{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:43:32Z","timestamp":1785545012605,"version":"3.56.0"},"reference-count":52,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Aging"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Many clinically relevant aspects of health are expressed through behavior, affect, and interaction, and therefore rely on observation rather than instrumental measurement; yet such information is often documented infrequently in routine care. Dementia, and particularly behavioral and psychological symptoms of dementia (BPSD), is a relevant case because symptoms fluctuate across time and context. Little is known about how structured daily symptom assessment can be integrated into routine dementia care practice.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This pilot study aimed to investigate whether structured daily observation of BPSD, supported by digital documentation, can be incorporated into everyday residential dementia care.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A convergent mixed methods design was applied across 4 nursing home units in southern Sweden. Feasibility was operationalized through 4 focus areas (implementation, practicality, acceptability, and integration), with adherence to the registration routine as the primary feasibility outcome. Quantitative data comprised structured registrations collected daily by care staff over 90 days for 8 residents with BPSD, analyzed descriptively, and interpreted using selected NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework domains to contextualize variation in symptom patterns, adherence, and registration practices. Semistructured dyadic interviews were analyzed using deductive content analysis guided by the same domains, with integration occurring at the analytical and interpretive stages.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 21,993 item-level registrations were completed: 19,123 NPI-NH (Neuropsychiatric Inventory \u2013 Nursing Home version) symptom ratings, recorded across 1623 shift registrations (1 per resident per shift), and 2870 individually selected variables. Overall adherence to the registration routine averaged 75% across shifts but varied considerably between residents (range 33%\u201090%) and between staff members. Mean time per shift registration decreased from 77.1 seconds in the initial 30-day period to 46.2 seconds in the final 30-day period (\n P<\/jats:italic>\n =.008). Symptom prevalence varied widely across NPI domains (7.5% to 38.1% of observation days), and daily symptom counts varied both between and within residents. The routine was experienced as technically straightforward and easy to incorporate into daily work. At the same time, challenges emerged, including time constraints, inconsistent participation, varying levels of interpretive confidence, and difficulties distinguishing among overlapping symptoms. Organizational routines and team stability were central to sustaining staff engagement.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The high number of completed registrations indicates that daily observations can be integrated into daily dementia care. The participants perceived it as meaningful and useful. Feasibility was primarily influenced by organizational and interpretive factors rather than technical constraints. Further research should explore strategies to support shared routines and sustain engagement over time.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/98024","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T21:43:01Z","timestamp":1784842981000},"page":"e98024-e98024","source":"Crossref","is-referenced-by-count":0,"title":["Daily Monitoring of Behavioral and Psychological Symptoms of Dementia in Residential Care: Mixed Methods Pilot Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1226-5422","authenticated-orcid":false,"given":"Johannes","family":"Malm","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9021-1802","authenticated-orcid":false,"given":"Ther\u00e9se","family":"Bielsten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3662-5486","authenticated-orcid":false,"given":"Charlotta","family":"Nilsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8163-5045","authenticated-orcid":false,"given":"Elzana","family":"Odzakovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8617-0355","authenticated-orcid":false,"given":"Ingemar","family":"K\u00e5reholt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","DOI":"10.1038\/s41514-024-00148-2","article-title":"Healthcare on the brink: navigating the challenges of an aging society in the United States","volume":"10","author":"Jones","journal-title":"NPJ Aging"},{"issue":"2","key":"R2","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1007\/s10433-022-00699-x","article-title":"Health system reforms and the needs of the ageing population \u2013 an analysis