- Pneumonia is common among patients
with advanced dementia
- Comfort and maximum relief of
symptoms is a primary goal for these patients.
- A recent study analyzes the
comfort and survival after treatment of pneumonia patients with advanced
is a broad term which describes a wide
range of symptoms involving a decline in a person's memory or other thinking
is the most
common type of dementia. Though there are medications that help improve the
symptoms temporarily, there is no treatment to stop the progression of
Many of the patients who are in the advanced stages of
Alzheimer's disease need to be cared for in a nursing home setting. They are
also prone to various serious infections, primarily pneumonia which could be
associated with a lot of discomfort, regardless of whether they are treated
with antibiotics or not. It could be quite challenging to treat pneumonia
in these patients.
‘Nursing home residents with dementia dying from pneumonia, experience more discomfort than residents dying of other causes.’
researchers of the current study assessed the effectiveness of a practice
guideline for optimal symptom relief for dementia patients with pneumonia.
conducted a single-blind,
multicenter, cluster randomized controlled trial in 32 Dutch nursing
- The trial
period was divided into a pre-intervention phase (before randomization)
and an intervention phase (after randomization). This was done to allow
for adjusting for changes in the outcomes over time. The primary goal of
the intervention was to improve patient comfort.
- Outcomes were assessed in the patient level. The main outcome
measures were discomfort and symptoms: discomfort (DS-DAT: Discomfort
Scale-Dementia of Alzheimer Type), (lack of) comfort (EOLD-CAD: End Of
Life in Dementia-Comfort Assessment in Dying), pain (PAINAD: Pain
Assessment in Advanced Dementia) and respiratory distress (RDOS:
Respiratory Distress Observation Scale).
- The 229 observers who performed
the observations were blind to the residents' condition, treatments and
the intervention. Observation period was limited to 15 days since cure
from pneumonia or death were expected by that time.
care was provided to all nursing homes in a pre-intervention phase. In the
intervention phase, matched clusters of homes were randomized to either
the control (n = 16) or intervention condition (n = 16).
episodes of pneumonia were included between January 1, 2012 and May 1,
were obtained for 399 episodes in 367 residents.
- In the
remaining 65 episodes, no observations took place, either due to
scheduling difficulties or death of the residents soon after diagnosis of
- 87.1% of
residents received antibiotic
- Thus, the
practice guideline for optimal symptom relief did not relieve discomfort
and symptoms in nursing home residents with dementia and pneumonia.
However, discomfort and symptoms decreased gradually throughout the data
collection in both the intervention homes and the control homes.
was reportedly low compared to previous studies and it decreased steadily
over the course of the study period.
study assessed the outcomes on a regular (almost daily) basis.
study used four different validated observational instruments to assess the
effects of practice guidelines on discomfort and symptoms over time.
- The attending physicians
reportedly did not include about 131 episodes in a timely manner, even though
they fulfilled the inclusion criteria.
- It was seen that in the 65 of 464
cases which lacked observations, residents often died soon after diagnosis
and the results were only based on residents who survived.
- The outcome measures included
symptoms that were most burdensome, however they do not necessarily cover
all symptoms of pneumonia.
- Residents who were not given
antibiotics were relatively less (12.9%), hence subgroup analyses could
not be performed.
studies are warranted to conclusively prove that an intervention which is
directed at awareness of discomfort and regular observations would be more
effective than a physician practice guideline.
- Tessa van der Maaden et al; Improving Comfort in People with Dementia and Pneumonia; BMC Medicine 2016