... by the Obama Administration came in response to a growing number of states ...
(Date:2/23/2017)... Miami, FL (PRWEB) , ... February 23, 2017 ... ... largest non-profit organization devoted exclusively to funding innovative lymphoma research and serving the ... services – will return to the La Gorce Country Club in Miami Beach ...
Breaking Medicine News(10 mins):
(Date:2/24/2017)... NEW YORK , Feb. 23, 2017 ... gives comprehensive insights on the various drugs ... The report covers all the drugs that ... Preclinical & Clinical). The pipeline focuses on ... small molecules, antibodies, stem cell therapies, recombinant ...
(Date:2/23/2017)... -- Visiomed, the French leader in medical grade ... the landscape of healthcare with their innovative use ... solutions. Recognizing the rising demand of self-monitoring alongside ... walls, Visiomed has launched BewellConnect, the most ground-breaking ... that is empowering the lives of patients. ...
(Date:2/23/2017)... , Feb. 23, 2017 ITL Limited, ( ASX: ITD ... results for the half year ended 31 December 2016 compared with ... Update" presentation can be viewed here . ... 2015: $1.04m; up 104%) Earnings per share of ... Revenue of $17.5m (Dec 2015: $15.7m; up 11%) ...
Breaking Medicine Technology: