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End‐of‐life treatment decisions in nursing home residents dying with dementia in the Netherlands
Author(s) -
Hendriks Simone A.,
Smalbrugge Martin,
Deliens Luc,
Koopmans Raymond T. C. M.,
OnwuteakaPhilipsen Bregje D.,
Hertogh Cees M. P. M.,
Steen Jenny T.
Publication year - 2017
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.4650
Subject(s) - dementia , medicine , palliative care , long term care , nursing homes , severe dementia , end of life care , pneumonia , family medicine , gerontology , nursing , disease
Objective The objective was to describe end‐of‐life treatment decisions for patients dying with dementia in various stages of dementia in long‐term care facilities in the Netherlands with elderly care physicians responsible for treatment and care. Methods We present data collected in the nationally representative Dutch End of Life in Dementia study (2007–2011). Within 2 weeks after death, 103 physicians completed questionnaires about the last phase of life in 330 residents with dementia who resided in 1 of 34 participating long‐term care facilities. We used descriptive statistics. Results Advance directives were rare (4.9%). A minority was hospitalized (8.0%) in the last month (mainly for fractures) or received antibiotics (24.2%) in the last week (mainly for pneumonia). Four residents received tube feeding or rehydration therapy in the last week. In almost half of the residents (42.3%), decisions were made not to start potentially life‐prolonging treatment such as hospital transfer and artificial nutrition and hydration. In more than half of the residents (53.7%), decisions were made to withdraw potentially life‐prolonging treatment such as artificial nutrition and hydration and medication. Antibiotics were more frequently prescribed for residents with less advanced dementia, but otherwise there were no differences in treatment decisions between residents with advanced and less advanced dementia. Conclusions Physicians often withhold potentially burdensome life‐prolonging treatment in nursing home residents in all stages of dementia in the Netherlands. This suggests that the physicians feel that a palliative care approach is appropriate at the end of life in dementia in long‐term care. Copyright © 2016 John Wiley & Sons, Ltd. StartCopTextCopyright © 2016 John Wiley & Sons, Ltd.