scholarly journals Antibiotic Use at the End-of-Life in Patients with Advanced Dementia: A Systematic Literature Review

2020 ◽  
Vol 41 (S1) ◽  
pp. s120-s120
Author(s):  
Alexandre Marra ◽  
Mireia Puig-Asensio ◽  
Eli Perencevich
Keyword(s):  
Literature Review ◽  
Cohort Studies ◽  
End Of Life ◽  
Systematic Literature Review ◽  
End Of Life Care ◽  
Final Analysis ◽  
Antibiotic Use ◽  
Life Care ◽  
Advanced Dementia ◽  
Days Of Therapy

Background: Improving the use of antibiotics across the care continuum will be necessary as we strive to protect our patients from antimicrobial resistance. One potential target for antimicrobial stewardship is during end-of-life care of patients with advanced dementia. We aimed to perform a systematic literature review measuring the burden of antibiotic use during end-of-life care in patients with dementia. Methods: We searched PubMed, CINAHL, and Embase through July 2019 for studies with the following inclusion criteria in the initial analysis: (1) end-of-life patients (ie, dementia, cancer, organ failure, frailty or multi-morbidity); (2) antibiotic use in the end-of-life care; with the final analysis restricted to (3) patients with advanced dementia. Only randomized controlled trials (RCTs) and cohort studies were included. Results: Of the 93 full-text articles, 17 studies (18.3%) met the selection criteria for further analysis. Most of the included studies were retrospective (n = 8) or prospective (n = 8) cohort studies. These studies in combination included 2,501 patients with advanced dementia. Also, 5 studies (698 patients, [27.9%]) were restricted to patients with Alzheimer’s disease. In 5 studies in which data were available, fewer than one-quarter of patients (19.9%, 498) with advanced dementia were referred to palliative care. In 12 studies >50% of patients received antibiotics during the end-of-life period. Also, 15 studies did not report the duration of antimicrobial therapy. Only 2 studies reported the antimicrobial consumption in days of therapy per 1,000 resident days. Only 6 studies studied whether the use of antibiotics was associated with beneficial outcomes (survival or comfort), and none of them evaluated potential adverse effects associated with antibiotic use. Conclusions: There are significant gaps in the literature surrounding antimicrobial use at the end of life in patients with advanced dementia. Future studies are needed to evaluate the benefits and harms of using antibiotics for patients during end-of-life care in this patient population.Acknowledgement. We thank Jennifer Deberg from Hardin Library for the Health Sciences, University of Iowa Libraries on the search methods.Disclosures: NoneFunding: None

Antibiotic use during end-of-life care: A systematic literature review and meta-analysis

2020 ◽  
pp. 1-7
Author(s):  
Alexandre R. Marra ◽  
Mireia Puig-Asensio ◽  
Erin Balkenende ◽  
Daniel J. Livorsi ◽  
Michihiko Goto ◽  
...  
Keyword(s):  
Literature Review ◽  
End Of Life ◽  
Systematic Literature Review ◽  
Meta Analysis ◽  
Antibiotic Use ◽  
Advanced Dementia ◽  
Inclusion Criteria ◽  
Number Of Patients ◽  
Days Of Therapy ◽  
Eol Care

Abstract Background: We performed a systematic literature review and meta-analysis measuring the burden of antibiotic use during end-of-life (EOL) care. Methods: We searched PubMed, CINAHL (EBSCO platform), and Embase (Elsevier platform), through July 2019 for studies with the following inclusion criteria in the initial analysis: antibiotic use in the EOL care patients (advanced dementia, cancer, organ failure, frailty or multi-morbidity). If the number of patients in palliative care consultation (PCC) was available, antibiotic use data were pooled to compare the proportion of patients who received antibiotics under PCC compared to those not receiving PCC. Random-effect models were used to obtain pooled mean differences, and heterogeneity was assessed using the I2 value. Results: Overall, 72 studies met the inclusion criteria and were included in the final review: 22 EOL studies included only patients with cancer; 17 studies included only patients with advanced dementia; and 33 studies included “mixed populations” of EOL patients. Although few studies reported antibiotic using standard metrics (eg, days of therapy), 48 of 72 studies (66.7%) reported antibiotic use in >50% of all patients. When the 3 studies that evaluated antibiotic use in PCC were pooled together, patients under PCC was more likely to receive antibiotics compared to patients not under PCC (pooled odds ratio, 1.73; 95% CI, 1.02–2.93). Conclusions: Future studies are needed to evaluate the benefits and harms of using antibiotics for patients during EOL care in diverse patient populations.

