A recent study examined the prevalence of burdensome interventions in advanced dementia patients towards the end of their lives, as well as the differences between men and women.
Healthcare in older adults and senior persons is often a serious concern for medical researchers and professionals. The –care portion of the term is often just as perplexing to practitioners as are the physiological, medical aspects.
In persons with dementia, it is difficult to understand how treatment may affect one’s sense of wellbeing. Oftentimes, families and doctors alike are faced with ethical or moral predicaments that may be quite difficult to resolve.
One such instance is the point of transition, often in later stages of the ailment, of a person from their home to a care facility such as a nursing home. Many families today are faced with such a dilemma. Their acceptance of the severity of the condition is contrasted with the image of the person whom they love and, quite often, has taken care of them for most of their life.
Many such questions remain unanswerable, particularly through research, and require one to reach into inner resources: compassion, resilience, and, quite often, faith, and spirituality. As medicine becomes better at keeping us alive and healthy well into our golden years, predictions of a sharp rise in people with dementia can be daunting. In Canada, for instance, over 550,000 people are living with dementia as of 2016. This number is predicted to rise to over 900,000 by 2031.
With such a rise in the number of dementia patients, researchers are becoming more concerned with, not only understanding the causes or treatment options but also with the care of the terminally ill. In nursing homes, while residents with advanced dementia live a median period of 1.3 years, it is common for them to be subjected to certain interventions that may be deemed burdensome.
Interventions such as intravenous antibiotic administration, transitions between medical facilities, and physical restraints, can be particularly burdensome to patients. Questions often arise as to whether these are necessary, or whether these cause more harm than good, particularly in the last days of life.
While researchers cannot answer such questions yet, some have begun examining how such burdensome interventions are administered in the population. In a recent article published in JAMA Network Open, researchers in Canada have examined differences between men and women in the prevalence of such interventions.
The project included over 27,000 nursing home residents with advanced dementia, over two-thirds (71%) of which were women- a sample representative of the prevalence of dementia.
The results of the study showed that, in the last 30 days of life, one in ten residents visited an emergency department. Likewise, one in five were hospitalized, and one in seven died in acute care settings. In addition, one in four were put under physical restraints, while more than one in three were administered antibiotics.
Men were significantly more likely to receive such burdensome interventions than women are. Moreover, only a small portion of the sample saw palliative care professionals in the year before death. Yet, those who did were significantly less likely to experience end-of-life transitions of care facilities, as well as be administered antibiotics.
These results are in line with other research projects that outline the prevalence of burdensome interventions in patients with dementia towards their last days. Particularly significant are the results demonstrating sex-differences in such interventions. As these variations are poorly understood, this study sheds light on important issues that need to be more thoroughly investigated.
Written by Maor Bernshtein
Reference: Stall, N. M., Fischer, H. D., Fung, K., Giannakeas, V., Bronskill, S. E., Austin, P. C., … Rochon, P. A. (2019). Sex-Specific Differences in End-of-Life Burdensome Interventions and Antibiotic Therapy in Nursing Home Residents With Advanced Dementia. JAMA Network Open, 2(8). doi: 10.1001/jamanetworkopen.2019.9557
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