2008 Woodie Awards
Antibiotics Overused in Dementia Patients?
Sarah Westen
Issue date: 3/6/08 Section: Sci/Tech
A recent study, published in the February 25 issue of Archives of Internal Medicine has reported that almost half of nursing home patients with advanced dementia are given antibiotics in the last two weeks of life.
It is unclear whether or not antibiotic therapy has any benefits, such as improving the quality of life or prolonging life, said Serena Gordon, a reporter for HealthDay News. "And, of concern are the risks associated with antibiotic use, such as pain from intravenous antibiotics and unpleasant side effects, as well as the fact that frequent use of antibiotics in people with advanced dementia may help fuel the growing problem of antibiotic resistance," she added.
"Antibiotic exposure is extensive in nursing home residents with advanced dementia, and it increases as patients near death," said study lead author Dr. Erika D'Agata, an assistant professor of medicine a t Harvard Medical School. "We really need to determine if antibiotics should be given to patients at the end of life. Do they benefit from treatment?"
The study raises ethical questions about when it is acceptable to withhold perhaps futile treatment and let people die.
"Advanced dementia is a terminal illness," said study co-author Dr. Susan Mitchell, a senior scientist with the Harvard-affiliated Hebrew Senior Life Institute for Aging Research in Boston. "If we substituted 'end-stage cancer' for 'advanced dementia,' I don't think people would have any problem understanding this."
The Alzheimer's Association considers Alzheimer's disease and other dementias to be fatal brain diseases. Patients often die of infections such as pneumonia; however, the underlying cause of death is damage to brain cells.
About 70 percent of the 5 million Americans with dementia will end up in a nursing home at the end of their lives. Repeated infections and fevers are common at the end of life, according to background information in the study, HealthDay reported.
The authors of an accompanying editorial in the Archives of Internal Medicine journal, Dr. Mitchell Schwaber and Dr. Yehuda Carmeli, of the Tel Aviv Medical Center's division of epidemiology, said in an e-mail interview with HealthDay: "In general, in the population of severely demented elderly patients, as the health of the patient deteriorates, infection becomes increasingly frequent. According to common medical practice, these episodes of infection are usually treated with antibiotics, but death often results nevertheless."
It is unclear whether or not antibiotic therapy has any benefits, such as improving the quality of life or prolonging life, said Serena Gordon, a reporter for HealthDay News. "And, of concern are the risks associated with antibiotic use, such as pain from intravenous antibiotics and unpleasant side effects, as well as the fact that frequent use of antibiotics in people with advanced dementia may help fuel the growing problem of antibiotic resistance," she added.
"Antibiotic exposure is extensive in nursing home residents with advanced dementia, and it increases as patients near death," said study lead author Dr. Erika D'Agata, an assistant professor of medicine a t Harvard Medical School. "We really need to determine if antibiotics should be given to patients at the end of life. Do they benefit from treatment?"
The study raises ethical questions about when it is acceptable to withhold perhaps futile treatment and let people die.
"Advanced dementia is a terminal illness," said study co-author Dr. Susan Mitchell, a senior scientist with the Harvard-affiliated Hebrew Senior Life Institute for Aging Research in Boston. "If we substituted 'end-stage cancer' for 'advanced dementia,' I don't think people would have any problem understanding this."
The Alzheimer's Association considers Alzheimer's disease and other dementias to be fatal brain diseases. Patients often die of infections such as pneumonia; however, the underlying cause of death is damage to brain cells.
About 70 percent of the 5 million Americans with dementia will end up in a nursing home at the end of their lives. Repeated infections and fevers are common at the end of life, according to background information in the study, HealthDay reported.
The authors of an accompanying editorial in the Archives of Internal Medicine journal, Dr. Mitchell Schwaber and Dr. Yehuda Carmeli, of the Tel Aviv Medical Center's division of epidemiology, said in an e-mail interview with HealthDay: "In general, in the population of severely demented elderly patients, as the health of the patient deteriorates, infection becomes increasingly frequent. According to common medical practice, these episodes of infection are usually treated with antibiotics, but death often results nevertheless."
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