Abstract
Objectives
Widespread antimicrobial misuse among nursing home (NH) residents with advanced dementia
raises concerns regarding the emergence of multidrug-resistant organisms and avoidable
treatment burden in this vulnerable population. The objective of this report was to
identify facility and resident level characteristics associated with receipt of antimicrobials
in this population.
Design
Cross-sectional analysis of baseline data from the Trial to Reduce Antimicrobial use
in Nursing home residents with Alzheimer's disease and other Dementias (TRAIN-AD).
Setting and Participants
Twenty-eight Boston area NHs, 430 long stay NH residents with advanced dementia.
Measures
The outcome was the proportion of residents who received any antimicrobials during
the 2 months prior to the start of TRAIN-AD determined by chart review. Multivariable
logistic regression was used to identify resident and facility characteristics associated
with this outcome.
Results
A total of 13.7% of NH residents with advanced dementia received antimicrobials in
the 2 months prior to the start of TRAIN-AD. Residents in facilities with the following
characteristics were significantly more likely to receive antimicrobials: having a
full time nurse practitioner/physician assistant on staff [adjusted odds ratio (aOR)
3.02; 95% confidence interval (CI), 1.54, 5.94], fewer existing infectious disease
practices (eg, antimicrobial stewardship programs, established algorithms for infection
management) (aOR, 2.35; 95% CI 1.14, 4.84), and having fewer residents with severely
cognitively impaired residents (aOR 1.96; 95% CI 1.12, 3.40). No resident characteristics
were independently associated with receipt of antimicrobials.
Conclusions and Implications
Facility-level characteristics are associated with the receipt of antimicrobials among
residents with advanced dementia. Implementation of more intense infectious disease
practices and targeting the prescribing practices of nurse practitioners/physician
assistants may be critical targets for interventions aimed at reducing antimicrobial
use in this population.
Keywords
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Article info
Publication history
Published online: August 21, 2020
Footnotes
This research was supported by the NIH-NIA (Grant R37AG032982).
The funding sources for this study played no role in the design or conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
