Healthcare professionals and surrogate decision-makers often face the challenging decision of whether to initiate or withhold antibiotics for people with dementia who have lost decisional capacity. A recent study, "Attitudes toward withholding antibiotics from people with dementia lacking decisional capacity: findings from a survey of Canadian stakeholders," provides valuable insights that can help practitioners navigate this complex terrain.
Key Findings
The study surveyed 1050 Quebec stakeholders, including senior citizens, family caregivers, nurses, and physicians, to assess their attitudes toward withholding antibiotics at different stages of dementia. The findings revealed that:
- Support for withholding antibiotics was high, ranging from 75% among seniors and caregivers at the advanced stage to 98% among physicians at the terminal stage.
- Religiosity and support for continuous deep sedation (CDS) and medical assistance in dying (MAID) were significant correlates of attitudes toward antibiotics.
Implications for Practice
The study underscores the importance of early discussions about end-of-life care goals and options with patients and their families. Here are some actionable steps for practitioners:
- Initiate Advance Care Planning (ACP): Start conversations about future care preferences early in the dementia trajectory. This helps patients make informed decisions and prepares surrogate decision-makers.
- Educate About Risks and Benefits: Clearly explain the risks, burdens, and benefits of antibiotic therapy and other end-of-life care options to patients and their families.
- Use Specific Documentation: Encourage the use of advance directives that explicitly address antibiotic therapy, especially given the high prevalence of infections in later stages of dementia.
- Provide Resources: Utilize educational tools like booklets to inform families about dementia progression, possible complications, and therapeutic options.
Encouraging Further Research
While this study provides valuable insights, it also highlights the need for ongoing research. Practitioners should stay updated on the latest findings and consider participating in or supporting further studies on this topic.
To read the original research paper, please follow this link: Attitudes toward withholding antibiotics from people with dementia lacking decisional capacity: findings from a survey of Canadian stakeholders.
