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Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers: The IN-PEACE Randomized Clinical Trial
Sachs GA, Johnson NM, Gao S, Torke AM, Hickman SE, Pemberton A, Vrobel A, Pan M, West J, Kroenke K. JAMA, 2025-03-18
Topic: Risk, prevention and care in population studies
Objective To determine whether integrated dementia palliative care reduces dementia symptoms, caregiver depression and distress, and emergency department (ED) visits and hospitalizations compared with usual care in moderate to severe dementia. Results A total of 201 dyads were enrolled (patients were 67.7% female; 43.3% African American; mean [SD] age, 83.6 [7.9] years); 3 dyads withdrew and 83 patients died over the course of the study, with at least 90% of eligible dyads in both groups completing each of the quarterly assessments. There was no significant difference in the rate of change in NPI-Q severity from baseline between groups over time (P = .87 for the group and time interaction). There were no significant differences in the secondary outcomes, except that there were fewer combined ED and hospitalization events in the dementia palliative care group (mean events/patient, 1.06 in dementia palliative care vs 2.37 in usual care; between-group difference, -1.31 [95% CI, -1.93 to -0.69]; relative risk, 0.45 [95% CI, 0.31 to 0.65]). Conclusions and relevance Among community-dwelling patients with moderate to severe dementia and their caregivers, dementia palliative care, compared with usual care, did not significantly improve patients' neuropsychiatric symptoms through 24 months.
Key findings
- Objective To determine whether integrated dementia palliative care reduces dementia symptoms, caregiver depression and distress, and emergency department (ED) visits and hospitalizations compared with usual care in moderate to severe dementia.
- Results A total of 201 dyads were enrolled (patients were 67.7% female; 43.3% African American; mean [SD] age, 83.6 [7.9] years); 3 dyads withdrew and 83 patients died over the course of the study, with at least 90% of eligible dyads in both groups completing each of the quarterly assessments.
- There was no significant difference in the rate of change in NPI-Q severity from baseline between groups over time (P = .87 for the group and time interaction).
- There were no significant differences in the secondary outcomes, except that there were fewer combined ED and hospitalization events in the dementia palliative care group (mean events/patient, 1.06 in dementia palliative care vs 2.37 in usual care; between-group difference, -1.31 [95% CI, -1.93 to -0.69]; relative risk, 0.45 [95% CI, 0.31 to 0.65]).
- Conclusions and relevance Among community-dwelling patients with moderate to severe dementia and their caregivers, dementia palliative care, compared with usual care, did not significantly improve patients' neuropsychiatric symptoms through 24 months.
Why it matters
Integrated dementia palliative care did not significantly improve patients' neuropsychiatric symptoms over 24 months compared with usual care, though there were fewer combined emergency department and hospitalization events. This is a null result for symptom improvement, with a possible benefit in reducing hospital use.
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Study details
- Study designRCT
- Participants201
- Effect sizeED visits + hospitalisations: RR 0.45 (95% CI 0.31-0.65); NPI-Q severity difference -0.24 (95% CI -2.33 to 1.84, not significant)
- Evidence strengthModerate
Limitations
Two sites in one US state; 83 of 201 patients died during follow-up; primary outcome was null so the hospitalisation benefit is a secondary finding.
How this study scored 77/100
Published in a top-tier journal, and it is a randomised controlled trial. We have no data on free to read, so that was left out: it earned 75 of the 98 points we could judge it on, which is 77 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 10 / 10 | Tier 1 — top-tier general journal (JAMA) |
| Journal's citation record | 4 / 4 | JAMA: journal h-index 1,011 (OpenAlex, 2026-10-29) |
| Study design | 11 / 12 | A randomised controlled trial |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 2 / 4 | 201 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 1 / 2 | Randomised (as stated in the record) |
| Times cited | 3 / 7 | Cited 27 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 9.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 5 / 6 | Cited 22.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 5 other studies in this library |
| Still being cited | 2 / 4 | Cited 27 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Kurt Kroenke: h-index 130 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Indiana University: institution h-index 926 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 39878993) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 75 / 98 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 75 of the 98 points we could judge it on is 77 out of 100. |
| Total | 77 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — PubMed Central lists this copy as free to read: the link above (checked 10 Oct 2026).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 10 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Sachs, G. A., Johnson, N. M., Gao, S., Torke, A. M., Hickman, S. E., Pemberton, A., et al. (2025). Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers: The IN-PEACE Randomized Clinical Trial. JAMA. https://doi.org/10.1001/jama.2024.25845
Vancouver
Sachs GA, Johnson NM, Gao S, Torke AM, Hickman SE, Pemberton A, et al. Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers: The IN-PEACE Randomized Clinical Trial. JAMA. 2025. doi:10.1001/jama.2024.25845. PMID: 39878993.
BibTeX
@article{sachs2025-39878993,
author = {Sachs, G. A. and Johnson, N. M. and Gao, S. and Torke, A. M. and Hickman, S. E. and Pemberton, A. and Vrobel, A. and Pan, M. and West, J. and Kroenke, K.},
title = {{Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers: The IN-PEACE Randomized Clinical Trial}},
journal = {JAMA},
year = {2025},
doi = {10.1001/jama.2024.25845},
pmid = {39878993},
url = {https://doi.org/10.1001/jama.2024.25845}
}
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