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Recurrent aspiration pneumonia in advanced dementia — SCE Acute Medicine MCQ

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HardMedicine in the elderlyRecurrent aspiration pneumonia in advanced dementiaSCE Acute Medicine

An 86-year-old man with advanced dementia is admitted from a nursing home with recurrent aspiration, fever and oxygen saturation 90% on air. He has severe frailty, is bedbound and has an advance care plan favouring comfort-focused care if seriously unwell. Chest radiograph shows right basal consolidation. His daughter asks whether hospital treatment can be avoided next time. What would you advise?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Review goals of care and consider an individualised plan for comfort-focused treatment in the care home

Recurrent aspiration in advanced dementia should prompt shared decision-making about goals of care, ceilings of treatment and where care is best delivered. Tube feeding does not reliably prevent aspiration in advanced dementia and may increase burden. The clinical pearl is that acute medicine includes recognising when treatment location and burden matter as much as diagnosis.

Reference: NICE NG97 dementia; GMC Treatment and care towards the end of life