[Treatment of @entity55 in nursing home residents with severe XXXX : for residents with poor prognosis, a more reserved approach in The Netherlands and more active treatment in the United States].

@entity1 @entity26 @entity303 @entity55
OBJECTIVE: To describe differences in the treatment of @entity55 and in the association of treatment with prognosis in Dutch and American nursing home @entity1 with late-stage @entity303 . Design. Prospective studies in The Netherlands and the American state of Missouri. METHOD: In 61 Dutch nursing homes and 36 in Missouri, severely demented @entity1 with @entity55 were included in the periods October 1996-July 1998 and August 1995-September 1998 respectively. Data was collected on their state of health, comorbidity, symptoms of @entity55 and treatment aspects such as antibiotic use, hospital admission and relief of symptoms. Comparisons were made between treatments in both countries and between groups of @entity1 with a similar probability of mortality within 2 weeks. RESULTS: A total of 328 Dutch and 280 American @entity1 were selected. Antibiotics were more frequently withheld in The Netherlands (in 33% of @entity1 ) than in Missouri (24%). Differences in antibiotic use were more pronounced in @entity1 with a poor prognosis (56% versus 15%). Dutch @entity1 were more frequently dehydrated but were less likely to receive rehydration therapy than American @entity1 , with a larger difference in @entity1 with a poor prognosis (2% versus 63%). Treatments to relieve symptoms that were provided more often in @entity1 with a poor prognosis (in 20-26%) were: @entity26 (both countries), and in The Netherlands also opiates, and hypnotics, sedatives or anxiolytics. CONCLUSION: In The Netherlands, curative treatment was frequently withheld in @entity1 with severe @entity303 and @entity55 , and even more frequently when the prognosis was poorer. Conversely, treatment in Missouri was more active in @entity1 with a poor prognosis. Despite more frequent palliative treatment goals in The Netherlands, treatments to relieve symptoms were provided infrequently and inconsistent with this approach. These insights may be helpful for decision-making in the treatment of @entity55 in @entity1 with severe @entity303 .
