Up to 90 percent of people in the advanced stages of Alzheimer’s disease must be cared for in a nursing home at some point during their lives, and many of those are prone to serious infections like pneumonia. A new study in the Archives of Internal Medicine looked at the antibiotic treatment that Alzheimer’s patients with pneumonia received. Researchers found that while the drugs can prolong life, in many cases it could prolong suffering. YNNEX7XYHUJJ
The findings underline the importance of proper end-of-life care for people with Alzheimer’s, a disease that takes its toll not just on the brain but on the whole body. Indeed, Alzheimer’s is the seventh leading cause of death in the United States, accounting for nearly 75,000 deaths yearly and exceeding the deaths caused by diabetes or pneumonia and flu.
The researchers, from Rush Medical Center in Chicago, studied patients with advanced Alzheimer’s and other forms of dementia in 22 nursing homes in the Boston area. Over 40 percent of the patients had at least one bout of pneumonia during the 18-month study period. Antibiotics did prolong survival in patients with pneumonia. But overall, it did not make patients feel more comfortable, and in many cases increased discomfort.
Antibiotics can cause well-known adverse effects like allergic reactions and severe digestive upset. But patients who received antibiotics also tended to suffer more pain, for a variety of reasons. In many cases, patients had to be transferred to hospitals for intensive treatment. There, antibiotics often had to be administered intravenously, leading to painful skin infections. The procedure might have to be repeated multiple times, as agitated patients tore drug lines out of their arms and the I.V. tubes had to put back in again and again.
In a commentary accompanying the study, Dr. Anna Chang and Dr. Louise Walter of the University of California, San Francisco, and the Veteran Affairs Medical Center in San Francisco note that patients and their families should carefully consider what it means “to treat pneumonia.” While most of us would not hesitate to pop an antibiotic if we got pneumonia, that may not be the best option for a frail and disoriented person in the final days of their life.
They call for greater awareness of all end-of-life issues for those with late-stage Alzheimer’s. They note that nursing home staff are not adequately educated about the fatal course of Alzheimer’s, which is the seventh leading cause of death overall. In one study, for example, only 1 percent of nursing home staff believed that residents with advanced dementia had a life expectancy of less than six months, when more than 70 percent actually die within that time frame.
They further note that in many cases, patient and family wishes about end-of-life care is not well understood or followed by medical staff, aggressive treatments like tube feeding are overused, and medical problems like pain, bedsores and aspiration of food is not properly managed. Less than a third of nursing home residents who die of advanced dementia receive hospice care, which manages pain and usually makes patients more comfortable in their final months.
By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.
Source: Jane L. Givens, Richard N. Jones, Michele L. Shaffer, Dan K. Kiely, and Susan L. Mitchell: “Survival and Comfort After Treatment of Pneumonia in Advanced Dementia.” Archives of Internal Medicine, July 12. 2010; Vol. 170(13): pages 1102-1107.
Anna Chang, M.D., Louise C. Walter, M.D.: “Recognizing Dementia as a Terminal Illness in Nursing Home Residents: Comment on "Survival and Comfort After Treatment of Pneumonia in Advanced Dementia." Archives of Internal Medicine, July 12, 2010. Vol. 170(13): pages 1107-1109.