Dementia, Lower Respiratory Tract Infection, and Long-Term Mortality
Objective
To examine long-term mortality and its determinants in nursing home residents with dementia diagnosed with a lower respiratory tract infection (LRI).
Setting and Patients
US (Missouri) nursing home residents (541) and Dutch residents (403) with dementia who were treated with antibiotics for an LRI.
Methods
Prospective studies of nursing home–acquired LRI in the US (Missouri) and in the Netherlands. Measurements included demographics, indicators of acute illness, general health condition, intake problems, and comorbid disease. Six-month mortality rates were calculated and Cox proportional hazards models were developed for mortality up to 2 years after diagnosis.
Results
Six-month mortality was 48.8% among Dutch residents and 36.4% among US residents. After multivariable adjustment, Dutch nationality was not associated with higher long-term mortality. Variables most strongly associated with long-term mortality were activity of daily living dependency and male gender. Other variables associated with outcome were diverse: respiratory difficulty, age, dehydration, congestive heart failure, decreased alertness, decubitus ulcers, Parkinson disease, weight loss/poor nutrition, and pulse rate.
Conclusion
LRI is followed by substantial mortality in the months after diagnosis, indicating high frailty of nursing home residents with dementia who develop LRI. A variety of patient characteristics, including many not directly related to LRI, were consistently associated with long-term mortality in two cohorts with differing illness severity. The results are relevant for informing families, evaluating poor long-term survival in the context of care and treatment, and balancing the potential burdens and benefits of care.
Keywords: Dementia, follow-up studies, nursing homes, palliative care, pneumonia, prognosis, survival rates
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All authors were involved in obtaining funding, critical revision of the manuscript for important intellectual content, and approval of the final manuscript for publication.
This study was funded by the National Institute of Aging, grant number AG18335, by ZonMw, The Netherlands, grant number 1365.0006/98-10-008 (2000-42), and by the Departments of Nursing Home Medicine, and Public and Occupational Health of the EMGO Institute, VU University Medical Center Amsterdam. The Dutch study was originally funded by the Dutch Ministry of Health, Welfare, and Sport (VWS, grant numbers 37851, 37852, 37853, 37832) and the Society “Het Zonnehuis.” The US LRI study was originally funded by the Agency for Healthcare Quality and Research grant number HS08551 and a Generalist Physician Faculty Scholars Award to D.R.M. from the Robert Wood Johnson Foundation. None of the authors have a conflict of interest in this study.
The study sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review or approval of the manuscript.
PII: S1525-8610(07)00204-6
doi:10.1016/j.jamda.2007.03.005
© 2007 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
