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Pneumonia: the demented patient's best friend? Discomfort after starting or withholding antibiotic treatment
van der Steen JT, Ooms ME, van der Wal G, Ribbe MW.. Journal of the American Geriatrics Society, 2002-10-01
Topic: Risk, prevention and care in population studies
Objectives To assess suffering in demented nursing home patients with pneumonia treated with antibiotics or without antibiotics. This study should provide the first empirical data on whether pneumonia is a "friend" or an "enemy" of demented patients and promote a debate on appropriate palliative care. Design Prospective cohort study. Setting Psychogeriatric wards of 61 nursing homes in the Netherlands. Participants Six hundred sixty-two demented patients with pneumonia treated with (77%) or without (23%) antibiotics. Measurements Using an observational scale (Discomfort Scale-Dementia of Alzheimer Type), discomfort was assessed at the time of the pneumonia treatment decision and periodically thereafter for 3 months or until death. (Thirty-nine percent of patients treated with antibiotics and 93% of patients treated without antibiotics died within 3 months.) Physicians also offered a retrospective judgment of discomfort 2 weeks before the treatment decision. In addition, pneumonia symptoms were assessed at baseline and on follow-up. Linear regression was performed with discomfort shortly before death as an outcome. Results A peak in discomfort was observed at baseline. Compared with surviving patients treated with antibiotics, the level of discomfort was generally higher in patients in whom antibiotic treatment was withheld and in nonsurvivors. However, these same patients had more discomfort before the pneumonia. Breathing problems were most prominent. Shortly before death from pneumonia, discomfort increased. Discomfort was higher shortly before death when pneumonia was the final cause of death than with death from other causes. Conclusion Irrespective of antibiotic treatment, pneumonia causes substantial suffering in demented patients. Adequate symptomatic treatment deserves priority attention.
Key findings
- Results A peak in discomfort was observed at baseline.
- Compared with surviving patients treated with antibiotics, the level of discomfort was generally higher in patients in whom antibiotic treatment was withheld and in nonsurvivors.
Study details
- Study designcohort study
- Evidence strengthModerate
How this study scored 52/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 30 of the 58 points we could judge it on, which is 52 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2002 — older than 20 years, still counted |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 12366622) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 30 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 30 of the 58 points we could judge it on is 52 out of 100. |
| Total | 52 / 100 | — |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
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APA 7th
van der Steen, J. T., Ooms, M. E., van der Wal, G., & Ribbe, M. W. (2002). Pneumonia: the demented patient's best friend? Discomfort after starting or withholding antibiotic treatment. Journal of the American Geriatrics Society. https://doi.org/10.1046/j.1532-5415.2002.50460.x
Vancouver
van der Steen JT, Ooms ME, van der Wal G, Ribbe MW. Pneumonia: the demented patient's best friend? Discomfort after starting or withholding antibiotic treatment. Journal of the American Geriatrics Society. 2002. doi:10.1046/j.1532-5415.2002.50460.x. PMID: 12366622.
BibTeX
@article{vandersteen2002-12366622,
author = {van der Steen, J. T. and Ooms, M. E. and van der Wal, G. and Ribbe, M. W.},
title = {{Pneumonia: the demented patient's best friend? Discomfort after starting or withholding antibiotic treatment}},
journal = {Journal of the American Geriatrics Society},
year = {2002},
doi = {10.1046/j.1532-5415.2002.50460.x},
pmid = {12366622},
url = {https://doi.org/10.1046/j.1532-5415.2002.50460.x}
}
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