Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2019 Jan;57(1):10-19.
doi: 10.1016/j.jpainsymman.2018.10.494. Epub 2018 Oct 18.

Triggered Palliative Care for Late-Stage Dementia: A Pilot Randomized Trial

Laura C Hanson  1 , Christine E Kistler  2 , Kyle Lavin  3 , Stacey L Gabriel  4 , Natalie C Ernecoff  5 , Feng-Chang Lin  6 , Greg A Sachs  7 , Susan L Mitchell  8
Affiliations
Randomized Controlled Trial

Triggered Palliative Care for Late-Stage Dementia: A Pilot Randomized Trial

Laura C Hanson et al. J Pain Symptom Manage. 2019 Jan.

Abstract

Context: Persons with late-stage dementia have limited access to palliative care.

Objective: The objective of this study was to test dementia-specific specialty palliative care triggered by hospitalization.

Methods: This pilot randomized controlled trial enrolled 62 dyads of persons with late-stage dementia and family decision-makers on admission to hospital. Intervention dyads received dementia-specific specialty palliative care consultation plus postacute transitional care. Control dyads received usual care and educational information. The primary outcome was 60-day hospital or emergency department visits. Secondary patient- and family-centered outcomes were patient comfort, family distress, palliative care domains addressed in the treatment plan, and access to hospice or community-based palliative care. Secondary decision-making outcomes were discussion of prognosis, goals of care, completion of Medical Orders for Scope of Treatment (MOST), and treatment decisions.

Results: Of 137 eligible dyads, 62 (45%) were enrolled. The intervention proved feasible, with protocol completion ranging from 77% (family two-week call) to 93% (initial consultation). Hospital and emergency department visits did not differ (intervention vs. control, 0.68 vs. 0.53 transfers per 60 days, P = 0.415). Intervention patients had more palliative care domains addressed and were more likely to receive hospice (25% vs. 3%, P < 0.019). Intervention families were more likely to discuss prognosis (90% vs. 3%, P < 0.001) and goals of care (90% vs. 25%, P < 0.001) and to have a MOST at 60-day follow-up (79% vs. 30%, P < 0.001). More intervention families made decisions to avoid rehospitalization (13% vs. 0%, P = 0.033).

Conclusion: Specialty palliative care consultation for hospitalized patients with late-stage dementia is feasible and promising to improve decision-making and some treatment outcomes.

Trial registration: ClinicalTrials.gov NCT02719938.

Keywords: Dementia; palliative care; randomized trial.

PubMed Disclaimer

Conflict of interest statement

Financial Conflict of Interest Disclosure: None

Figures

Figure 1:
Figure 1:
Enrollment and Participant Flow
See this image and copyright information in PMC

References

    1. Reisberg B, Ferris SH, De Leon MJ et al. The global deterioration scale for assessment of primary degenerative dementia. Am J Psych 1982; 139:1136–1139 - PubMed
    1. Hebert LE, Weuve J, Scherr PA, Evans DA. Alzheimer disease in the United States (2010–2050) estimated using the 2010 census. Neurol 2013; 80:1778–1783. - PMC - PubMed
    1. Alzheimer’s Association. Latest Facts and Figures Report, 2018. https://www.alz.org/alzheimersdementia/facts-figures. Accessed July 12, 2018.
    1. Kelley AS, McGarry K, Fahle S, Marshall SM, Du Q, Skinner JS. Out-of-pocket spending in the last five years of life. J Gen Intern Med 2012; 28:304–309. - PMC - PubMed
    1. Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and meta-analysis. Alzheimers Dement 2013; 9(1):63–75. - PubMed

Publication types

Associated data