Men With Advanced Dementia Face More Burdens in Nursing Homes Than Women

Nathan Stall, MD

New data suggests that men in nursing homes with advanced dementia are statistically more likely to experience burdensome interventions such as transitions of care, invasive procedures, and physical restraints than women.

A team of investigators, led by Nathan M. Stall, MD, of ICES in Toronto, examined 27,243 decedent nursing home residents from the Research Ethics Board of Sunnybrook Health Sciences Centre in Ontario with advanced dementia and evaluated the population-based frequency factors, and sex differences in burdensome interventions and antibiotic therapy.

There was a total of 19,363 women in the study, while less than 29% of the study population was comprised of men. The median age of the study’s population was 88.

Approximately 19% of the women in the study were hospitalized, while nearly 29% of men were hospitalized (P <.001). Also, 2433 residents had emergency department visits, 8.2% of the women and 10.8% of the men in the study (P <.001).

The investigators also found that 11.8% of women and 18.2% of men died in an acute care facility (P <.001) and invasive procedures such as mechanical ventilation (.6% for women and 1.2% for men) and physical restraint (28.3% for women and 30.4% for men).

A higher percentage of men (41.4%) received an antibiotic than women (34.1%).

The investigators also discovered that only a small number of residents in the study saw a palliative care physician in a year prior to their death, but those who did were significantly less likely to experience an end-of-life transition of care and to receive antibiotics.

“Only 3309 residents (12.1%; 2382 women [12.3%] vs 927 men [11.8%]) saw a palliative care physician in the year before death, but those who did experienced greater than 50% lower odds of an end-of-life transition of care (adjusted OR, .48; 95% CI, .43-.54); P&thinsp;<&thinsp;.001) and greater than 25% lower odds of receiving antibiotics (adjusted OR, .74; 95% CI, .68-.81; P&thinsp;<&thinsp;.001),” the authors wrote.

The investigators believe the study results prove that more sex-specific care is needed in nursing homes.

“In this study, many nursing home residents with advanced dementia, especially men, received burdensome interventions and antibiotics in their final days of life,” the authors wrote. “These findings appear to emphasize the need for sex-specific analysis in dementia research as well as the expansion of palliative care and end-of-life antimicrobial stewardship in nursing homes.”

People with advanced dementia generally have profound memory impairment, minimal verbal communication, the loss of ambulatory abilities, an inability to perform daily activities, and urinary fecal incontinence. Nursing home residents with advanced dementia, while commonly subjected to burdensome interventions, only have a median survival time of just 1.3 years.

While previous research has highlighted the burden of interventions for nursing home residents with advanced dementia, including transition of care, medications of questionable benefit, invasive procedures, and parenteral therapy and tube feeding, it has not integrated sex-specific analysis.

The study, “Sex-Specific Differences in End-of-Life Burdensome Interventions and Antibiotic Therapy in Nursing Home Residents With Advanced Dementia,” was published online in JAMA Geriatrics.