Wendy K. Bodine
Assistant Editor

The findings of a study conducted by Harvard Medical School suggest that elderly patients with terminal advanced dementia are receiving too many antibiotics to help them fight off infections, and the results have sparked an ethical debate as to whether terminally-ill patients should be treated with antibiotics in their final days.

Some experts assert that the overuse of antibiotics in nursing homes and long-term care facilities could result in the development of “superbugs,” which are resistant to conventional treatment, in these environments. They also question whether treatment with antibiotics benefits these patients. The findings of the study were published in the February 25, 2008, issue of the Archives of Internal Medicine.

About 70% of the 5 million Americans who currently have dementia will spend their last days in a nursing home, where they are prone to experience an increase in infections and fevers due to their illness. “As the health of the patient deteriorates, infection becomes increasingly frequent. These episodes…are usually treated with antibiotics, but death often results nevertheless,” according to the authors of an editorial on the study, which appeared in the same issue of the journal.

The Harvard study found that about half of nursing home patients with advanced dementia receive antibiotics in the last 2 weeks of life, but what was not evident was whether these patients experienced any apparent benefits, such as extending life or improving the quality of life. Another concern raised was that of unpleasant side effects of the medicines experienced by the patients, such as pain from intravenous (IV) or intramuscular administration.

Researchers looked at data from 214 patients with advanced dementia in 21 nursing homes in the Boston area. All patients were unable to recognize loved ones, did not speak, were unable to walk or feed themselves, and were incontinent. These patients were observed for 18 months or until they died; 99 patients passed away during the study. The researchers found that 42% of those who died received antibiotics within 2 weeks of their deaths, many via IV.

Experts not involved in the study are divided in their views on the subject. One side argues that “people do recover from these infections,” and the antibiotics may buy the patients a few more days, weeks, or even months of life. The quality of that life, however, may not be what the patients or their families would want, according to the opposing view, and contend that these patients should be permitted a “dignified death” by allowing them to succumb to these infections. The study authors concurred that further investigation into the contribution of antibiotic administration to antimicrobial resistance in the nursing home setting is necessary.

For other articles in this issue, see:

Look Out Kids: Here Comes Another Shot

Heart Expert Defends Role as Lipitor Pitchman

USP <797> Finally Finalized for Sterile Compounding

FDA Clears Way for Educating About Off-label Therapies

Ohio Board Says Docs Still Muddle E-Rx's

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