When nursing home residents with dementia or other cognitive impairments become ill with pneumonia, dehydration or other conditions, they are often sent to the hospital even though they could also receive appropriate care in the nursing home. In previous research Dr. Joan Teno and colleagues in public health have investigated these transitions. In a brief new report July 16 in the Journal of the American Medical Association, Teno reports that aggressive hospital care is not necessarily helping these seniors survive. Among a sample of 1.3 million cognitively impaired nursing home residents in federal records, survival among those who experienced two “burdensome transitions” within a year was much lower than among those who did not. Seniors without such transitions lived on for 476 days compared to only 95 days for those hospitalized at least twice for pneumonia, or 146 for those treated for urinary tract infections. “Nursing home residents with advanced cognitive impairment who underwent multiple hospitalizations for the same infections or dehydration had poor survival,” Teno and co-authors wrote. “The observed survival suggests that the first hospitalization with these diagnoses for [nursng home] residents with advanced cognitive impairment should result in reconsideration of the goals of care and the appropriateness of continued hospitalizations.”

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