Abstract
BackgroundPneumonia is a serious disease associated with mortality among patients with dementia. However, the reported frequency of pneumonia as a cause of death in patients with dementia varies, the reason for which has not been fully elucidated.MethodsWe conducted a systematic search in PubMed and the Cochrane Database of Systematic Reviews (inception to December 2016). Two authors independently determined the suitability of studies and potential bias and extracted the data. The primary outcome was frequency of pneumonia-associated death in patients with dementia. Stratified subgroup analysis was conducted among studies grouped according to type of mortality cause (immediate or underlying), information source of mortality cause (autopsy or death certificate), and study setting (clinic, hospital, or nursing home).ResultsWe included 7 studies reporting the cause of death among patients with dementia and 12 studies comparing the cause of death among patients with and without dementia. The frequency of pneumonia-associated death among 19 eligible studies was 29.69% (95% confidence interval [CI], 25.86–33.53). Those frequencies differed according to whether the source for information about cause of death was an autopsy confirmation (49.98%; 95% CI, 43.75–56.71) or death certificate (19.65%; 95% CI, 15.48–23.83) and according to whether the type of mortality cause was an indirect cause of death (13.96%; 95% CI, 9.42–18.51) or direct cause of death (44.45%; 95% CI, 29.81–50.10). The risk of pneumonia-associated death in patients with dementia was twice as high as among those without dementia (odds ratio, 2.15; 95% CI, 1.63–2.83; p < 0.001).ConclusionThe various frequencies of pneumonia-associated death in patients with dementia were associated with the information source, type of mortality cause, and study setting. Patients with dementia in the terminal stages urgently require careful clinical management of pneumonia, to maximize patient life expectancy and quality.
Highlights
Pneumonia is a primary cause of hospitalization and mortality, especially for older adults [1,2]
We included 7 studies reporting the cause of death among patients with dementia and 12 studies comparing the cause of death among patients with and without dementia
The frequency of pneumonia-associated death among 19 eligible studies was 29.69% (95% confidence interval [CI], 25.86–33.53). Those frequencies differed according to whether the source for information about cause of death was an autopsy confirmation (49.98%; 95% CI, 43.75–56.71) or death certificate (19.65%; 95% CI, 15.48–23.83) and according to whether the type of mortality cause was an indirect cause of death (13.96%; 95% CI, 9.42–18.51) or direct cause of death (44.45%; 95% CI, 29.81–50.10)
Summary
Pneumonia is a primary cause of hospitalization and mortality, especially for older adults [1,2]. Our previous study indicated that dementia was a risk factor for the occurrence of aspiration pneumonia in older adults [4]. The reported frequency of pneumonia-associated death among older adults with dementia varies, ranging from 12% to 70% [6,7,8,9,10,11,12,13]. We hypothesized that the frequency of pneumonia-associated death differ depending on the methods used to obtain information about the cause of death (autopsy or death certificate), types of mortality cause (immediate or underlying cause), study settings, and the subtypes of dementia investigated. The reported frequency of pneumonia as a cause of death in patients with dementia varies, the reason for which has not been fully elucidated
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