N/A
N=7
Palliative Care for Persons With ADRD and CI in SNF
Advance Care Planning · Palliative Care · Skilled Nursing Facility · Cognitive Impairment
Bottom Line
View on ClinicalTrials.gov: NCT05308004 ↗Enrolled (actual)
7
Serious AEs
—
Results posted
Aug 2024
Primary outcome: Primary: Number of Participants That Completed Patient Quality of Life Survey — 4; 3; 3; 3 Participants
Study Design & Population
- Study type
- Interventional
- Phase
- N/A
- Interventions
- Palliative Care Consultation (Other)
- Age
- Adult, Older Adult · 60+ yrs
- Sex
- All
- Sponsor
- University of Maryland, Baltimore
- Primary completion
- Apr 2023
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Number of Participants That Completed Patient Quality of Life Survey |
4; 3; 3; 3 | — |
| SECONDARY Number of Participants That Completed Satisfaction With Care Survey (SWC-EOLD) |
4; 3; 3; 3 | — |
| SECONDARY Number of Participants That Completed the Symptom Management Survey (SM-EOLD) |
4; 3; 3; 3 | — |
Summary
Alzheimer's disease and related dementias (ADRD) are serious, life limiting illnesses with no known cure. Dementia is the fifth-leading cause of death in older adults and the majority of people with advanced dementia die in nursing homes (NHs). Miller et al reported that 40% of U.S. NH residents dying with advanced dementia received Skilled Nursing Facility (SNF) care in the last 90 days of life, and receipt of this care was associated significantly with poorer end-of-life outcomes, including a higher risk of dying in a hospital, compared to decedents with no SNF care. SNF care is a Medicare post-acute rehabilitation service delivered in NHs focused on intense rehabilitation and/or aggressive, disease-modifying therapies. Regardless of life expectancy, use of SNF care precludes access to Hospice services. Palliative care (PC) offers an evidence-based alternative.
Eligibility Criteria
KEY INCLUSION CRITERIA
Patients:
- Admitted for SNF post-acute care at a participating NHs following a recent hospitalization
- Age ≥ 60 years old
- Speaks English (if verbal)
- If non-verbal/unable to participate in a conversation and/or unable to make decisions, a legally authorized representative (LAR)/surrogate decision maker who can make decisions for the patient as determined by ACTs staff
- Documented ADRD diagnosis in the medical record or history of cognitive impairment (defined as BIMS score ≤ 12)
- At least one global indicator for PC at SNF admission (provider would not be surprised if patient died within 1 year, believes the patient would benefit from advance care planning or symptom management; frequent hospital or NH SNF admissions; complex care requirements; decline in function; feeding intolerance; unintended decline in weight; or previous hospice assessment or enrollment and subsequent discharge)
Surrogate/LAR:
- ≥18 years old
- Family member or friend of an eligible patient as determined by ACTs staff
- Speaks English
KEY EXCLUSION CRITERIA
Patients:
- Who have previously received or are referred for PC by their primary care team
- With a discharge plan within 48 hours of screening
- Currently receiving hospice care
- Who do not have one global indicator of need
- No documented ADRD diagnosis or history of cognitive impairment in the medical record
- That are non-English speaking, (if verbal)
- If unable to make decisions, do not have an LAR/surrogate decision maker.
Surrogate/LAR:
- < 18 years of age
- Not a family Member or friend of an eligible patient
- Non-English speaking
Data sourced from ClinicalTrials.gov (NCT05308004). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.