Treatment of Nursing Home Residents with Dementia and Lower Respiratory Tract Infection in the United States and the Netherlands: An Ocean Apart

Authors

  • Jenny T. Van Der Steen PhD,

    1. From the *Institute for Research in Extramural Medicine (EMGO Institute), Department of Nursing Home Medicine, and Department of Social Medicine, VU University Medical Center, Amsterdam, the Netherlands§Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MissouriDepartment of Philosophy, University of Hawaii at Hilo, Hilo, Hawaii.
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  • Robin L. Kruse PhD, MSPH,

    1. From the *Institute for Research in Extramural Medicine (EMGO Institute), Department of Nursing Home Medicine, and Department of Social Medicine, VU University Medical Center, Amsterdam, the Netherlands§Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MissouriDepartment of Philosophy, University of Hawaii at Hilo, Hilo, Hawaii.
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  • Marcel E. Ooms MD, PhD,

    1. From the *Institute for Research in Extramural Medicine (EMGO Institute), Department of Nursing Home Medicine, and Department of Social Medicine, VU University Medical Center, Amsterdam, the Netherlands§Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MissouriDepartment of Philosophy, University of Hawaii at Hilo, Hilo, Hawaii.
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  • Miel W. Ribbe MD, PhD,

    1. From the *Institute for Research in Extramural Medicine (EMGO Institute), Department of Nursing Home Medicine, and Department of Social Medicine, VU University Medical Center, Amsterdam, the Netherlands§Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MissouriDepartment of Philosophy, University of Hawaii at Hilo, Hilo, Hawaii.
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  • Gerrit Van Der Wal MD, PhD,

    1. From the *Institute for Research in Extramural Medicine (EMGO Institute), Department of Nursing Home Medicine, and Department of Social Medicine, VU University Medical Center, Amsterdam, the Netherlands§Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MissouriDepartment of Philosophy, University of Hawaii at Hilo, Hilo, Hawaii.
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  • Lawrence L. Heintz PhD,

    1. From the *Institute for Research in Extramural Medicine (EMGO Institute), Department of Nursing Home Medicine, and Department of Social Medicine, VU University Medical Center, Amsterdam, the Netherlands§Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MissouriDepartment of Philosophy, University of Hawaii at Hilo, Hilo, Hawaii.
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  • David R. Mehr MD, MS

    1. From the *Institute for Research in Extramural Medicine (EMGO Institute), Department of Nursing Home Medicine, and Department of Social Medicine, VU University Medical Center, Amsterdam, the Netherlands§Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MissouriDepartment of Philosophy, University of Hawaii at Hilo, Hilo, Hawaii.
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  • Supported by National Institute of Aging Grant AG18335 and by ZonMw Grant 1365.0006 / 98-10-008 (2000-42). The Dutch study was originally funded by the Dutch Ministry of Health, Welfare and Sport Grants 37851, 37852, 37853, and 37832 and the Society ‘Het Zonnehuis.’ The U.S. LRI study was originally funded by Agency for Healthcare Quality and Research Grant HS08551 and a Generalist Physician Faculty Scholars Award to Dr. Mehr from the Robert Wood Johnson Foundation.

Address correspondence to Dr. J. T. van der Steen, EMGO-instituut VU medisch centrum, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands. E-mail: j.vandersteen@vumc.nl

Abstract

Objectives: To compare treatment of nursing home residents with dementia and lower respiratory tract infection (LRI) in Missouri and the Netherlands.

Design: Two separate but simultaneous prospective cohort studies.

Setting: Nursing homes in Missouri (n=36) and the Netherlands (n=61).

Participants: Selected residents (701 from Missouri and 551 from the Netherlands) diagnosed with LRI and dementia.

Measurements: Treatment, dementia severity, symptoms and signs of LRI, and general health condition were recorded at the time of diagnosis of LRI. Death was monitored at follow-up. Treatment and mortality, stratified for dementia severity, are reported.

Results: Treatment of nursing home-acquired LRI in Missouri residents involved a larger number of antibiotics, more frequent hospitalization, and greater use of intravenous antibiotics and rehydration therapy than in Dutch residents of equal dementia severity. Furthermore, for Missouri residents, intensive interventions were more often provided irrespective of severe dementia. By contrast, in both countries, treatments to relieve symptoms of LRI were provided for only a minority of residents. Dutch mortality rates were higher overall.

Conclusion: Care for U.S. nursing home residents with LRI and dementia is more aggressive than care for Dutch residents, particularly in residents with severe dementia. These results are relevant to the debate on optimal care in relation to curative or palliative treatment goals.

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