Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers DOI

Greg A. Sachs,

Nina M. Johnson,

Sujuan Gao

et al.

JAMA, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 29, 2025

Care management benefits community-dwelling patients with dementia, but studies include few moderate to severe dementia or from racial and ethnic minority populations, lack palliative care, seldom reduce health care utilization. To determine whether integrated reduces symptoms, caregiver depression distress, emergency department (ED) visits hospitalizations compared usual in dementia. A randomized clinical trial of their caregivers enrolled March 2019 December 2020 2 sites central Indiana (2-year follow-up completed on January 7, 2023). Electronic record screening identified dementia; confirmed eligibility, including stage. The intervention consisted monthly calls a trained nurse social worker evidence-based protocols help manage patients' neuropsychiatric issues (eg, advance planning, hospice) (n = 99). Usual received written resource information clinicians 102). primary outcome was Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score (scores range 0-36, higher scores indicating worse patient symptoms). Secondary outcomes included Symptom Management End-of-Life Dementia scores, (Patient Health Questionnaire-8) distress (NPI-Q distress) combined ED hospitalization events. Outcomes were assessed quarterly for 24 months until death. total 201 dyads (patients 67.7% female; 43.3% African American; mean [SD] age, 83.6 [7.9] years); 3 withdrew 83 died over the course study, at least 90% eligible both groups completing each assessments. For vs groups, NPI-Q 9.92 9.41 baseline 9.15 9.39 months, respectively (between-group difference -0.24 [95% CI, -2.33 1.84]). There no significant rate change between time (P .87 group interaction). differences secondary outcomes, except that there fewer events (mean events/patient, 1.06 2.37 care; between-group difference, -1.31 -1.93 -0.69]; relative risk, 0.45 0.31 0.65]). Among caregivers, did not significantly improve symptoms through months. ClinicalTrials.gov Identifier: NCT03773757.

Language: Английский

Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers DOI

Greg A. Sachs,

Nina M. Johnson,

Sujuan Gao

et al.

JAMA, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 29, 2025

Care management benefits community-dwelling patients with dementia, but studies include few moderate to severe dementia or from racial and ethnic minority populations, lack palliative care, seldom reduce health care utilization. To determine whether integrated reduces symptoms, caregiver depression distress, emergency department (ED) visits hospitalizations compared usual in dementia. A randomized clinical trial of their caregivers enrolled March 2019 December 2020 2 sites central Indiana (2-year follow-up completed on January 7, 2023). Electronic record screening identified dementia; confirmed eligibility, including stage. The intervention consisted monthly calls a trained nurse social worker evidence-based protocols help manage patients' neuropsychiatric issues (eg, advance planning, hospice) (n = 99). Usual received written resource information clinicians 102). primary outcome was Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score (scores range 0-36, higher scores indicating worse patient symptoms). Secondary outcomes included Symptom Management End-of-Life Dementia scores, (Patient Health Questionnaire-8) distress (NPI-Q distress) combined ED hospitalization events. Outcomes were assessed quarterly for 24 months until death. total 201 dyads (patients 67.7% female; 43.3% African American; mean [SD] age, 83.6 [7.9] years); 3 withdrew 83 died over the course study, at least 90% eligible both groups completing each assessments. For vs groups, NPI-Q 9.92 9.41 baseline 9.15 9.39 months, respectively (between-group difference -0.24 [95% CI, -2.33 1.84]). There no significant rate change between time (P .87 group interaction). differences secondary outcomes, except that there fewer events (mean events/patient, 1.06 2.37 care; between-group difference, -1.31 -1.93 -0.69]; relative risk, 0.45 0.31 0.65]). Among caregivers, did not significantly improve symptoms through months. ClinicalTrials.gov Identifier: NCT03773757.

Language: Английский

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