Related Experiment Video
Updated: Apr 7, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Interventions Associated With the Management of Suspected Infections in Advanced Dementia
Elizabeth Yates1, Susan L Mitchell2, Daniel Habtemariam3
1University of Michigan Medical School, Ann Arbor, Michigan, USA.
Context:
Nursing 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.
Objectives:
To describe interventions used to manage suspected infections in advanced dementia and identify factors associated with greater intervention use.
Methods:
Residents 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.
Results:
A 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.
Conclusion:
NH 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.
Insights
Nursing home residents with advanced dementia often undergo invasive infection treatments. Advance directives may be beneficial for those prioritizing comfort, potentially reducing burdensome interventions.
Area of Science:
- Gerontology
- Infectious Diseases
- Palliative Care
Background:
- Residents in nursing homes with advanced dementia often experience suspected infections.
- Antimicrobial treatment is common, but evidence for bacterial infection is frequently lacking.
- The use of other interventions for suspected infections in this population is not well understood.
Purpose of the Study:
- To document the interventions used for suspected infections in advanced dementia patients.
- To identify factors associated with increased intervention use in these cases.
Main Methods:
- A 12-month observational study in 35 Boston nursing homes.
- Data collected on interventions such as blood draws, chest X-rays, urine samples, and hospital transfers.
- Mixed-effects regression analysis used to identify factors associated with intervention use.
Main Results:
- Over 72% of suspected infections involved at least one intervention.
- Hospital transfer occurred in 10.3%, blood draws in 43.3%, chest X-rays in 24.2%, and urine samples in 44.8%.
- Factors like black race, absence of a do-not-hospitalize order, not being on hospice, and specific suspected infection sources (respiratory, urine, fever of unknown origin) were linked to higher intervention rates.
Conclusions:
- Nursing home residents with advanced dementia frequently receive interventions for suspected infections.
- These interventions can be burdensome.
- Advance directives may be suitable for residents with comfort as their primary care goal to limit interventions.
Related Concept Videos
01:17Urinary Tract Infection IV: Nursing Management
01:29Endocarditis IV: Nursing Management
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...