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Hebrew SeniorLife researcher finds
Date:2/25/2008

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

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