of recent policy paths and reform trends in Finland and Sweden","volume":"19","author":"Tynkkynen","journal-title":"Eur J Ageing"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","first-page":"383","DOI":"10.30574\/ijsra.2024.11.1.0067","article-title":"Demographic shifts and healthcare: a review of aging populations and systemic challenges","volume":"11","author":"Ogugua","journal-title":"Int J Sci Res Arch"},{"issue":"3","key":"R4","doi-asserted-by":"publisher","DOI":"10.1002\/puh2.213","article-title":"Public health challenges and responses to the growing ageing populations","volume":"3","author":"Khan","journal-title":"Public Health Chall"},{"issue":"4","key":"R5","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.ejcnurse.2011.06.008","article-title":"Person-centered care \u2013 ready for prime time","volume":"10","author":"Ekman","journal-title":"Eur J Cardiovasc Nurs"},{"issue":"9","key":"R6","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1108\/JHOM-01-2021-0008","article-title":"Adoption of the concept of person-centred care into discourse in Europe: a systematic literature review","volume":"35","author":"Rosengren","journal-title":"J Health Organ Manag"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/s13012-021-01140-0","article-title":"Barriers and facilitators to implementing evidence-based guidelines in long-term care: a qualitative evidence synthesis","volume":"16","author":"McArthur","journal-title":"Implementation Sci"},{"issue":"4","key":"R8","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1111\/scs.12376","article-title":"Barriers and facilitators to the implementation of person-centred care in different healthcare contexts","volume":"31","author":"Moore","journal-title":"Scand J Caring Sci"},{"issue":"3","key":"R9","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1515\/cclm-2018-0658","article-title":"Digital transformation in healthcare \u2013 architectures of present and future information technologies","volume":"57","author":"Gopal","journal-title":"Clin Chem Lab Med"},{"issue":"2","key":"R10","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1080\/23288604.2019.1583040","article-title":"Digital technology and the future of health systems","volume":"5","author":"Mitchell","journal-title":"Health Syst Reform"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.2196\/46992","article-title":"Digital health technology for real-world clinical outcome measurement using patient-generated data: systematic scoping review","volume":"25","author":"Pyper","journal-title":"J Med Internet Res"},{"issue":"5","key":"R12","doi-asserted-by":"publisher","first-page":"1146","DOI":"10.2337\/dc19-1459","article-title":"Effects of continuous glucose monitoring on metrics of glycemic control in diabetes: a systematic review with meta-analysis of randomized controlled trials","volume":"43","author":"Maiorino","journal-title":"Diabetes Care"},{"issue":"8","key":"R13","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1038\/s41591-019-0508-1","article-title":"Clinical-grade computational pathology using weakly supervised deep learning on whole slide images","volume":"25","author":"Campanella","journal-title":"Nat Med"},{"issue":"7788","key":"R14","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1038\/s41586-019-1799-6","article-title":"International evaluation of an AI system for breast cancer screening","volume":"577","author":"McKinney","journal-title":"Nature"},{"issue":"13-14","key":"R15","doi-asserted-by":"publisher","first-page":"3328","DOI":"10.1111\/jocn.16469","article-title":"Clinical judgement in nursing \u2013 an evolutionary concept analysis","volume":"32","author":"Connor","journal-title":"J Clin Nurs"},{"issue":"7","key":"R16","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1016\/j.jamda.2014.03.006","article-title":"Computer-assisted direct observation of behavioral agitation, engagement, and affect in long-term care residents","volume":"15","author":"Casey","journal-title":"J Am Med Dir Assoc"},{"issue":"1","key":"R17","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.jval.2016.11.005","article-title":"Clinician-reported outcome assessments of treatment benefit: report of the ISPOR Clinical Outcome Assessment Emerging Good Practices Task Force","volume":"20","author":"Powers","journal-title":"Value Health"},{"issue":"Suppl 1","key":"R18","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1159\/000512208","article-title":"The collaborative aging research using technology initiative: an open, sharable, technology-agnostic platform for the research community","volume":"4","author":"Beattie","journal-title":"Digit Biomark"},{"issue":"1","key":"R19","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-022-00863-9","article-title":"Content and comprehensiveness in the nursing documentation for residents in long-term dementia care: a retrospective chart