{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T12:03:50Z","timestamp":1765454630401,"version":"3.46.0"},"reference-count":25,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JDAD"],"abstract":"<jats:p>Background: Dementia is a chronic, multifactorial syndrome with a high incidence and prevalence worldwide. The clinical assessment of these patients is challenging, imposing several barriers related to the system, the healthcare professional and the patient. While numerous assessment tools exist for dementia, few are specifically validated or widely used in palliative care. This study evaluates the relevance of using the Integrated Palliative Outcome Scale for Dementia (IPOS-Dem) in Portugal. The primary objective is to synthesize evidence on the implementation and clinical performance of IPOS-Dem in people with dementia receiving palliative care\u2014including feasibility, acceptability, validity, reliability, and clinical applicability\u2014while the secondary objective is to assess the instrument\u2019s relevance and potential for cultural\/linguistic adaptation to context. Methods: A systematic review of the literature was carried out, with research in evidence-based medicine databases on the use of the Integrated Palliative Outcome Scale for Dementia (IPOS-Dem) in palliative care, using the terms \u201cdementia\u201d, \u201calzheimer\u201d, \u201clewy body\u201d, \u201ccognitive impair\u201d, \u201coutcome\u201d, \u201cIPOS-Dem\u201d, \u201cpatient outcome assessment\u201d, \u201coutcome assessment\u201d, \u201cscale\u201d, \u201cpalliative care\u201d, and \u201cpalliative outcome scale\u201d. Results: The IPOS-Dem was considered to be a useful tool for monitoring patients with dementia while receiving palliative care, allowing for a comprehensive and systematic evaluation of symptoms, as well as involving family members in the care process. It facilitates the identification of previously unknown symptoms and issues, particularly emotional and social concerns. Its use led to an improvement in symptom control and greater family involvement in care. The reduction in missing response rates and the time required to complete the scale with repeated use indicated good adaptation to the scale\u2019s implementation. Difficulties were reported in assessing patients with communication impairments. Some staff also highlighted the need for training in using the scale. The Swiss Easy-Read IPOS-Dem showed significant variation in scores between evaluators, which raises concerns about the reliability and consistency of the scale, indicating that the tool requires further validation. Digital models, although they may present some inconveniences, were suggested as a potential improvement in acceptability. Conclusions: Our review suggests that IPOS-Dem provides initial evidence of feasibility, acceptability, and potential clinical usefulness in dementia palliative care, making its implementation beneficial for the Portuguese population. Translation and adaptation to the Portuguese population and culture will be necessary, but the scale is promising, and we recommend its national use.<\/jats:p>","DOI":"10.3390\/jdad2040047","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T11:17:27Z","timestamp":1765451847000},"page":"47","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["IPOS-Dem Scale in the Assessment of Patients with Dementia in Palliative Care\u2014Potential for Adaptation: A Systematic Review"],"prefix":"10.3390","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8130-5761","authenticated-orcid":false,"given":"Fernanda","family":"Quartilho","sequence":"first","affiliation":[{"name":"Palliative Care Study Center, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7538-0158","authenticated-orcid":false,"given":"Joana Brand\u00e3o","family":"Silva","sequence":"additional","affiliation":[{"name":"Palliative Care Study Center, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"},{"name":"Doctoral Program Medical Sciences, Abel Salazar Institute of Biomedical Sciences, 4050-313 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6715-3621","authenticated-orcid":false,"given":"Daniela","family":"Cunha","sequence":"additional","affiliation":[{"name":"Doctoral Program Nursing Sciences, Portuguese Catholic University, 4169-005 Porto, Portugal"},{"name":"Porto School of Nursing, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2219-569X","authenticated-orcid":false,"given":"Daniel","family":"Canelas","sequence":"additional","affiliation":[{"name":"Palliative Care Study Center, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2656-8935","authenticated-orcid":false,"given":"Jo\u00e3o Rocha","family":"Neves","sequence":"additional","affiliation":[{"name":"Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"RISE-Health, Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"},{"name":"Department of Vascular Surgery, Unidade Local de Sa\u00fade, Alto Ave, 4835-044 Guimar\u00e3es, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2585-200X","authenticated-orcid":false,"given":"Jos\u00e9 Paulo","family":"Andrade","sequence":"additional","affiliation":[{"name":"Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"RISE-Health, Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"}]},{"given":"Mar\u00edlia","family":"Dourado","sequence":"additional","affiliation":[{"name":"Palliative Care Study Center, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research, 3000-075 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6623-7420","authenticated-orcid":false,"given":"Hugo","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Palliative Care Study Center, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"},{"name":"Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research, 3000-075 Coimbra, Portugal"},{"name":"Community Palliative Care Team Gaia, Local Health Unit Gaia and Espinho, 4400-129 Vila Nova de Gaia, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.psc.2017.10.011","article-title":"Palliative Care for Dementia","volume":"41","author":"Stewart","year":"2018","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_2","unstructured":"Dementia (2024, March 24). OMS. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/dementia."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.amjmed.2018.01.022","article-title":"Dementia","volume":"131","author":"Gale","year":"2018","journal-title":"J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1159\/000516503","article-title":"How Many People Live with Dementia in Portugal? A Discussion Paper of National Estimates","volume":"39","author":"Verdelho","year":"2021","journal-title":"Port. J. Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1177\/08919887241237220","article-title":"Forecasted Dementia Prevalence in Portugal (2020\u20132080)","volume":"37","author":"Alves","year":"2024","journal-title":"J. Geriatr. Psychiatry Neurol."},{"key":"ref_6","unstructured":"Connor, S., Morris, C., and Jaramillo, E. (2020). Global Atlas of Palliative Care, World Health Organization (WHO). [2nd ed.]."},{"key":"ref_7","doi-asserted-by":"crossref","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":"ref_8","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.maturitas.2015.09.003","article-title":"The basis, ethics and provision of palliative care for dementia: A review","volume":"83","author":"Hilal","year":"2016","journal-title":"Maturitas"},{"key":"ref_9","unstructured":"(2024, December 19). Palliative Care Outcome Scale (POS)-Home. Available online: https:\/\/pos-pal.org\/maix\/."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e2764","DOI":"10.1590\/1518-8345.0993.2764","article-title":"The Palliative Outcome Scale (POS) applied to clinical practice and research: An integrative review","volume":"24","author":"Rugno","year":"2016","journal-title":"Rev. Lat. Am. Enferm."},{"key":"ref_11","first-page":"111","article-title":"Medir Qualidade de Vida em Cuidados Paliativos","volume":"21","author":"Med","year":"2008","journal-title":"Port"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Antunes, B., and Ferreira, P.L. (2020). Validation and cultural adaptation of the Integrated Palliative care Outcome Scale (IPOS) for the Portuguese population. BMC Palliat. Care, 19.","DOI":"10.1186\/s12904-020-00685-z"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1177\/02692163211004403","article-title":"Culture in the spotlight\u2014Cultural adaptation and content validity of the integrated palliative care outcome scale for dementia: A cognitive interview study","volume":"35","author":"Hodiamont","year":"2021","journal-title":"Palliat. Med."},{"key":"ref_14","unstructured":"(2025, November 18). Checklist for Systematic Reviews and Research Syntheses. Critical Appraisal Checklist for Systematic Reviews and Research Syntheses 2. Available online: https:\/\/jbi.global\/sites\/default\/files\/2019-05\/JBI_Critical_Appraisal-Checklist_for_Systematic_Reviews2017_0.pdf."},{"key":"ref_15","unstructured":"(2025, May 01). PRISMA 2020 Checklist. Available online: https:\/\/www.bmj.com\/content\/372\/bmj.n71."},{"key":"ref_16","unstructured":"Nha Hong, Q., Pluye, P., F\u00e0bregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., Gagnon, M.-P., Griffiths, F., and Nicolau, B. (2025, May 01). Mixed Methods Appraisal Tool (MMAT) Version 2018-User Guide. Available online: http:\/\/mixedmethodsappraisaltoolpublic.pbworks.com\/w\/file\/fetch\/127916259\/MMAT_2018_criteria-manual_2018-08-01_ENG.pdf."},{"key":"ref_17","first-page":"548","article-title":"Strength of Recommendation Taxonomy (SORT): A Patient-Centered Approach to Grading Evidence in the Medical Literature","volume":"69","author":"Ebell","year":"2004","journal-title":"Am. Fam. Physician"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Ellis-Smith, C., Higginson, I.J., Daveson, B.A., Henson, L.A., and Evans, C.J. (2018). 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. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0200240"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"588","DOI":"10.12968\/ijpn.2019.25.12.588","article-title":"A collaborative approach in dementia care to improve clinical effectiveness and priorities for research through audit","volume":"25","author":"Kinley","year":"2019","journal-title":"Int. J. Palliat. Nurs."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Spichiger, F., Volken, T., Larkin, P., Meichtry, A.A., and Koppitz, A. (2023). Inter-rating reliability of the Swiss easy-read integrated palliative care outcome scale for people with dementia. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0286557"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1191\/0269216305pm1018oa","article-title":"The last days of life of nursing home patients with and without dementia assessed with the palliative care outcome scale","volume":"19","author":"Brandt","year":"2005","journal-title":"Palliat. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Puente-Fern\u00e1ndez, D., Campos-Calder\u00f3n, C.P., Esteban-Burgos, A.A., Hueso-Montoro, C., Rold\u00e1n-L\u00f3pez, C.B., and Montoya-Ju\u00e1rez, R. (2020). Palliative Care Symptoms, Outcomes, and Interventions for Chronic Advanced Patients in Spanish Nursing Homes with and without Dementia. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17051465"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e13987","DOI":"10.1111\/hex.13987","article-title":"Co-design of the EMBED-Care Framework as an intervention to enhance shared decision-making for people affected by dementia and practitioners, comprising holistic assessment, linked with clinical decision support tools: A qualitative study","volume":"27","author":"Aworinde","year":"2024","journal-title":"Health Expect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e70011","DOI":"10.1111\/hex.70011","article-title":"Co-Designing a Palliative Dementia Care Framework to Support Holistic Assessment and Decision Making: The EMBED-Care Framework","volume":"27","author":"Davies","year":"2024","journal-title":"Health Expect."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"20552076231211118","DOI":"10.1177\/20552076231211118","article-title":"Co-design of a theory-based implementation plan for a holistic eHealth assessment and decision support framework for people with dementia in care homes","volume":"9","author":"Gillam","year":"2023","journal-title":"Digit. Health"}],"container-title":["Journal of Dementia and Alzheimer's Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/3042-4518\/2\/4\/47\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T12:00:24Z","timestamp":1765454424000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/3042-4518\/2\/4\/47"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,11]]},"references-count":25,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jdad2040047"],"URL":"https:\/\/doi.org\/10.3390\/jdad2040047","relation":{},"ISSN":["3042-4518"],"issn-type":[{"value":"3042-4518","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,11]]}}}