At the end of the lives of the more than 5 million Americans with dementia approximately 70% of them will live in nursing homes. Common among these patients are recurrent infections and fever.

Erika D’Agata, M.D., M.P.H., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, studied 214 residents in 21 nursing homes with advanced dementia. Participant’s initial assessment began between 2003 and 2006, then examined every 3 months for a maximum of 18 months. During each evaluation antibiotic therapy was noted.

During the follow-up period:

•  Averaged 322 days.
• An average of 65% of the participants were given at least one course of antibiotics with the average being 4 courses of antibiotics.
• Approximately 46% of the participants died during the study.
• Of those patients who died 42% received antibiotics during the 2 week period before their death.
• Participants were 41% more likely to be given antibiotics intravenously before their death.

What is significant is that participants who died and received antibiotics 2 weeks before had an increase of usage by 42% when compared to their usage 6-8 weeks prior to their death. Because of the increase use of intravenous administration before death, D’Agata questions if this method may be more uncomfortable for patients with advanced dementia.

The researchers feel that extensive use of antimicrobials and pattern of antimicrobial management in advanced dementia raises concerns in respect to a patient’s treatment so near to the end of their life. They add that the increased use of antibiotics at the end of the patient’s life also increases the risk of development and spread of antimicrobial resistance in a nursing home setting.