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Severe Dementia and Adverse Outcomes of Nursing Home‐Acquired Pneumonia: Evidence for Mediation by Functional and Pathophysiological Decline
Author(s) -
Van Der Steen Jenny T.,
Ooms Marcel E.,
Mehr David R.,
Van Der Wal Gerrit,
Ribbe Miel W.
Publication year - 2002
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1046/j.1532-5415.2002.50108.x
Subject(s) - medicine , dementia , pneumonia , hazard ratio , aspiration pneumonia , odds ratio , mortality rate , cohort study , confidence interval , quartile , prospective cohort study , intensive care medicine , disease
OBJECTIVES: To assess whether the severity of dementia is related to unfavorable outcomes of nursing home‐acquired pneumonia and how this relationship is mediated. DESIGN: Prospective cohort study. SETTING: Psychogeriatric wards of 61 nursing homes in the Netherlands. MEASUREMENTS: Dementia severity and the possible mediators swallowing disturbance, aspiration, insufficient food intake, weight loss, and dehydration were measured and related to the following outcomes: death (rate), cure rate, and increase in discomfort at the onset of pneumonia. PARTICIPANTS: Demented patients (n = 374) treated with antibiotics for pneumonia. RESULTS: Dementia severity was independently related to death rate within the first week after pneumonia (hazard rate ratio = 3.0 for the most severely demented quartile versus the least demented quartile, 95% confidence interval (CI) = 1.1–8.3) and to 3‐month mortality (odds ratio (OR) = 2.5, 95% CI = 1.1–5.4). The latter relation was in part mediated by aspiration and weight loss (OR dementia severity adjusted for these mediators declined from 2.5 to 1.9, 95% CI = 0.8–4.3). Dementia severity was not related to cure rate within 2 weeks nor to an increase in discomfort after 3 days compared with before the pneumonia. CONCLUSION: The functional and pathophysiological consequences of progressive dementia account in part for increased 3‐month mortality after pneumonia. Mid‐term mortality is expected to be high only in the most severely demented patients and in less severely demented patients who aspirated or who lost weight. Implications for end‐of‐life decision‐making and effectiveness of preventive and curative interventions are discussed. J Am Geriatr Soc 50:439–448, 2002.