Table of ContentsView AllTable of ContentsIV AntibioticsGoals of CareAntibiotic OptionsAdvance Directives
Table of ContentsView All
View All
Table of Contents
IV Antibiotics
Goals of Care
Antibiotic Options
Advance Directives
It used to be standard to giveantibioticsto people with late-stagedementiabecause the disease makes infections—such aspneumonia—more common. Now, however, some doctors may recommend against antibiotics, believing the risks outweigh the benefits.
This article looks at when antibiotics should be used in people with late-stage dementia, how they’re administered in different settings, and why it can help to have an advance directive.
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Problems With Intravenous Antibiotics
A review of the research on antibiotics inlate-stage dementiasuggests they may often be overused.
IVs are most often placed in the back of the hand and taped down to keep them from coming out. This can be uncomfortable or even painful.
Middle or later-stage dementia leads to confusion. When someone doesn’t understand why they have an IV, they often try to pull it out. To prevent this, people are sometimes physicallyrestrainedor tranquilized.That adds to their discomfort and, much of the time, to confusion and fear.
One study tracked nursing home residents with late-stage dementia and found that among those who died, more than 40% received antibiotics in the last two weeks of life, many of them intravenously (IV).
Requirements of IV AntibioticsIV antibiotics generally require hospitalization and frequent blood tests. But somenursing homes, including sub-acute rehab and long-term care facilities, can provide them. If a person receives regular nurse visits, they might be able to have IV antibiotics at home.
Requirements of IV Antibiotics
IV antibiotics generally require hospitalization and frequent blood tests. But somenursing homes, including sub-acute rehab and long-term care facilities, can provide them. If a person receives regular nurse visits, they might be able to have IV antibiotics at home.
IV Fluids in Late-Stage Dementia
Antibiotics and Goals of Care
Research suggests decisions abouttreating pneumoniawith antibiotics should depend on the goal of care. A study of nursing home residents with advanced dementia found that antibiotics improved survival but decreased comfort.
Thus, they suggested that for those with a goal ofcomfort care, antibiotics should either be withheld or only given orally. However, for those with a goal of prolonging life, antibiotics should be aggressively administered.
But do antibiotics really help stave off infections like pneumonia? According to multiple studies, their success rate in late-stage dementia is questionable.
These researchers expressed concern that antibiotics in late-stage dementia merely prolong thedying processrather than effectively treating the infection.
Do People With Dementia Live Longer in Nursing Homes?
If you want to avoid IV antibiotics, you may be able to request them in pill or injectable forms. Keep in mind that oral and injected antibiotics are weaker than IV drugs and not as effective against pneumonia.
Some people, when faced with the decision of using or withholding antibiotics, might ask forpalliative careorhospice careto assist them with the decision-making process and with meeting treatment goals for their loved one.
Types of DementiaVascular dementiaAlzheimer’s diseaseLewy body dementiaWernicke-Korsakoff syndromeFrontotemporal dementia (Pick’s disease)Progressive supranuclear palsyHuntington’s disease
Types of Dementia
Vascular dementiaAlzheimer’s diseaseLewy body dementiaWernicke-Korsakoff syndromeFrontotemporal dementia (Pick’s disease)Progressive supranuclear palsyHuntington’s disease
The Benefit of Advance Medical Directives
It can be helpful to ask your loved one questions about their medical preferences prior to a physical and mental decline so you can make sure their wishes are carried out. These wishes can be specified in a living will.
You can also identify someone to serve as your power of attorney for healthcare decisions. These documents can offer protection for you if you’re ever unable to make or communicate your decisions.
Summary
Antibiotics are often given to people with late-stage dementia to treat or prevent infections like pneumonia. An IV may pose problems with this group, as people with dementia may be confused about why it’s there and pull it out.
You can request oral or injectable antibiotics if you want to avoid an IV. However, they may not be as effective.
An advance directive or living will can help you ensure you’re managing treatment in the way your loved one wants.
A Word From Verywell
Whether to use or avoid antibiotics in late-stage dementia is one of many decisions you and your family may need to make on behalf of your loved one. The more questions you ask while they’re still able to answer, the better you’ll understand which medical choices honor their preferences.
If you’re unsure whether to have IV antibiotics administered, talk to your loved one’s healthcare team. They can help you gather the information you need to make a decision.
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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Aloisi G, Marengoni A, Morandi A, et al.Drug prescription and delirium in older inpatients: Results from the Nationwide Multicenter Italian Delirium Day 2015-2016.J Clin Psychiatry. 2019 Mar 12;80(2):18m12430. doi: 10.4088/JCP.18m12430.
van der Steen JT, Di Giulio P, Giunco F.Pneumonia in nursing home patients with advanced dementia: Decisions, intravenous rehydration therapy, and discomfort.Am J Hosp Palliat Care. 2018;35(3):423–430. doi:10.1177/1049909117709002
van der Steen JT.Prolonged life and increased symptoms vs prolonged dying and increased comfort after antibiotic treatment in patients with dementia and pneumonia.Archives of Internal Medicine. 2011;171(1):93. doi:10.1001/archinternmed.2010.487
Givens JL, Kiely DK, Carey K, Mitchell SL.Healthcare proxies of nursing home residents with advanced dementia: Decisions they confront and their satisfaction with decision-making.Journal of the American Geriatrics Society. 2009;57(7):1149-1155. doi:10.1111/j.1532-5415.2009.02304.x
van der Steen JT, Lane P, Kowall NW, Knol DL, Volicer L.Antibiotics and mortality in patients with lower respiratory infection and advanced dementia.J Am Med Dir Assoc. 2012;13(2):156-161. doi:10.1016/j.jamda.2010.07.001
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