Greg A. Sachs, MD 

 reduces the frequency of emergency department visits.

“Our main outcome that we're most excited about was that we reduce the use of the emergency room or hospital by half in the intervention group compared to the usual care,” lead investigator Greg A. Sachs, MD, from Regenstrief Institute, told 

Sachs and colleagues conducted IN-PEACE (Indiana Palliative Excellence in Alzheimer Care Efforts), a randomized clinical trial assessing palliative care for neuropsychiatric symptoms among community-dwelling patients with moderate-to-severe dementia. Secondary outcomes included Symptom Management in End-of-Life Dementia scores, caregiver depression scores (via Patient Health Questionnaire-8), caregiver distress scores (NPI-Q distress), and combined emergency department and hospitalization events. Primary and secondary outcomes were assessed quarterly for 24 months, with the 2-year follow-up completed either by January 7, 2023, or death.

Patients with moderate to severe dementia and their caregivers were recruited between March 2019 and December 2020 from 2 cites in central Indiana, totaling 201 dyads. The mean age of patients was 83.6 years; 67.7% were female and 43.3% were African American.

Neuropsychiatric Inventory severity scores for patients receiving palliative care did not significantly change from baseline to 24 months (9.92 vs 9.15) compared with those receiving usual care (9.41 vs 9.39) (between-group difference at 24 months, -0.24; 95% confidence interval [CI], -2.33 to 1.84; 

The trial failed to meet its primary endpoint, with patients receiving insignificant improvement of neuropsychiatric symptoms through 24 months for individuals receiving palliative care for dementia compared with usual care.

“We were surprised that [palliative care] didn't have a bigger impact on symptoms, especially since some of the interventions we were using had previously been shown to reduce neuropsychiatric symptoms, such as agitation or psychotic features,” Sachs said.

Although these findings did surprise Sachs and his team, he reflected that this could be because patients already had low levels of neuropsychiatric symptoms at baseline. The neuropsychiatric levels stayed relatively low for both patients receiving palliative and usual care.

“We may have been attracting into our study people who were already doing relatively well with respect to some of the symptoms,” Sachs said.

The finding that palliative care for dementia cuts emergency department visits was particularly exciting for Sachs and colleagues. The study took place during the COVID-19 pandemic when people with dementia were getting hospitalized at a high rate, with a high mortality. Despite this, they were still able to reduce visits to the emergency department.

“[The findings] support the notion that we should be trying to do palliative care upstream from hospice, rather than waiting until the last weeks or months of life in hospice, which, by the way, is very difficult to prognosticate in patients with dementia, we're not very accurate figuring out when somebody's sort of within that 6-month zone,” Sachs said. “If we can have both palliative care specialists and primary care, incorporating more of this approach into ongoing care over the last few years of life, we think that it could provide the greatest benefit to patients and families.”

Disclosures for Sachs include Nova Nordisk Inc.

Sachs GA, Johnson NM, Gao S, Torke AM, Hickman SE, Pemberton A, Vrobel A, Pan M, West J, Kroenke K. Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers: The IN-PEACE Randomized Clinical Trial. JAMA. 2025 Jan 29. doi: 10.1001/jama.2024.25845. Epub ahead of print. PMID: 39878993.

Derman, C. Palliative Care for Dementia Cuts Emergency Department Visits, Hospitalizations. HCPLive. January 30, 2025. 

https://www.hcplive.com/view/palliative-care-dementia-cuts-emergency-department-visits-hospitalizations

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HCPLive spoke with Sachs about his study on palliative care for dementia, which reduced ED visits but didn’t significantly improve neuropsychiatric symptoms.

Greg A. Sachs, MD

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