Rural end-of-life care from the experiences and perspectives of patients and family caregivers: A systematic literature review

2017 ◽  
Vol 31 (10) ◽  
pp. 895-912 ◽  
Author(s):  
Suzanne Rainsford ◽  
Roderick D MacLeod ◽  
Nicholas J Glasgow ◽  
Christine B Phillips ◽  
Robert B Wiles ◽  
...  
Keyword(s):  
Developing Countries ◽  
Literature Review ◽  
End Of Life ◽  
Family Caregivers ◽  
Systematic Literature Review ◽  
End Of Life Care ◽  
Community Support ◽  
Developed Countries ◽  
Life Care ◽  
Rural Patients

Background: End-of-life care must be relevant to the dying person and their family caregiver regardless of where they live. Rural areas are distinct and need special consideration. Gaining end-of-life care experiences and perspectives of rural patients and their family caregivers is needed to ensure optimal rural care. Aims: To describe end-of-life care experiences and perspectives of rural patients and their family caregivers, to identify facilitators and barriers to receiving end-of-life care in rural/remote settings and to describe the influence of rural place and culture on end-of-life care experiences. Design: A systematic literature review utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources: Four databases (PubMed, CINAHL, Scopus and Web of Science) were searched in January 2016, using a date filter of January 2006 through January 2016; handsearching of included article references and six relevant journals; one author contacted; pre-defined search terms and inclusion criteria; and quality assessment by at least two authors. Results: A total of 27 articles (22 rural/remote studies) from developed and developing countries were included, reporting rural end-of-life care experiences and perspectives of patients and family caregivers. Greatest needs were informational (developed countries) and medications (developing countries). Influence of rural location included distances, inaccessibility to end-of-life care services, strong community support and importance of home and ‘country’. Conclusion: Articulation of the rural voice is increasing; however, there still remain limited published rural studies reporting on patient and family caregivers’ experiences and perspectives on rural end-of-life care. Further research is encouraged, especially through national and international collaborative work.

scholarly journals Measuring Experience With End-of-Life Care: A Systematic Literature Review

2015 ◽  
Vol 49 (5) ◽  
pp. 904-915.e3 ◽  
Author(s):  
Jessica Penn Lendon ◽  
Sangeeta C. Ahluwalia ◽  
Anne M. Walling ◽  
Karl A. Lorenz ◽  
Oluwatobi A. Oluwatola ◽  
...  
Keyword(s):  
Literature Review ◽  
End Of Life ◽  
Systematic Literature Review ◽  
End Of Life Care ◽  
Life Care

The experience of providing end-of-life care to a relative with advanced dementia: An integrative literature review

2012 ◽  
Vol 11 (2) ◽  
pp. 155-168 ◽  
Author(s):  
Shelley C. Peacock
Keyword(s):  
Literature Review ◽  
End Of Life ◽  
Family Caregivers ◽  
End Of Life Care ◽  
Terminal Illness ◽  
Life Care ◽  
Advanced Dementia ◽  
Symptoms Of Depression ◽  
People With Dementia ◽  
End Stage

AbstractThe number of people with dementia is growing at an alarming rate. An abundance of research over the past two decades has examined the complex aspects of caring for a relative with dementia. However, far less research has been conducted specific to the experiences of family caregivers providing end-of-life care, which is perplexing, as dementia is a terminal illness. This article presents what is known and highlights the gaps in the literature relevant to the experiences of family caregivers of persons with dementia at the end of life. A thorough search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed databases from 1960 to 2011 was conducted. Ten studies were identified that specifically addressed the experience of family caregivers providing end-of-life care to a relative with advanced dementia. Common themes of these studies included: 1) the experience of grief, 2) guilt and burden with decision making, 3) how symptoms of depression may or may not be resolved with death of the care receiver, 4) how caregivers respond to the end-stage of dementia, and 5) expressed needs of family caregivers. It is evident from this literature review that much remains to be done to conceptualize the experience of end-of-life caregiving in dementia.

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