PneuMonitor - Comfort and prognosis in patients with pneumonia and dementia

Many people in western countries currently die with dementia. In up to two-thirds of these patients, pneumonia is the terminal event. Earlier work has indicated severe suffering, along with under treatment of symptoms of the pneumonia. Comfort care is appropriate when death is near, but prognostication is difficult.

The PneuMonitor study examines whether suffering in patients with dementia and pneumonia can be reduced by the implementation of an evidence and consensus based practice guideline for optimal symptom relief. This practice guideline was developed using a Delphi study, and consists of a checklist that lists symptoms of pneumonia, observational instruments for dyspnea and pain, and the core guideline that provides information about treatments to relieve symptoms of pneumonia. Matched pairs of thirty-two nursing homes that participated in the study (matched by location, number of psycho geriatric beds and baseline DS-DAT scores) were randomly assigned (cluster-randomization) to the control (usual care) or the intervention group. Regular independent observations for discomfort, pain and respiratory difficulty are performed from diagnosis of pneumonia until cure or death (within 14 days) to examine suffering.

Implementation of a practice guideline for optimal symptom relief in Dutch nursing homes will reduce suffering in patients with dementia and pneumonia.

Outcomes discomfort, pain and respiratory difficulty and conciousness: observations (when possible) twice daily on the day of diagnosis pneumonia (day 0) and day 1. Daily from day 2 until day 10, and one last time on day 13 or 14 or 15. Survival: minimum 3 months, maximum 3.5 years.

A practice guideline for optimal symptom relief based on evidence and consensus among national and international experts.