['The old man's friend': differences between The Netherlands and the United States with regards to decision-making for the treatment of pneumonia in nursing home patients with dementia].

Lower respiratory-tract infections are a leading cause of death in frail elderly patients. A comparative study of nursing home patients with dementia in The Netherlands and the United States found a difference in attitudes regarding the treatment of pneumonia. Specifically, treatment regimens were far more aggressive in the United States than in The Netherlands for patients with severe illness. Antibiotics were withheld in 56% of these patients in The Netherlands compared with 15% in the United States. Despite the different treatment approaches, adjusted mortality rates were similar. In The Netherlands, geriatricians and family members of patients with dementia have become aware of the potentially harmful effects of the aggressive treatment approaches that are often part of professional treatment protocols, particularly in patients for whom palliative care is more appropriate.