JAMDA
Volume 8, Issue 6 , Pages 396-403 , July 2007

Dementia, Lower Respiratory Tract Infection, and Long-Term Mortality

  • Jenny T. van der Steen, PhD

      Affiliations

    • EMGO Institute of the VU University Medical Center, Amsterdam, The Netherlands
    • Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
    • Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, The Netherlands
    • J.T.v.d.S. and R.L.K. had full access to all the data in the study and they take responsibility for the integrity of the data and the accuracy of the data analyses.
    • J.T.v.d.S.’s role in the study included study conception and design, acquisition of the data, analysis, and interpretation of the data, and drafting the manuscript.
    • Corresponding Author InformationAddress correspondence to Jenny T. van der Steen, PhD, VU University Medical Center, EMGO Institute, Department of Nursing Home Medicine and Department of Public and Occupational Health, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
    • ,
  • David R. Mehr, MD, MS

      Affiliations

    • Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO.
    • D.R.M. and R.L.K. were involved in study conception and design, acquisition of the data, and interpretation of the data.
    • ,
  • Robin L. Kruse, PhD, MSPH

      Affiliations

    • Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO.
    • J.T.v.d.S. and R.L.K. had full access to all the data in the study and they take responsibility for the integrity of the data and the accuracy of the data analyses.
    • D.R.M. and R.L.K. were involved in study conception and design, acquisition of the data, and interpretation of the data.
    • ,
  • Miel W. Ribbe, MD, PhD

      Affiliations

    • EMGO Institute of the VU University Medical Center, Amsterdam, The Netherlands
    • Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, The Netherlands
    • G.v.d.W. and M.W.R. were involved in study conception and design, and supervision.
    • ,
  • Gerrit van der Wal, MD, PhD

      Affiliations

    • EMGO Institute of the VU University Medical Center, Amsterdam, The Netherlands
    • Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
    • G.v.d.W. and M.W.R. were involved in study conception and design, and supervision.

References 

  1. Morrison RS, Siu AL. Survival in end-stage dementia following acute illness. JAMA. 2000;284:47–52
  2. van der Steen JT, Mehr DR, Kruse RL, et al. Predictors of mortality for lower respiratory infections in nursing home residents with dementia were validated transnationally. J Clin Epidemiol. 2006;59:970–979
  3. Mitchell SL, Kiely DK, Hamel MB, et al. Estimating prognosis for nursing home residents with advanced dementia. JAMA. 2004;291:2734–2740
  4. Larson EB, Shadlen M-F, Wang L, et al. Survival after initial diagnosis of Alzheimer disease. Ann Intern Med. 2004;140:501–509
  5. Flacker JM, Kiely DK. Mortality-related factors and 1-year survival in nursing home residents. J Am Geriatr Soc. 2003;51:213–221
  6. Newcomer R, Covinsky KE, Clay T, et al. Predicting 12-month mortality for persons with dementia. J Gerontol B Psychol Sci Soc Sci. 2003;58:S187–S198
  7. Cohen-Mansfield J, Marx MS, Lipson S, et al. Predictors of mortality in nursing home residents. J Clin Epidemiol. 1999;52:273–280
  8. Muder RR, Brennen C, Swenson DL, et al. Pneumonia in a long-term care facility (A prospective study of outcome). Arch Intern Med. 1996;156:2365–2370
  9. Fine MJ, Stone RA, Singer DE, et al. Processes and outcomes of care for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team (PORT) cohort study. Arch Intern Med. 1999;159:970–980
  10. Mortensen EM, Kapoor WN, Chang CC, et al. Assessment of mortality after long-term follow-up of patients with community-acquired pneumonia. Clin Infect Dis. 2003;37:1617–1624
  11. Mehr DR, Binder EF, Kruse RL, et al. Predicting mortality in nursing home residents with lower respiratory tract infection: the Missouri LRI Study. JAMA. 2001;286:2427–2436
  12. van der Steen JT, Ooms ME, van der Wal G, et al. Withholding or starting antibiotic treatment in patients with dementia and pneumonia: prediction of mortality with physicians’ judgment of illness severity and with specific prognostic models. Med Decis Making. 2005;25:210–221
  13. van der Steen JT, Kruse RL, Ooms ME, et al. Treatment of nursing home residents with dementia and lower respiratory tract infection in the United States and the Netherlands: An ocean apart. J Am Geriatr Soc. 2004;52:691–699
  14. Kruse RL, Mehr DR, van der Steen JT, et al. Antibiotic treatment and survival of nursing home patients with lower respiratory tract infection: a cross-national analysis. Ann Fam Med. 2005;3:422–429
  15. Long-Term Care Facility Resident Assessment Instrument (RAI) User’s Manual: For Use With Version 2.0 of the Health Care Financing Administration’s Minimum Data Set, Resident Assessment Protocols, and Utilization Guidelines. Washington, DC: Health Care Financing Administration; 1995;
  16. van der Steen JT, Ooms ME, Adèr HJ, et al. Withholding antibiotic treatment in pneumonia patients with dementia: A quantitative observational study. Arch Intern Med. 2002;162:1753–1760
  17. Morris JN, Fries BE, Mehr DR, et al. MDS Cognitive Performance Scale. J Gerontol. 1994;49:M174–M182
  18. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40:373–383
  19. Steen JT van der, Mehr DR, Kruse RL, et al. Treatment strategy and risk of functional decline and mortality after nursing-home acquired lower respiratory tract infection: Two prospective studies in residents with dementia. Int J Geriatr Psychiatry Mar 6; [Epub ahead of print].
  20. Kruse RL, Mehr DR, Boles KE, et al. Does hospitalization impact survival after lower respiratory infection in nursing home residents?. Med Care. 2004;42:860–870
  21. van der Steen JT, Kruse R, Mehr D, et al. Decline after a lower respiratory tract infection in US and Dutch nursing home residents with dementia. Gerontologist. 2005;45:446;(Spec No 2)
  22. Alvarez-Fernandez B, Garcia-Ordonez MA, Martinez-Manzanares C, et al. Survival of a cohort of elderly patients with advanced dementia: Nasogastric tube feeding as a risk factor for mortality. Int J Geriatr Psychiatry. 2005;20:363–370
  23. Sands LP, Yaffe K, Lui LY, et al. The effects of acute illness on ADL decline over 1 year in frail older adults with and without cognitive impairment. J Gerontol A Biol Sci Med Sci. 2002;57:M449–M454
  24. Bula CJ, Ghilardi G, Wietlisbach V, et al. Infections and functional impairment in nursing home residents: a reciprocal relationship. J Am Geriatr Soc. 2004;52:700–706
  25. Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia: a review of the evidence. JAMA. 1999;282:1365–1370
  26. van der Steen JT, Ooms ME, Mehr DR, et al. Severe dementia and adverse outcomes of nursing home-acquired pneumonia: Evidence for mediation by functional and pathophysiological decline. J Am Geriatr Soc. 2002;50:439–448

 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

JAMDA
Volume 8, Issue 6 , Pages 396-403 , July 2007

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