When to Use Antibiotics in Late-Stage Dementia

It used to be standard to give antibiotics to people with late-stage dementia because the disease makes infections—such as pneumonia—more common. Now, however, some doctors may recommend against antibiotics, believing the risks outweigh the benefits.

This article looks at when antibiotics should be used in people with late-stage dementia, how they're administered in different settings, and why it can help to have an advance directive.

Problems With Intravenous Antibiotics

A review of the research on antibiotics in late-stage dementia suggests they may often be overused.

The strongest antibiotics, which are often needed by people with dementia who have infections, are given intravenously. A healthcare provider inserts a needle that's connected to a bag and tube that deliver medication directly into the veins.

IVs are most often placed in the back of the hand and taped down to keep them from coming out. This can be uncomfortable or even painful.

Middle or later-stage dementia leads to confusion. When someone doesn't understand why they have an IV, they often try to pull it out. To prevent this, people are sometimes physically restrained or tranquilized. That adds to their discomfort and, much of the time, to confusion and fear.

One study tracked nursing home residents with late-stage dementia and found that among those who died, more than 40% received antibiotics in the last two weeks of life, many of them intravenously (IV).

Antibiotics and Goals of Care

Research suggests decisions about treating pneumonia with antibiotics should depend on the goal of care. A study of nursing home residents with advanced dementia found that antibiotics improved survival but decreased comfort.

Thus, they suggested that for those with a goal of comfort care, antibiotics should either be withheld or only given orally. However, for those with a goal of prolonging life, antibiotics should be aggressively administered.

But do antibiotics really help stave off infections like pneumonia? According to multiple studies, their success rate in late-stage dementia is questionable.

A study published in the Journal of American Medical Directors found that, in people with dementia and respiratory infections like pneumonia, antibiotics did extend their life, but only, on average, by a few days.

These researchers expressed concern that antibiotics in late-stage dementia merely prolong the dying process rather than effectively treating the infection.

Antibiotic Options

If you want to avoid IV antibiotics, you may be able to request them in pill or injectable forms. Keep in mind that oral and injected antibiotics are weaker than IV drugs and not as effective against pneumonia.

Some people, when faced with the decision of using or withholding antibiotics, might ask for palliative care or hospice care to assist them with the decision-making process and with meeting treatment goals for their loved one.

The Benefit of Advance Medical Directives

It can be helpful to ask your loved one questions about their medical preferences prior to a physical and mental decline so you can make sure their wishes are carried out. These wishes can be specified in a living will.

You can also identify someone to serve as your power of attorney for healthcare decisions. These documents can offer protection for you if you're ever unable to make or communicate your decisions.

Summary

Antibiotics are often given to people with late-stage dementia to treat or prevent infections like pneumonia. An IV may pose problems with this group, as people with dementia may be confused about why it's there and pull it out.

Research suggests IV antibiotics may be appropriate for someone with the goal of prolonging life. If someone is more concerned with comfort care, though, they may not be a good choice. Some studies suggest antibiotics in late-stage dementia only extend life by a few days.

You can request oral or injectable antibiotics if you want to avoid an IV. However, they may not be as effective.

An advance directive or living will can help you ensure you're managing treatment in the way your loved one wants.

A Word From Verywell

Whether to use or avoid antibiotics in late-stage dementia is one of many decisions you and your family may need to make on behalf of your loved one. The more questions you ask while they're still able to answer, the better you'll understand which medical choices honor their preferences.

If you're unsure whether to have IV antibiotics administered, talk to your loved one's healthcare team. They can help you gather the information you need to make a decision.