{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:09:13Z","timestamp":1790784553731,"version":"4.1.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In long-term care facilities, regular proxy-completed multidimensional assessments may help staff detect meaningful decline in residents with dementia, including temporal changes in physical symptoms, mood, behavior, and social interaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a secondary analysis of publicly available, de-identified longitudinal IPOS-Dem data from a Swiss stepped-wedge cluster-randomized trial to develop and evaluate a concise resident-level model predicting recurrent short-term deterioration on IPOS-Dem subscales among Swiss long-term care residents with dementia. Monthly observations were converted into prediction episodes. Deterioration was prospectively defined as a \u22650.5-point increase in DEBI (dementia emotional and behavioral impact-reflecting emotional and behavioral symptoms) or DPII (dementia physical\/interaction impact indicating physical, functional, communication, and interaction-related concerns) at the next observation within 14\u201345 days. Recurrent deterioration was defined as deterioration in &amp;gt;33% of eligible episodes. Candidate logistic-regression predictors included mean DEBI\/DPII, recent monthly DEBI\/DPII changes, age, sex, intervention exposure, study-time variables, cluster group, and DEBI \u00d7 DPII.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The episode-level dataset included 2,107 eligible prediction episodes from 222 residents; 535 episodes deteriorated (25.4%), and 72\/222 residents (32.4%) met recurrent-deterioration criteria. In the final model, higher mean-centered DEBI increased the odds of recurrent deterioration (OR 2.655, 95% CI 1.382\u20135.101,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003), as did older age (OR 1.055\/year, 95% CI 1.006\u20131.107,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.027). Mean-centered dDEBI reduced risk (OR 0.089, 95% CI 0.009\u20130.873,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.038). DEBI \u00d7 DPII was significant (OR 0.341, 95% CI 0.118\u20130.991,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.048). Performance was reasonable (AUC 0.754; Brier 0.179).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Serial IPOS-Dem monitoring provides actionable indicators of level and trajectory for recurrent deterioration. External validation and longitudinal modeling are needed to address resident- and facility-level dependence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1874583","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T15:43:11Z","timestamp":1790782991000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Monitoring of palliative care outcomes for nursing home residents with dementia: a secondary exploratory analysis of monthly recurrent deterioration data"],"prefix":"10.3389","volume":"14","author":[{"given":"Stefania","family":"Serban","sequence":"first","affiliation":[{"name":"Sibiu Municipal Hospital","place":["Sibiu, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Neamtu","sequence":"additional","affiliation":[{"name":"Clinical Department, Faculty of Medicine, Lucian Blaga University of Sibiu","place":["Sibiu, Romania"]},{"name":"Research Department, Pediatric Clinical Hospital","place":["Sibiu, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela Viorica","family":"Mosoiu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Transilvania University of Bra\u015fov","place":["Bra\u015fov, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian Cosmin","family":"Ilie","sequence":"additional","affiliation":[{"name":"Department of Public Health and Sanitary Management, Victor Babe\u015f University of Medicine and Pharmacy","place":["Timi\u015foara, Romania"]},{"name":"Center for Translational Research and Systems Medicine, Faculty of Medicine, Victor Babe\u015f University of Medicine and Pharmacy","place":["Timi\u015foara, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estera","family":"Boeriu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Victor Babe\u015f University of Medicine and Pharmacy","place":["Timi\u015foara, Romania"]},{"name":"Onco-Hematology Department, Louis \u0162urcanu Emergency Clinical Hospital for Children","place":["Timi\u015foara, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Mirabela","family":"Mihailescu-Marin","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Bra\u015fov","place":["Bra\u015fov, Romania"]},{"name":"HOSPICE House of Hope Foundation","place":["Bra\u015fov, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"B1","year":"2025","journal-title":"Dementia"},{"key":"B2","doi-asserted-by":"publisher","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","author":"GBD","year":"2022","journal-title":"Lancet Public Health."},{"key":"B3","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1177\/0269216313493685","article-title":"White paper defining optimal palliative care in older people with dementia: a delphi study and recommendations from the European association for palliative care","volume":"28","author":"Van der Steen","year":"2014","journal-title":"Palliat Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"699","DOI":"10.3389\/fpsyt.2020.00699","article-title":"Palliative care in advanced dementia","volume":"11","author":"Eisenmann","year":"2020","journal-title":"Front Psychiatry."},{"key":"B5","doi-asserted-by":"publisher","first-page":"791","DOI":"10.21037\/apm-23-503","article-title":"Palliative care in dementia","volume":"13","author":"Gupta","year":"2024","journal-title":"Ann Palliat Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"CD011513","DOI":"10.1002\/14651858.CD011513.pub3","article-title":"Palliative care interventions in advanced dementia","volume":"9","author":"Walsh","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0319403","article-title":"Identifying unmet palliative care needs of nursing home residents: a scoping review","author":"Crowley","year":"2025","journal-title":"PLoS ONE."