ABSTRACT
OBJECTIVE: The purpose of this study was to develop a statistical model for predicting short term survival in patients with dementia of the Alzheimer type (DAT). DESIGN: A prospective cohort study. SETTING: Three 25-bed intermediate medical care units using a structured approach to patient care management including palliative care options and patients from a second, traditional long-term care setting. PARTICIPANTS: Of 104 patients with advanced DAT monitored for 34 months, 68 patients (97% white male) who had at least one fever episode were included in the model development phase. Data from 71 additional DAT patients with at least one fever episode were used to test the statistical model. MAIN OUTCOME MEASURES: Six-month survival following a fever episode. RESULTS: Older age and higher severity of DAT at the time of the fever episode, palliative care, and hospital admission for long-term care within 6 months prior to the fever were found to be positively associated with likelihood of mortality within 6 months of the fever onset. Adjusted odds ratios for each of these variables were statistically significant. The model performed well in subsequent testing on an independent sample of patients. CONCLUSION: Results provide a formula which can be used to predict likelihood of dying within 6 months following onset of a fever in DAT patients. This statistical prediction is recommended for use in combination with clinical judgment to certify DAT patients for Medicare hospice coverage.
Subject(s)
Alzheimer Disease/mortality , Fever/mortality , Age Factors , Aged , Alzheimer Disease/complications , Alzheimer Disease/diagnosis , Anti-Bacterial Agents/therapeutic use , Female , Fever/complications , Fever/therapy , Geriatric Assessment , Hospice Care/standards , Humans , Length of Stay/statistics & numerical data , Logistic Models , Long-Term Care , Male , Mental Status Schedule , Middle Aged , Nursing Assessment , Predictive Value of Tests , Prognosis , Prospective Studies , Severity of Illness Index , Survival AnalysisABSTRACT
Fever episodes in 104 institutionalized patients with Alzheimer's disease were prospectively evaluated to determine the impact of antibiotic treatment on fever outcomes. During the 34-month observation period, 75 patients developed 172 episodes of fever and 29 patients had no fevers. Patients who developed fevers had more advanced disease than patients who did not. Patients who received diagnostic workup of all fevers and treatment with antibiotics (Antibiotic Group) were compared with patients who received comfort measures only (Palliative Group). The incidence of fever was similar in the Antibiotic and Palliative groups. Survival analysis revealed that, for the more severely affected patients, there was no difference in survival between the groups. Among less severely affected patients, survival was higher for the Antibiotic than the Palliative Group. These results suggest that treatment of fever with antibiotics does not alter the outcome of fever in patients with advanced Alzheimer's disease.
KIE: The object of this study was to compare the effectiveness of antibiotic treatment for fever with a palliative approach in a group of hospitalized patients with Alzheimer's disease. One hundred and four patients were divided into three groups, based on the occurrence of fever and on the treatment strategy used, and observed for 34 months. Those who developed fevers had more advanced disease than those who did not. The incidence of fever was similar for the antibiotic and palliative groups, and for the more severely demented patients in each group there was no difference in survival. Among less demented patients those who received antibiotics had a higher rate of survival than those who received palliative treatment. The authors suggest that these observations should be taken into account by health personnel and family members weighing the benefits and burdens of diagnostic workups and treatments in Alzheimer's patients with fevers.