review","volume":"21","author":"Laukvik","journal-title":"BMC Nurs"},{"issue":"2","key":"R20","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1080\/13607863.2022.2032597","article-title":"Residential aged care staff perceptions and responses towards neuropsychiatric symptoms: a mixed methods analysis of electronic healthcare records","volume":"27","author":"Eikelboom","journal-title":"Aging Ment Health"},{"issue":"1","key":"R21","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-024-04899-1","article-title":"Factors impacting clinical data and documentation quality in Australian aged care and disability services: a user-centred perspective","volume":"24","author":"Tshering","journal-title":"BMC Geriatr"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-022-01046-2","article-title":"A mixed-methods study of quality differences between applied documentation approaches in nursing homes","volume":"21","author":"Larjow","journal-title":"BMC Nurs"},{"issue":"5","key":"R23","doi-asserted-by":"publisher","DOI":"10.2196\/30405","article-title":"Impact of electronic health records on information practices in mental health contexts: scoping review","volume":"24","author":"Kariotis","journal-title":"J Med Internet Res"},{"issue":"2","key":"R24","doi-asserted-by":"publisher","first-page":"e105","DOI":"10.1016\/S2468-2667(21)00249-8","article-title":"Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019","volume":"7","author":"Nichols","journal-title":"Lancet Public Health"},{"key":"R25","unstructured":"Dementia, fact sheet. World Health Organization. Mar 31, 2025. URL: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/dementia [Accessed 04-08-2025]"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2012.00073","article-title":"Behavioral and psychological symptoms of dementia","volume":"3","author":"Cerejeira","journal-title":"Front Neurol"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.832199","article-title":"Neuropsychiatric or behavioral and psychological symptoms of dementia (BPSD): focus on prevalence and natural history in Alzheimer\u2019s disease and frontotemporal dementia","volume":"13","author":"Lagan\u00e0","journal-title":"Front Neurol"},{"issue":"3","key":"R28","doi-asserted-by":"publisher","first-page":"e180","DOI":"10.1093\/geront\/gnw195","article-title":"Living with dementia: a meta-synthesis of qualitative research on the lived experience","volume":"58","author":"G\u00f3rska","journal-title":"Gerontologist"},{"issue":"3","key":"R29","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1192\/bjp.bp.108.049619","article-title":"Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population","volume":"194","author":"Savva","journal-title":"Br J Psychiatry"},{"issue":"4","key":"R30","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1017\/S1041610217002009","article-title":"Assessing BPSD with the support of the NPI-NH: a discourse analysis of clinical reasoning","volume":"30","author":"Melander","journal-title":"Int Psychogeriatr"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-026-07321-0","article-title":"Exploring conditions for implementing daily monitoring of behavioral and psychological symptoms of dementia (BPSD) in dementia care: insights from a participatory design study","volume":"26","author":"Malm","journal-title":"BMC Geriatr"},{"issue":"1","key":"R32","doi-asserted-by":"publisher","DOI":"10.1002\/trc2.70057","article-title":"Person\u2010centered care at population scale: the Swedish Registry for Behavioral and Psychological Symptoms of Dementia","volume":"11","author":"J\u00f6nsson","journal-title":"Alzheimers Dement Transl Res Clin Interv"},{"issue":"3","key":"R33","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1002\/gps.4002","article-title":"Which behavioral and psychological symptoms of dementia are the most problematic? Variability by prevalence, intensity, distress ratings, and associations with caregiver depressive symptoms","volume":"29","author":"Fauth","journal-title":"Int J Geriatr Psychiatry"},{"issue":"1","key":"R34","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-10-1","article-title":"A tutorial on pilot studies: the what, why and how","volume":"10","author":"Thabane","journal-title":"BMC Med Res Methodol"},{"issue":"6 Pt 2","key":"R35","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1111\/1475-6773.12117","article-title":"Achieving integration in mixed methods designs \u2013 principles and practices","volume":"48","author":"Fetters","journal-title":"Health Serv Res"},{"issue":"5","key":"R36","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1016\/j.amepre.2009.02.002","article-title":"How we design feasibility studies","volume":"36","author":"Bowen","journal-title":"Am J Prev Med"},{"key":"R37","unstructured":"Nationella riktlinjer f\u00f6r v\u00e5rd och omsorg vid demenssjukdom: St\u00f6d f\u00f6r styrning och ledning [in