Hebrew SeniorLife researcher finds

More than 66 percent of residents with advanced dementia received at least one course of antibiotic therapy during an average of 322 days of follow-up. Among the 99 residents who died during the observation period, nearly 52 percent received at least one course of antibiotics within eight weeks of death, and 42% received antibiotics during the 2 weeks prior to death. As subjects approached death, the number of antibiotic therapy courses increased significantly.

This is the first comprehensive study to describe the quantity, type and pattern of antibiotics prescribed for advanced dementia patients. Earlier studies focused on the treatment of specific infections, such as pneumonia, or studied residents in only a single institution.

“Despite these differences,” the researchers say, “our study corroborates that antimicrobial agents are commonly prescribed in advanced dementia and extends these findings by a marked increase in antimicrobial use as death becomes imminent.”

In an accompanying editorial, two epidemiologists from Tel Aviv Medical Center in Israel argue that physicians must “consider every decision to use antibiotics in this population as we would decisions regarding other treatment modalities, including resuscitation and major surgery.” That is, physicians must determine if using these medications for specific patients justifies the risk placed on others by antimicrobial resistance. “We must challenge the assumptions that it is always acceptable to treat bacterial infection with antibiotics, and that deliberation is required only in the event that one wishes not to treat.”

Drs. Mitchell and D’Agata say their findings are a “first step” toward a better understanding of the public health risks posed by antibiotic resistance and that the development of programs and guidelines to reduce the use of antimicrobial agents in advanced dementia is warranted.

Scientists at the Institute for Aging Research conduct rigorous medical and social studies, leading the way in developing strategies for maximizing individuals’ strength, vigor and physical well-being, as well as their cognitive and functional independence, in late life. Hebrew SeniorLife is a 100+-year-old organization committed to maximizing quality of life of seniors through an integrated network of housing, health care, research and teaching programs, serving more than 4,000 seniors annually in the Greater Boston area.