Pneumonia in Nursing Home Patients With Advanced Dementia: Decisions, Intravenous Rehydration Therapy, and Discomfort.

The study was observational, so it cannot show whether intravenous rehydration therapy changed discomfort. The study was not large enough to compare discomfort between treatment groups or over time. Discomfort was not assessed at the exact time of the decision, and the decision date was not recorded. The time between decisions and discomfort assessments varied, so the discomfort pattern around each decision is uncertain. Only nursing home patients in one Italian region were analysed, and physicians were on staff, so results may not apply to other settings. The analysis used only pneumonia decisions from a subset of enrolled patients. Fluid intake was not measured. Symptom-relieving medication was not fully captured, so comfort care may be underreported. Discomfort close to death could not be explored because fewer patients died. The analysis used only the first decision in patients who did not receive rehydration at baseline.

The authors declared no potential conflicts of interest. The work received financial support from the Associazione Cremonese per la Cura del Dolore-ONLUS, Italy, and one author received a career award from the Netherlands Organisation for Scientific Research.

Do not conclude that intravenous rehydration therapy relieves discomfort. Most patients also received antibiotics, discomfort was not measured at the exact time of the decision, and the study could not test whether rehydration affected discomfort.