Swedish]. Swedish National Board of Health and Welfare; 2017. Report No.: 2017-12\u20132. URL: https:\/\/www.socialstyrelsen.se\/contentassets\/8315c1b65e064fcb92065392c74b942c\/2017-12-2.pdf [Accessed 18-7-2026]"},{"issue":"12","key":"R38","doi-asserted-by":"publisher","first-page":"2308","DOI":"10.1212\/wnl.44.12.2308","article-title":"The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia","volume":"44","author":"Cummings","journal-title":"Neurology"},{"key":"R39","unstructured":"Cummings JL . Neuropsychiatric Inventory \u2013 Nursing Home Version (NPI-NH). npiTEST; Jun 1, 2009. URL: https:\/\/www.dementiaresearch.org.au\/wp-content\/uploads\/2016\/01\/NPI-NH_cr.pdf [Accessed 30-06-2026]"},{"issue":"12","key":"R40","doi-asserted-by":"publisher","first-page":"1642","DOI":"10.1177\/1049732310376520","article-title":"Approaches to and outcomes of dyadic interview analysis","volume":"20","author":"Eisikovits","journal-title":"Qual Health Res"},{"issue":"9","key":"R41","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1177\/1049732313501889","article-title":"Introducing dyadic interviews as a method for collecting qualitative data","volume":"23","author":"Morgan","journal-title":"Qual Health Res"},{"issue":"11","key":"R42","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8775","article-title":"Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies","volume":"19","author":"Greenhalgh","journal-title":"J Med Internet Res"},{"issue":"1","key":"R43","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-023-01287-y","article-title":"Identifying barriers and facilitators to successful implementation of computerized clinical decision support systems in hospitals: a NASSS framework-informed scoping review","volume":"18","author":"Abell","journal-title":"Implement Sci"},{"issue":"1","key":"R44","doi-asserted-by":"publisher","DOI":"10.2196\/23775","article-title":"Spread, scale-up, and sustainability of video consulting in health care: systematic review and synthesis guided by the NASSS framework","volume":"23","author":"James","journal-title":"J Med Internet Res"},{"issue":"1","key":"R45","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-05596-6","article-title":"Experiences from implementation of internet-delivered cognitive behaviour therapy for insomnia in psychiatric health care: a qualitative study applying the NASSS framework","volume":"20","author":"Kadesj\u00f6 Banck","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"R46","doi-asserted-by":"publisher","first-page":"30","DOI":"10.20982\/tqmp.12.1.p030","article-title":"Why Welch\u2019s test is type I error robust","volume":"12","author":"Derrick","journal-title":"Quant Methods Psychol"},{"issue":"1","key":"R47","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process","volume":"62","author":"Elo","journal-title":"J Adv Nurs"},{"issue":"S2","key":"R48","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s11577-017-0454-1","article-title":"How to construct a mixed methods research design","volume":"69","author":"Schoonenboom","journal-title":"K\u00f6ln Z Soziol"},{"issue":"4","key":"R49","doi-asserted-by":"publisher","first-page":"e253","DOI":"10.1093\/geront\/gnaa207","article-title":"Person-centered care in persons living with dementia: a systematic review and meta-analysis","volume":"62","author":"Lee","journal-title":"Gerontologist"},{"issue":"5","key":"R50","doi-asserted-by":"publisher","first-page":"e73","DOI":"10.1016\/j.ijmedinf.2012.10.007","article-title":"Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review","volume":"82","author":"Cresswell","journal-title":"Int J Med Inform"},{"issue":"1","key":"R51","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-4191-1","article-title":"Towards successful digital transformation through co-creation: a longitudinal study of a four-year implementation of digital monitoring technology in residential care for persons with dementia","volume":"19","author":"Dugstad","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"R52","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1007\/s10433-021-00627-5","article-title":"Digital care technologies in people with dementia living in long-term care facilities to prevent falls and manage behavioural and psychological symptoms of dementia: a systematic review","volume":"19","author":"Chan","journal-title":"Eur J Ageing"}],"container-title":["JMIR Aging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aging.jmir.org\/2026\/1\/e98024","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:23:08Z","timestamp":1785536588000},"score":1,"resource":{"primary":{"URL":"https:\/\/aging.jmir.org\/2026\/1\/e98024"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":52,"URL":"https:\/\/doi.org\/10.2196\/98024","relation":{},"ISSN":["2561-7605"],"issn-type":[{"value":"2561-7605","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"article-number":"v9i1e98024"}}