New York Times (July 23, 2010): When Pneumonia Follows Dementia

Publication Date: 
Fri, 07/23/2010

The 323 residents living in Boston-area nursing homes had entered the final stages of dementia.

“They couldn’t recognize family members,” said the geriatrician and researcher Dr. Jane Givens. “They spoke fewer than six words. They were bed-bound.”

They couldn’t take sips of water without assistance; they’d become incontinent. Their average age was 86. And they’d developed pneumonia.

This is a common; at some point within their final three months, more than a third of patients with advanced dementia have pneumonia. The question, for families and medical professionals, is how to respond. If the patients receive antibiotics, the standard treatment for this infection, will they feel better? Live longer? Both? Neither?

A study conducted by Dr. Givens and her colleagues at the Hebrew SeniorLife Institute for Aging Research,  published in the most recent issue of the Archives of Internal Medicine, can help family members grapply with this complicated decision.  And they’ll have to, because most older people don’t have advance directives, and those with serious dementia can no longer speak for themselves.

It’s complicated, in part, because “people have a hard time understanding the course of the disease,” Dr. Givens said.