IN-PEACE, which provides palliative care integrated with state-of-the-art dementia care to patients with dementia and their caregivers, cut in half the number of emergency department visits and hospitalisations of study participants. African American individuals and those with lower incomes benefited the most in reduction of use of these medical facilities.

A decrease of 50% in emergency department visits and hospitalisations has the potential to greatly benefit millions of patients and caregivers by keeping individuals with dementia at home and out of these settings where they often develop complications and decline in function. Reduction of use of these facilities also conveys cost savings to the health care system.

"Palliative Care Program for Community-Dwelling Individuals with Dementia and Caregivers: The IN-PEACE Randomised Clinical Trial" is published in JAMA.

The IN-PEACE, an acronym for Indiana Palliative Excellence in Alzheimer Care Efforts, randomised clinical trial is believed to be the first study to explicitly combine palliative and dementia care for individuals living, typically with family caregivers, at home rather than in a nursing home.

Participants in both arms of IN-PEACE were older, frailer and experienced more severe Alzheimer's disease or other dementias than many individuals who have participated in previously developed dementia management programs.

Patient and family participants in the intervention arm of the IN-PEACE study received monthly check-ins via telephone for up to two years from an experienced, highly trained nurse or social worker to help caregivers manage a number of concerns including patients' neuropsychiatric symptoms, caregiver distress and palliative care issues such as advance care planning and referral to hospice. Education and communication skills were emphasised in this innovative supportive care model.

Regular contact enabled problems to be tackled with advice and coaching to help prevent escalation to an emergency room visit or hospitalisation. Those in the usual care arm of the study were given publicly available educational material from the Alzheimer's Association and other sources but did not receive care manager support. Emergency department visits and hospitalisations did not decline in the usual care group.

"With IN-PEACE we built upon decades of design and implementation of seminal dementia care management programs by Regenstrief Institute and Indiana University brain care experts to novelly graft our expertise in palliative care to dementia care, combining formerly separate lines of work," said Greg A. Sachs, M.D., of Regenstrief Institute and the Indiana University School of Medicine, who led the IN-PEACE study.

"Typically, if patients with dementia receive palliative care they receive it very late in the course of their illness, sometimes not until they enrol in hospice in the last weeks or months of life.

"We pushed palliative care further upstream so that people could be receiving it for months to years, providing robust support to both the patient and the family and enabling them to better manage without having to go to the emergency department or the hospital.

"While we were pleased with the dramatic cut in emergency department visits and hospitalisations, we did not see a decrease in neuropsychiatric symptoms such as depression or anxiety, which we had hoped to find in the patients in our study.

"This may be because the IN-PEACE care managers were available to promptly address patients' changes in condition and suggest options other than going to an ED or a hospital, or because our patient population had a low burden of symptoms or both.

"More than 40% of patients and of caregivers in our study were African American, a significantly higher percentage than in many other dementia studies. IN-PEACE provided access to resources to individuals who typically wouldn't receive this kind of care and they benefited the most.

"Many studies describe health disparities; IN-PEACE actually made a difference."

Additional information on IN-PEACE study participants:

"Our findings indicate that for every 100 persons with advanced dementia being cared for at home, IN-PEACE could lead to 59 fewer hospitalisations and 72 fewer emergency department visits over a two-year period," said study senior author Kurt Kroenke, M.D., of Regenstrief Institute and IU School of Medicine.

"This would not only decrease the burden of these events for patients and caregivers but also enough cost savings to more than pay for the program."

The Centers for Medicare and Medicaid Services' new Guiding an Improved Dementia Experience (GUIDE) payment model provides health systems and medical practices with financial resources to provide the kind of comprehensive management of patients and support for caregivers that the IN-PEACE model addresses.

More information: Greg A. Sachs et al, Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers, JAMA (2025). DOI: 10.1001/jama.2024.25845