BACKGROUND AND OBJECTIVES: Alzheimer’s disease or related dementia are a major
cause of death in the United States. While effective interventions have been
developed to deliver palliative care to nursing home residents with ADRD, little
work has identified effective interventions to reach assisted living (AL)
residents with dementia.
RESEARCH DESIGN AND METHODS: 118 AL residents with dementia from 10 different
ALs in Florida participated. A pilot study using a cluster-randomized trial was
conducted, with six sites randomized to receive a palliative care educational
intervention for staff (N =23) to deliver care to residents; four sites were
usual care. The feasibility of the intervention was assessed by examining
recruitment, retention and treatment fidelity at 6 months. Cohen’s d statistic
was used to calculate facility level treatment effect sizes on key outcomes
(documentation of advance care planning discussions, hospice admission, and
documentation of pain screening).
RESULTS: The intervention proved feasible with high ratings of treatment
fidelity. The intervention also demonstrated preliminary evidence for efficacy
of the intervention, with effect sizes for the treatment group over .80 for
increases in documentation of ACP discussions compared to the control group.
Hospice admissions had a smaller effect size (.16) and documentation of pain
screenings had no effect.
DISCUSSION AND IMPLICATIONS: The pilot results suggest that the intervention
shows promise as a resource for educating and empowering AL staff on
implementing person-centered palliative care delivery to persons with dementia
in assisted living. a larger, fully powered randomized trial Is needed to test
for its efficacy.