Stephen J.LurieMD, PhD, Senior EditorPhil B.FontanarosaMD, Executive Deputy Editor
To the Editor: Drs Morrison and Siu1 concluded that patients with advanced dementia and pneumonia had a higher 6-month mortality rate than cognitively intact patients. In this sample, patients with dementia were more likely to reside in nursing homes than cognitively intact patients. However, pneumonia in nursing homes is quite a different disease than that seen in the community. Klebsiella pneumoniae and Staphylococcus aureus are frequently isolated in nursing home patients, in contrast to such pathogens as Streptococcus pneumoniae and Haemophilus influenzae that are more common in community-dwelling patients.2,3 The mortality due to pneumonia may be more than twice as high in nursing home patients (40%) as in community patients (20%).2- 4 Therefore, the authors' results do not fully reflect the effect of dementia on mortality due to pneumonia.
Inoue K, Sawada M, Kawai S, Nakahara R, Sano H. Mortality From Pneumonia and Hip Fractures in Patients With Advanced Dementia. JAMA. 2000;284(19):2447. doi:10.1001/jama.284.19.2447-JLT1115-2-1