A systematic review of distress due to pneumonia experienced by older people with end-stage dementia

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  • Hirahara Satoshi
    Tokyo Fureai Health Co-operative Kajiwara Clinic
  • Yamaguchi Yasuhiro
    Jichi Medical University Saitama Medical Center, Department of Respiratory Medicine
  • Yamanaka Takashi
    The University of Tokyo, Graduate School of Medicine, Department of Home Care Medicine
  • Hirakawa Yoshihisa
    Nagoya University Graduate School of Medicine, Department of Public Health and Health Systems
  • Miura Hisayuki
    National Center for Geriatrics and Gerontology, Department of Home Care and Regional Liaison Promotion

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Other Title
  • 末期認知症高齢者の肺炎の苦痛に関する系統的レビュー
  • マッキ ニンチショウ コウレイシャ ノ ハイエン ノ クツウ ニ カンスル ケイトウテキ レビュー

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<p>Aim: Many older people with end-stage dementia die of pneumonia, but the details of their distress have been unclear. The present study clarified the distress experienced by such individuals due to pneumonia.</p><p>Methods: We searched for literature corresponding to 5 clinical questions (CQs) concerning including "What distress is experienced by older people with end-stage dementia due to pneumonia (CQ1) ?" using a search formula with the Web version of the Central Medical Magazine, MEDLINE (STN)/EMBASE (STN), Cochrane Library, and extracted 604 articles. Forty-two articles corresponding to 5 CQs were extracted by primary screening using abstracts, and 17 articles were adopted after the secondary screening. A total of six articles corresponding to CQ1 were ultimately analyzed.</p><p>Results: Older people with end-stage dementia who died of pneumonia reported more discomfort and dyspnea than those who died of dehydration. Their main symptoms were respiratory symptoms, such as cough, sputum, and dyspnea, a fever and somnolence. Distress such as dyspnea and discomfort among older people with end-stage dementia recovering from pneumonia peaked on the day of the diagnosis. Furthermore, in older people with end-stage dementia dying of pneumonia, distresses began approximately one week before death and peaked on the day before death. A few days before death, several distressing symptoms, such as pain, dyspnea and restlessness/agitation, were often observed at the same time.</p><p>Conclusions: If older people with end-stage dementia contract pneumonia and die from it, attentive palliative care is needed to manage their severe discomfort, dyspnea and other sources of distress.</p>

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