BURDENSOME INTERVENTIONS AND ANTIBIOTIC USE AMONG END-OF-LIFE NURSING HOME RESIDENTS WITH DEMENTIA
Bibliographic record
Abstract
Older nursing home residents with advanced dementia have limited life expectancies. These individuals often receive intensive medical care towards the end-of-life thereby incurring burdensome interventions and antimicrobials of questionable benefit. We aimed to describe the frequency, nature, and predictors of burdensome interventions and antimicrobials received by Ontario nursing home residents with advanced dementia during the last 30 days of life. A population-based retrospective cohort study was conducted using linked administrative records. Logistic regression was used to determine the patient and facility characteristics associated with receipt of burdensome interventions. We included 27,243 Ontario nursing home residents with advanced dementia who died between June 2010 and March 2015. The majority (71.1%) were women and the average age of death was 87.1 ± 7.2 years. Nearly half (46.8%) were dependent for their basic activities of daily living with 8.1% being totally bedbound. In the last 30 days of life, 21.8% were hospitalized, 8.9% visited an emergency department, and 9.8% received medical resuscitation. More than 1 in 3 (36.2%) were dispensed an antibiotic, and 86.6% of residents received a physical restraint. Male sex, fewer days in nursing home prior to death, and lower income were all independently associated with transfer to acute care and medical resuscitation, while palliative care consultation, bedbound status, and older age were negative predictors. We conclude that many older Ontario nursing home residents with advanced dementia receive burdensome interventions and antimicrobial agents at the end-of-life. The provision of care for these patients must align with their life expectancies and goals of care.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".