Palliative Care for Persons With ADRD and CI in SNF

Trial details

Who runs it

University of Maryland, Baltimore

Trial code

NCT05308004

Record updated

2024. december 27.

Original description

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.Read full original descriptionShow less

Palliative Care Consultations for Persons With Alzheimer's Disease and Related Dementia and Cognitive Impairment in the Medicare Skilled Nursing Facility (SNF) Setting

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.

Inclusion: 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.

Exclusion: Who have previously received or are referred for PC by their primary care team; Currently receiving hospice care; No documented ADRD diagnosis or history of cognitive impairment in the medical record; < 18 years of age; Patients:; With a discharge plan within 48 hours of screening; Who do not have one global indicator of need; That are non-English speaking, (if verbal); If unable to make decisions, do not have an LAR/surrogate decision maker; Surrogate/LAR:; Not a family Member or friend of an eligible patient; Non-English speaking.

ClinicalTrials.gov NCT05308004