The impact of inclusion in a palliative care program for patients with advanced dementia

Abstract

Background

Despite evidence, it remains unclear whether the inclusion of patients with advanced dementia (AD) in palliative care (PC) is beneficial. The aim of this study is to examine the impact of enrolment in a PC program on the subsequent clinical management of these patients.

Methods

A retrospective cohort study including patients with AD admitted between June 2022 and June 2025. Patients were classified into two groups: included in palliative care (PCU group) or not included (NO-PCU group). We compared the mean number of hospital care transitions, the proportion of invasive and/or life-sustaining treatments, and the total length of hospital stay. Outcomes were adjusted using negative binomial regression.

Results

298 patients were included, 149 assigned to each group, with 67% being female and a mean age of 88 years (SD 6.6). The mean number of hospital care transitions was 2.7 in the non-PCU group vs. 1.7 in the PCU group (p < 0.001). After adjustment for confounding, the effect remained significant: IRR 0.52 (95% CI: 0.49-0.54). Inclusion in the PCU group was associated with a significant reduction in interventional procedures -6%; 95% CI: −9.9% to -2.2%) and in the use of broad-spectrum antibiotics (mean difference: −0.7; p < 0.001). The total hospital length of stay was 30 days (95% CI: 22.7-37.3) in the PCU group vs 111 days (95% CI: 25.6-196.4) in the non-PCU group (p < 0.001).

Conclusion

Inclusion in a PC program for patients with AD is associated with lower rates of hospital care transitions and reduced use of invasive procedures.