Healthcare Proxy Awareness of Suspected Infections in Nursing Home Residents with Advanced Dementia

• Autores: Jane L. Givens, Sara Spinella, Claire K. Ankuda, Erika D'Agata, Michele L. Shaffer, Daniel Habtemariam, Susan L. Mitchell
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 63, Nº. 6, 2015, págs. 1084-1090
• Idioma: inglés
• Enlaces
  • Texto completo
• Resumen

  • Objectives To determine healthcare proxy involvement in decision-making regarding infections in individuals with advanced dementia.

    Design Prospective cohort study.

    Setting Thirty-five Boston-area nursing homes (NHs).

    Participants NH residents with advanced dementia and their proxies (N = 362).

    Measurements Charts were abstracted monthly (up to 12 months) for documentation of suspected infections and provider–proxy discussions for each episode. Proxies were interviewed within 8 weeks of the infection to determine their awareness and decision-making involvement. Factors associated with proxy awareness and discussion documentation were identified.

    Results There were 496 suspected infections; proxies were reached for interview for 395 (80%). Proxy–provider discussions were documented for 207 (52%) episodes, yet proxies were aware of only 156 (39%). Proxies participated in decision-making for 89 (57%) episodes of which they were aware. Proxy awareness was associated with antimicrobial use (adjusted odds ratio (AOR) = 3.43, 95% confidence interval (CI) = 1.94–6.05), hospital transfer (AOR = 3.00, 95% CI = 1.19–7.53), infection within 30 days of death (AOR = 3.32, 95% CI = 1.54–7.18), and fewer days between infection and study interview (AOR = 2.71, 95% CI = 1.63–4.51). Discussion documentation was associated with the resident residing in a dementia special care unit (AOR = 1.71, 95% CI = 1.04–2.80), the resident not on hospice (AOR = 3.25, 95% CI = 1.31–8.02), more provider visits (AOR = 1.71, 95% CI = 1.07–2.75), proxy visits of more than 7 h/wk (AOR = 1.93, 95% CI = 1.02–3.67), and episode within 30 days of death (AOR = 3.99, 95% CI = 1.98–8.02).

    Conclusion Proxies are unaware of and do not participate in decision-making for most suspected infections that NH residents with advanced dementia experience. Proxy awareness of episodes and documentation of provider–proxy discussions are not congruent.