van der Steen Jenny T, Kruse Robin L, Ooms Marcel E, Ribbe Miel W, van der Wal Gerrit, Heintz Lawrence L, Mehr David R
Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, The Netherlands.
J Am Geriatr Soc. 2004 May;52(5):691-9. doi: 10.1111/j.1532-5415.2004.52204.x.
To compare treatment of nursing home residents with dementia and lower respiratory tract infection (LRI) in Missouri and the Netherlands.
Two separate but simultaneous prospective cohort studies.
Nursing homes in Missouri (n=36) and the Netherlands (n=61).
Selected residents (701 from Missouri and 551 from the Netherlands) diagnosed with LRI and dementia.
Treatment, dementia severity, symptoms and signs of LRI, and general health condition were recorded at the time of diagnosis of LRI. Death was monitored at follow-up. Treatment and mortality, stratified for dementia severity, are reported.
Treatment of nursing home-acquired LRI in Missouri residents involved a larger number of antibiotics, more frequent hospitalization, and greater use of intravenous antibiotics and rehydration therapy than in Dutch residents of equal dementia severity. Furthermore, for Missouri residents, intensive interventions were more often provided irrespective of severe dementia. By contrast, in both countries, treatments to relieve symptoms of LRI were provided for only a minority of residents. Dutch mortality rates were higher overall.
Care for U.S. nursing home residents with LRI and dementia is more aggressive than care for Dutch residents, particularly in residents with severe dementia. These results are relevant to the debate on optimal care in relation to curative or palliative treatment goals.
比较密苏里州和荷兰养老院中患有痴呆症和下呼吸道感染（LRI）的居民的治疗情况。
两项独立但同时进行的前瞻性队列研究。
密苏里州的36家养老院和荷兰的61家养老院。
选定的被诊断患有LRI和痴呆症的居民（701名来自密苏里州，551名来自荷兰）。
在诊断LRI时记录治疗情况、痴呆严重程度、LRI的症状和体征以及总体健康状况。随访期间监测死亡情况。报告按痴呆严重程度分层的治疗和死亡率。
与痴呆严重程度相同的荷兰居民相比，密苏里州居民的养老院获得性LRI治疗使用的抗生素更多、住院更频繁、静脉抗生素和补液治疗的使用更多。此外，对于密苏里州居民，无论痴呆严重程度如何，都更经常提供强化干预措施。相比之下，在这两个国家，只有少数居民接受了缓解LRI症状的治疗。荷兰的总体死亡率更高。
美国养老院中患有LRI和痴呆症的居民的护理比荷兰居民更积极，尤其是在患有严重痴呆症的居民中。这些结果与关于治疗性或姑息性治疗目标的最佳护理的辩论相关。
