Discomfort in dementia patients dying from pneumonia and its relief by antibiotics

Discomfort in dementia patients dying from pneumonia and its relief by antibiotics

Abstract

Dementia patients frequently die after a pneumonia or prolonged intake problems. Maintaining comfort is a goal of palliative care in end-stage dementia. To compare discomfort in dementia patients dying after a pneumonia with patients dying after intake problems, and to assess associations with treatment, we combined 2 Dutch prospective studies. We selected 559 pneumonia patients and 166 patients with intake problems who had no pneumonia. Discomfort was observed with the Discomfort Scale – Dementia of Alzheimer Type (DS-DAT). Linear regression was performed with the dependent DS-DAT levels shortly before death in 314 patients who died within 2 weeks. Compared with discomfort in patients with intake problems, unadjusted and adjusted discomfort in patients with pneumonia was higher both at t 0 and before death. In adjusted analyses, antibiotic treatment (mostly oral) was associated with less discomfort before death (beta -1.1, CI -2.2 – -0.03), while invasive rehydration (received by only 8 patients) was associated with more discomfort (beta 3.5, CI 0.6 – 6.3). Death from pneumonia may cause great suffering in dementia patients. If confirmed in a study with different case mix and treatments, antibiotics may be used to decrease discomfort even when death is imminent.
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3 Responses

  1. Why should ‘any’ discomfort be allowed for a dementia patient recieving pallitive care?

    • Dan………excellent point. I suspect hospital personnel don’t consider pneumonia to be that discomforting.

  2. My mother has had alzheimers for 17 years. The doctor has recommended we stop feeding her. He said the alternative will be she will asperate and get pnemonia. My question is which will be less painful for my mother. Dying from pnemonia or dying from withholding food and fluid.

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