In a study, researchers followed 214 residents with advanced dementia living in 21 Boston-area nursing homes for an average of 322 days. They found that 142 residents (66%) received at least one course of antibiotics in that period, with an average of four courses. Of the 99 residents who died in the study period, 42 (42%) received antibiotics in the 2 weeks preceding death.
The researchers report that "the proportion of residents taking antimicrobials was seven times greater in the last 2 weeks of life compared with 6 to 8 weeks before death." Thirty of 72 courses of antibiotics in the last 2 weeks of life (42%) were delivered I.V. rather than by mouth.
Researchers say this pattern of high antibiotic use at the end of life raises concerns about burdensome treatments for dying patients and may also increase the risk of antibiotic resistance in nursing homes. They call for development of programs to guide clinicians in the use of antibiotics for patients with advanced dementia.
D'Agata E, Mitchell SL, Patterns of antimicrobial use among nursing home residents with advanced dementia, Archives of Internal Medicine, February 25, 2008.