When to Use Antibiotics in Late-Stage Dementia

As people with dementia decline into the late stages, they are prone to infections. One frequent infection is pneumonia. If your loved one is suspected of developing pneumonia, you might be asked the question of if you want antibiotics administered. This question can surprise some families because they may assume that antibiotics are always used if an infection is identified. However, there are times when physicians might not recommend antibiotic treatment.

Some antibiotics are given as pills by mouth, while others are in the form of an injection (shot). The strongest type of antibiotics is typically administered intravenously (IV). Some of these IV antibiotics require frequent blood tests and hospitalization, although some nursing homes (including sub-acute rehab and long term care facilities) are able to provide IV antibiotics. Some people might even go home with IV antibiotics and have a nurse come regularly to assist in administering them.

Due to confusion in middle or later stage dementia, people with IVs may be more likely to be restrained (either physically or through strong tranquilizing medicines) since they may not understand the reason for the IV and attempt to pull it out.

A review of the research on antibiotics suggests that antibiotics may often be overused in advanced dementia. One study tracked nursing home residents with late-stage dementia and found that among those who died, more than 40 percent received antibiotics in the last two weeks of life, many of them intravenously.

Research suggests that decisions about treating pneumonia with antibiotics should depend on the goal of the care. A study comparing nursing home residents with advanced dementia found that antibiotics improved survival rates but decreased comfort rates. Thus, they suggested that for those with a goal of comfort care, antibiotics should either be withheld or only given orally, and for those with a goal of prolonging life, antibiotics should be aggressively administered.

But, do they really work? According to multiple studies, the success of antibiotics in the late stages of dementia for pneumonia is questionable. The Journal of American Medical Directors published a study that found that antibiotics, when used for people with dementia and respiratory infections such as pneumonia, extended life, but on average only by several days. These researchers pointed out the concern that antibiotics in late-stage dementia merely prolonged the dying process, rather than effectively treated the infection.

If your loved one is in a nursing home, you may be able to have IV antibiotics administered by an IV right at the facility. The benefit of this is that your loved one would not have to make the transition to an unfamiliar hospital environment. Some facilities have this capability, while others do not. Your family member may be able to take an oral (by mouth) antibiotic, but typically oral antibiotics are not as effective in fighting pneumonia in advanced dementia.

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

It can be helpful to ask your loved one questions about their medical preferences prior to a physical and mental decline so that you can have peace of mind, knowing that you're ensuring that 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 the time comes when you are unable to clearly make decisions by yourself.

You may find it uncomfortable to talk about using (or not using) antibiotics in the late stages of dementia. This hesitation is normal and understandable. However, remember that, by asking questions about the proposed treatment of your loved one, you are gaining an understanding of their options and about which medical choices help honor their medical preferences.

Please note that the information included on this website and linked to both on and from this site is not medical advice and is for guidance and information only. I have made every effort to report information that is medically accurate and scientifically researched, but this is not a substitute for care and guidance from a physician.