RPD105 - Palliative Care Consultation Timing and Outcomes in Dementia Compared to Cancer and Other Chronic Conditions

Key Message : Patients with dementia received earlier palliative care than patients with other serious chronic diseases, excluding cancer. Despite more skilled nursing facility discharges, lower readmissions and in-hospital mortality, frailty rarely guided consultation timing. Integrating dementia- and frailty-informed referral strategies could enhance timely, equitable, and person-centered palliative care for this vulnerable population.

Abstract: Background/Rationale: Early palliative care (PC) improves outcomes, yet consultation timing and outcomes differ across serious illnesses. Little is known about how dementia compares with cancer, heart failure (HF), end-stage renal disease (ESRD), and multimorbidity (≥2 these conditions), or how frailty and demographics may influence consultation patterns.

Objectives/

Purpose: To compare PC consultation timing, demographics, and outcomes among hospitalized dementia patients versus other serious illnesses, and to identify predictors of timely consultation and explore whether frailty was routinely considered during consultation.

Methods/Approach: Retrospective cohort study of hospitalized adults receiving PC consultation across four Southeastern U.S. hospitals (2024–2025). Consultation timing was defined as early (≤24h), 24-72h, or late (>72h) from admission. Frailty was measured using an electronic Frailty Index (eFI)(1). Outcomes included consultation timing, discharge disposition, in-hospital mortality, 30-day readmission, hospice referral, and code status change. Multivariable logistic regression assessed predictors of timely consultation (≤72h).

Results: Amongst 13,450 hospitalized patients, we observed prevalences of: 30% HF, 28% cancer, 13% dementia, 2% ESRD, and 27% multimorbidity. Patients with dementia had earlier PC (20%) than ESRD (10%), HF (16%), or multimorbidity (18%), but less than cancer (25%, p< 0.001). Patients with dementia were primarily ≥80y (60%), female (59%), and Medicare insured (94%). They had the lowest in-hospital mortality (7.4%) and 30-day readmission (11%), yet highest rate of SNF discharge (42%). Hospice referral was higher in dementia (20%) than ESRD (12%) or HF (14%, p< 0.001). Older age was associated with timely consultation (65-79: aOR=2.04 [1.17-3.65]; 80+:aOR=2.10 [1.20-3.74] vs 18-64), while full code status associated with delayed consultation (aOR=0.7 [0.56-0.87]). Among patients ≥65y, frailty status was not associated with consultation timing (p=0.64).

Conclusion/Implications: Patients with dementia represent a distinct, clinically vulnerable PC population. Although they received earlier PC than most non-cancer groups, frailty was seldom used to guide timing, underscoring the need for dementia- and frailty-informed referral strategies.

References: 1. Pajewski NM, Lenoir K, Wells BJ, et al. Frailty screening using the
electronic health record within a Medicare accountable care organization. J Gerontol A Biol Sci Med Sci. 2019;74:1771-7. https://doi.org/10.1093/gerona/glz017