• Elizabeth Yates, Susan L Mitchell, Daniel Habtemariam, Alyssa B Dufour, and Jane L Givens.
• University of Michigan Medical School, Ann Arbor, Michigan, USA.
• J Pain Symptom Manage. 2015 Dec 1;50(6):806-13.

ContextNursing home (NH) residents with advanced dementia are commonly suspected of having infections. Most episodes are treated with antimicrobials, although evidence supporting bacterial infections is often lacking. The extent to which other interventions are used in managing suspected infections is unknown.ObjectivesTo describe interventions used to manage suspected infections in advanced dementia and identify factors associated with greater intervention use.MethodsResidents with advanced dementia who experienced suspected infections in 35 Boston NHs were followed for 12 months. Data describing interventions used in managing each episode were ascertained, including blood draws, chest radiographs, procurement of urine samples, and hospital transfers. Resident and episode characteristics associated with greater intervention use were identified using mixed model regression.ResultsA total of 240 residents experienced 496 suspected infections involving the following interventions: any, n = 360 (72.6%); hospital transfer, n = 51 (10.3%); blood draw, n = 215 (43.3%); chest radiograph, n = 120 (24.2%); and urine sample, n = 222 (44.8%). Factors associated with greater intervention use included black race (adjusted odds ratio [AOR] 3.19; 95% CI, 1.37-7.44); no do not hospitalize order (AOR, 1.83; 95% CI, 1.16-2.90); not on hospice (AOR, 5.41; 95% CI, 2.14-13.70); and suspected source being respiratory (AOR, 10.67; 95% CI, 4.99-22.80), urine (AOR, 15.79; 95% CI, 7.41-33.66) or fever of unknown source (AOR, 20.26; 95% CI, 8.42-48.73) vs. skin/soft tissue.ConclusionNH residents with advanced dementia frequently experience potentially burdensome interventions when suspected of having an infection. Advance directives to limit such interventions may be appropriate for residents whose goal of care is comfort.Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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