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Ventilators questioned for dementia patients ‘near end’

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Use of ventilators can prolong the suffering of patients with advanced dementia towards the end of life, according to the authors of a long-term study.

The research, published in the journal JAMA Internal Medicine, examined more than 635,000 cases where patients with advanced dementia and severe impairments were admitted to hospital.

“It would be sad to think a vulnerable patient was admitted to ICU to fill a recently-built empty bed”

Vincent Mor

The 13-year study, spanning about 2,600 hospitals in the US, found the use of mechanical ventilation nearly doubled among this type of patient between 2000 and 2013. However, the one-year death rate remained above 80%.

The findings raise concerns about causing unnecessary suffering and the costs of care, said palliative care specialist and study co-author Dr Joan Teno.

“These findings call for new efforts to ensure the use of mechanical ventilation is consistent with patients’ care goals and their clinical condition,” she said.

A previous study co-written by Dr Teno, who is a professor of medicine, gerontology and geriatrics at the University of Washington School of Medicine, found 96% of relatives of similar patients wanted care to focus on comfort rather than keeping someone going.

The newly-published study involved dementia patients with an average age of 84 who had been in a nursing home for at least 120 days before going into hospital. The vast majority – 98% – were bedbound.

University of Washington; Brown University

Ventilators questioned for dementia patients ‘near end’

Source: University of Washington; Brown University

Joan Teno and Vincent Mor

The researchers found a link between the number of intensive care beds in a hospital and the use of mechanical ventilation – suggesting ventilation may be being employed simply because the equipment was available.

Over time, being admitted to a hospital that had increased its intensive care beds by 10 was linked to a 6% higher chance of a frail patient being put on a ventilator, the study found.

“While it is rarely known in advance that a treatment like mechanical ventilation in the ICU is futile for any given patient, it would be sad to think a vulnerable patient was admitted to ICU to fill a recently-built empty bed, which our data suggests may be happening,” said co-author Vincent Mor, professor of health services, policy and practice at the Brown University School of Public Health.

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