We read with interest the article by Givens et al1 suggesting that antimicrobial treatment of suspected pneumonia episodes is associated with prolonged survival but not with improved comfort in nursing home (NH) residents with advanced dementia. We would first like to comment positively on the attention given to NHs and to the condition of patients living in these facilities. The discussion is relevant also in Italy, since the presence of patients with dementia in NHs is approximately 70%.2 However, we express some concerns about the methods and potential implications. The scales used to assess comfort among residents (ie, the Symptom Management at End-Of-Life in Dementia [SM-EOLD] and the Comfort Assessment in Dying with Dementia [CAD-EOLD] scales)3 are exclusively based on reports of caregivers, whose reliability may be questionable and possibly depend on individual education, cultural background, and general beliefs about end-of-life themes. It is very difficult to measure items such as depression, fear, and anxiety (all included in the SM-EOLD scale) in patients such as those in the study by Givens and colleagues.1 We recognize that the assessment of suffering is problematic in these patients, but we believe that an ideally reliable tool should not be left out of consideration in an objective assessment.
Rozzini R, Bellelli G, Trabucchi M. Antibiotic Treatment for Patients Affected by Severe Dementia and Pneumonia. Arch Intern Med. 2011;171(1):93. doi:10.1001/archinternmed.2010.486