},{"key":"B8","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1177\/0269216316675096","article-title":"Development of a caregiver-reported measure to support systematic assessment of people with dementia in long-term care: the integrated palliative care outcome scale for dementia","volume":"31","author":"Ellis-Smith","year":"2017","journal-title":"Palliat Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e0200240","DOI":"10.1371\/journal.pone.0200240","article-title":"How can a measure improve assessment and management of symptoms and concerns for people with dementia in care homes? A mixed-methods feasibility and process evaluation of IPOS-Dem","volume":"13","author":"Ellis-Smith","year":"2018","journal-title":"PLoS ONE."},{"key":"B10","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s41687-022-00420-7","article-title":"Integrated palliative outcome scale for people with dementia: easy language adaptation and translation","volume":"6","author":"Spichiger","year":"2022","journal-title":"J. Patient Rep Outcomes."},{"key":"B11","doi-asserted-by":"publisher","first-page":"4234","DOI":"10.1111\/jan.14953","article-title":"Improving caring quality for people with dementia in nursing homes using IPOS-Dem: a stepped-wedge cluster randomized controlled trial protocol","volume":"77","author":"Spichiger","year":"2021","journal-title":"J Adv Nurs."},{"key":"B12","doi-asserted-by":"publisher","first-page":"105351","DOI":"10.1016\/j.jamda.2024.105351","article-title":"Person profile dementia intervention in long-term care: a stepped-wedge cluster-randomized trial","volume":"26","author":"Spichiger","year":"2025","journal-title":"J Am Med Dir Assoc."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e0286557","DOI":"10.1371\/journal.pone.0286557","article-title":"Inter-rating reliability of the Swiss easy-read Integrated palliative care outcome scale for people with dementia","volume":"18","author":"Spichiger","year":"2023","journal-title":"PLoS ONE."},{"key":"B14","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s12904-025-01691-9","article-title":"Internal consistency and structural validity of the Swiss easy-read integrated palliative care outcome scale for people with dementia: a secondary exploratory factor analysis","volume":"24","author":"Spichiger","year":"2025","journal-title":"BMC Palliat Care."},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.5281\/zenodo.4008427","article-title":"Data from: Intervention effect of person profiles for people with advanced dementia: stepped-wedge cluster randomized trial","author":"Spichiger","year":"2024"},{"key":"B16","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s11136-013-0583-6","article-title":"Time to health-related quality of life score deterioration as a modality of longitudinal analysis for health-related quality of life studies in oncology: do we need RECIST for quality of life to achieve standardization?","volume":"24","author":"Anota","year":"2015","journal-title":"Qual Life Res."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2535","DOI":"10.1007\/s11136-022-03088-0","article-title":"Time to deterioration of patient-reported outcomes in non-small cell lung cancer: exploring different definitions","volume":"31","author":"Walding","year":"2022","journal-title":"Qual Life Res."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e0259840","DOI":"10.1371\/journal.pone.0259840","article-title":"ICU delirium burden predicts functional neurologic outcomes","volume":"16","author":"Paixao","year":"2021","journal-title":"PLoS ONE."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1030","DOI":"10.1186\/s12877-024-05608-8","article-title":"Empowering informal caregivers and nurses to take a person-centered view: adaptation and clinical utility of the integrated palliative outcome scale (IPOS-Dem) for use in acute and community care settings","volume":"24","author":"de Wolf-Linder","year":"2024","journal-title":"BMC Geriatr."},{"key":"B20","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1177\/02692163251347826","article-title":"Translation and cross-cultural adaptation of integrated palliative care outcome scale for dementia","author":"Chen","year":"2025","journal-title":"Palliat Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"2045","DOI":"10.1016\/j.jamda.2020.11.017","article-title":"Prognostication in home-dwelling patients with advanced dementia: the Palliative Support DEMentia Model (PalS-DEM)","volume":"22","author":"Hum","year":"2021","journal-title":"J Am Med Dir Assoc."},{"key":"B22","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1186\/s12877-023-03945-8","article-title":"Predicting mortality in patients diagnosed with advanced dementia presenting at an acute care hospital: the PROgnostic Model for Advanced DEmentia (PRO-MADE)","volume":"23","author":"Kaur","year":"2023","journal-title":"BMC Geriatr."},{"key":"B23","doi-asserted-by":"publisher","first-page":"47","DOI":"10.3390\/jdad2040047","article-title":"IPOS-Dem scale in the assessment of patients with dementia in palliative care\u2014potential for adaptation: a systematic review","volume":"2","author":"Quartilho","year":"2025","journal-title":"J dement Alzheimer's dis."},{"key":"B24","doi-asserted-by":"publisher","first-page":"105853","DOI":"10.1016\/j.archger.2025.105853","article-title":"Development, validation, and clinical utility of a risk prediction model to identify older women with dementia for proactive palliative care","volume":"134","author":"Gebresillassie","year":"2025","journal-title":"Arch Gerontol Geriatr."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1929","DOI":"10.1001\/jama.2010.1572","article-title":"Prediction of 6-month survival of nursing home residents with advanced dementia using ADEPT vs. hospice eligibility guidelines","volume":"304","author":"Mitchell","year":"2010","journal-title":"JAMA."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1874583\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T15:43:11Z","timestamp":1790782991000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1874583\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":25,"alternative-id":["10.3389\/fpubh.2026.1874583"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1874583","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"1874583"}}