Palliative Care for People With Moderate-Severe Dementia in the Community: Results of the In-Peace Trial

Abstract

Dementia care management programs in the community demonstrate some benefits. Study limitations include limited numbers of people living with dementia (PLWD) with advanced disease or from minoritized populations; lack of palliative care components; and limited success reducing health care utilization. IN-PEACE tested dementia care management integrated with palliative care for PLWD with moderate-severe disease in the community and their caregivers. 201 PLWD-caregiver dyads were randomized to either a dementia care coordinator (99) or usual care (102) and followed for 24 months. Outcomes were neuropsychiatric symptoms (NPI-Q severity) and symptom management (SM-EOLD) in PLWD; distress (NPI-Q distress) and depression symptoms (PHQ-8) in caregivers; and the combined measure of ED visits/hospitalizations. Outcomes were assessed quarterly. Separate mixed effects models were run for each symptom/distress measure and a zero-inflated Poisson model compared the mean number of ED/hospitalization events. Subgroup analyses were conducted based on baseline NPI-Q severity, sex, race, income, and health system. There were no statistically significant differences between groups in any symptoms or distress measures in PLWD or caregivers. PLWD receiving the intervention, however, had substantially fewer ED/hospitalization events (means 1.06 events versus 2.37, p < 0.007). The intervention reduced the proportion of PLWD who had one or more ED/hospitalization events (78.4% of controls vs. 50.5% of intervention, p < 0.001). The relative risk reduction was 35.6% for an event, absolute risk reduction 27.9%, and number needed to treat (NNT) of 3.6. PLWD with higher NPI-Q at baseline and Black PLWD experienced greater reductions in ED visit hospitalization events.