Triggered Palliative Care for Advanced Dementia

Alzheimer's disease and related dementias affect 5 million Americans at an annual cost of
$215 billion. Dementia is a contributing cause for 1 in 3 deaths, and is the only major cause
of death with no effective prevention or treatment. Dementia-specific palliative care is
needed to address the unique symptoms and treatment decisions relevant to this disease.

Investigators therefore propose to develop and pilot test a model of palliative care
consultation for advanced dementia patients, triggered by hospitalization for a serious acute
illness. After systematic refinement of operational protocols and tools with stakeholders,
they will enroll persons with advanced dementia plus an acute illness associated with high
risk of death in the coming year. Patients will be enrolled with their family decision-makers
(N=60 dyads) in a randomized feasibility trial. Intervention dyads will receive specialty
palliative care consultation during hospital admission, plus post-discharge collaborative
care by their outpatient primary care provider and a palliative care nurse practitioner.
Control dyads will receive usual care.

The research objective is to generate preliminary data for a large multi-site randomized
controlled trial of a model of palliative care consultation for advanced dementia.

Specific aims are:

Aim 1: To develop a best-practice model of palliative care consultation for advanced dementia
triggered by hospital admission for serious acute illness.

Aim 2: To conduct a pilot randomized trial of triggered palliative care consultation for
advanced dementia (versus usual care) to demonstrate the feasibility of conducting a larger
randomized trial.

Inclusion Criteria:

- Diagnosis of dementia from Alzheimer's or other underlying cause

- Global Deterioration Scale (GDS) Stage 5, 6 or 7

- acute illness hospitalization

Exclusion Criteria:

- No English-speaking family decision-maker

- Primary physician expects study to be too stressful for family caregiver