UPLIFT Clinical Trial: Impact of Palliative Care Consults in Nursing Homes

Key Message : The UPLIFT-AD trial tested a palliative care consultation model for long-stay residents with moderate-to-advanced cognitive impairment within 16 nursing homes across 2 states. Assessment of symptoms post-intervention by nursing home staff shows a reduction in symptom burden.

Abstract:

Background: People living in nursing homes (NHs) have significant illness, functional limitations, and cognitive impairment. Despite documented needs, evidence-based palliative care (PC) supports are inconsistently available in this setting.

Objectives: The UPLIFT-AD trial evaluated a PC program aimed to reduce symptom burden among residents with cognitive impairment by building internal PC capacity (e.g., PC knowledge and practice) in NHs and external specialty PC consultation.

Methods: Sixteen NHs (8 in both Indiana and Maryland) participated in this modified stepped-wedge clinical trial. Residents with moderate-to-advanced cognitive impairment were enrolled. Prior to the start of the intervention, NH staff PC Leads were identified and trained; PC education for all staff was delivered. External PC specialists provided in-person consultations to residents screened as having PC needs throughout the 1-year intervention period. The primary outcome was frequency and intensity of residents’ symptoms over the past 30 days, measured at baseline and 12 months, using the modified End-of-Life in Dementia Comfort Assessment in Dying (EOLD-CAD) and End-of-Life in Dementia Symptom Management (EOLD-SM) instruments. Resident data were collected from NH staff and family members.

Results: The sample included 612 NH residents. At baseline, residents’ average age was 76; 61% were female; and 65% were White. Staff reported on outcomes for >95% of eligible residents at all timepoints; family were more difficult to reach (response rate ≈33%). Mean symptom burden reported by staff significantly decreased from baseline to 12 months (from 3.56 (SE = 0.24) to 3.08 (SE = 0.25); p<.001). Family members reported decreases too, but did not reach statistical significance (from 5.41 (SE = 0.25) to 4.89 (SE = 0.30); p= 0.094). Family reported higher symptom burden than staff on average.

Conclusions: The UPLIFT-AD trial shows that a PC program focused on specialty consultations in NHs lowers the symptom burden in residents with moderate-to-advanced cognitive impairment.

References: N/A