Pneumonia, Intake Problems, and Survival Among Nursing Home Residents With Variable Stages of Dementia in the Netherlands: Results From a Prospective Observational Study

Simone A. Hendriks, Martin Smalbrugge, Arianne B. Van Gageldonk-Lafeber, Francisca Galindo-Garre, Maarten Schipper, Cees M.P.M. Hertogh, Jenny T. Van Der Steen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: We explored how pneumonia and intake problems affect survival in nursing home residents in variable stages of dementia. Methods: In a longitudinal observational study (372 residents) with up to 3.5 years of follow-up, we examined relationships between dementia severity, the development of pneumonia, intake problems, and mortality using joint modeling, Cox models, and mediation analyses. Dementia severity was measured semiannually with the Bedford Alzheimer Nursing Severity-Scale (BANS-S). Results: The median BANS-S score at baseline was 13 (range, 7 to 28). Pneumonia occurred in 103 (28%) and intake problems in 126 (34%) of 367 residents with complete registration of pneumonia and intake problems. Compared with dementia severity, incident pneumonia and, even more so, incident intake problems were more strongly associated with mortality risk. Pneumonia and intake problems both mediated the relationship between more severe dementia and mortality. Discussion: Developing pneumonia and intake problems affects survival, and this is not limited to advanced dementia. The occurrence of pneumonia and intake problems are important signals to consider a palliative care approach in nursing home residents with dementia, and an active focus on advance care planning is needed. Future studies should investigate whether this is also relevant for patients in primary care.

Original languageEnglish
Pages (from-to)200-208
Number of pages9
JournalAlzheimer Disease and Associated Disorders
Volume31
Issue number3
DOIs
Publication statusPublished - 2017

Cite this

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title = "Pneumonia, Intake Problems, and Survival Among Nursing Home Residents With Variable Stages of Dementia in the Netherlands: Results From a Prospective Observational Study",
abstract = "Objectives: We explored how pneumonia and intake problems affect survival in nursing home residents in variable stages of dementia. Methods: In a longitudinal observational study (372 residents) with up to 3.5 years of follow-up, we examined relationships between dementia severity, the development of pneumonia, intake problems, and mortality using joint modeling, Cox models, and mediation analyses. Dementia severity was measured semiannually with the Bedford Alzheimer Nursing Severity-Scale (BANS-S). Results: The median BANS-S score at baseline was 13 (range, 7 to 28). Pneumonia occurred in 103 (28{\%}) and intake problems in 126 (34{\%}) of 367 residents with complete registration of pneumonia and intake problems. Compared with dementia severity, incident pneumonia and, even more so, incident intake problems were more strongly associated with mortality risk. Pneumonia and intake problems both mediated the relationship between more severe dementia and mortality. Discussion: Developing pneumonia and intake problems affects survival, and this is not limited to advanced dementia. The occurrence of pneumonia and intake problems are important signals to consider a palliative care approach in nursing home residents with dementia, and an active focus on advance care planning is needed. Future studies should investigate whether this is also relevant for patients in primary care.",
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author = "Hendriks, {Simone A.} and Martin Smalbrugge and {Van Gageldonk-Lafeber}, {Arianne B.} and Francisca Galindo-Garre and Maarten Schipper and Hertogh, {Cees M.P.M.} and {Van Der Steen}, {Jenny T.}",
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Pneumonia, Intake Problems, and Survival Among Nursing Home Residents With Variable Stages of Dementia in the Netherlands : Results From a Prospective Observational Study. / Hendriks, Simone A.; Smalbrugge, Martin; Van Gageldonk-Lafeber, Arianne B.; Galindo-Garre, Francisca; Schipper, Maarten; Hertogh, Cees M.P.M.; Van Der Steen, Jenny T.

In: Alzheimer Disease and Associated Disorders, Vol. 31, No. 3, 2017, p. 200-208.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Pneumonia, Intake Problems, and Survival Among Nursing Home Residents With Variable Stages of Dementia in the Netherlands

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AU - Hendriks, Simone A.

AU - Smalbrugge, Martin

AU - Van Gageldonk-Lafeber, Arianne B.

AU - Galindo-Garre, Francisca

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AU - Van Der Steen, Jenny T.

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N2 - Objectives: We explored how pneumonia and intake problems affect survival in nursing home residents in variable stages of dementia. Methods: In a longitudinal observational study (372 residents) with up to 3.5 years of follow-up, we examined relationships between dementia severity, the development of pneumonia, intake problems, and mortality using joint modeling, Cox models, and mediation analyses. Dementia severity was measured semiannually with the Bedford Alzheimer Nursing Severity-Scale (BANS-S). Results: The median BANS-S score at baseline was 13 (range, 7 to 28). Pneumonia occurred in 103 (28%) and intake problems in 126 (34%) of 367 residents with complete registration of pneumonia and intake problems. Compared with dementia severity, incident pneumonia and, even more so, incident intake problems were more strongly associated with mortality risk. Pneumonia and intake problems both mediated the relationship between more severe dementia and mortality. Discussion: Developing pneumonia and intake problems affects survival, and this is not limited to advanced dementia. The occurrence of pneumonia and intake problems are important signals to consider a palliative care approach in nursing home residents with dementia, and an active focus on advance care planning is needed. Future studies should investigate whether this is also relevant for patients in primary care.

AB - Objectives: We explored how pneumonia and intake problems affect survival in nursing home residents in variable stages of dementia. Methods: In a longitudinal observational study (372 residents) with up to 3.5 years of follow-up, we examined relationships between dementia severity, the development of pneumonia, intake problems, and mortality using joint modeling, Cox models, and mediation analyses. Dementia severity was measured semiannually with the Bedford Alzheimer Nursing Severity-Scale (BANS-S). Results: The median BANS-S score at baseline was 13 (range, 7 to 28). Pneumonia occurred in 103 (28%) and intake problems in 126 (34%) of 367 residents with complete registration of pneumonia and intake problems. Compared with dementia severity, incident pneumonia and, even more so, incident intake problems were more strongly associated with mortality risk. Pneumonia and intake problems both mediated the relationship between more severe dementia and mortality. Discussion: Developing pneumonia and intake problems affects survival, and this is not limited to advanced dementia. The occurrence of pneumonia and intake problems are important signals to consider a palliative care approach in nursing home residents with dementia, and an active focus on advance care planning is needed. Future studies should investigate whether this is also relevant for patients in primary care.

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