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Peer-reviewedCC BYFrontiers in public health

Monitoring of palliative care outcomes for nursing home residents with dementia: a secondary exploratory analysis of monthly recurrent deterioration data

  • Stefania Serban1
  • Bogdan Neamtu2
  • Daniela Viorica Mosoiu3
  • Adrian Cosmin Ilie4
  • Estera Boeriu5
  • Maria-Mirabela Mihailescu-Marin6
6 affiliations
  1. 1Sibiu Municipal Hospital , ,
  2. 2Clinical Department, Faculty of Medicine, Lucian Blaga University of Sibiu , ,
  3. 3Faculty of Medicine, Transilvania University of Braşov , ,
  4. 4Department of Public Health and Sanitary Management, Victor Babeş University of Medicine and Pharmacy , ,
  5. 5Department of Pediatrics, Victor Babeş University of Medicine and Pharmacy , ,
  6. 6Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Braşov , ,
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Abstract

Background: 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.

Methods: 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 ≥0.5-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 14–45 days. Recurrent deterioration was defined as deterioration in >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 × DPII.

Results: 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 1.382–5.101, p = 0.003), as did older age (OR 1.055/year, 95% CI 1.006–1.107, p = 0.027). Mean-centered dDEBI reduced risk (OR 0.089, 95% CI 0.009–0.873, p = 0.038). DEBI × DPII was significant (OR 0.341, 95% CI 0.118–0.991, p = 0.048). Performance was reasonable (AUC 0.754; Brier 0.179).

Conclusion: 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.

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Cite

BibTeXRIS
BibTeX
@article{serban2026monitoring,
  title = {{Monitoring of palliative care outcomes for nursing home residents with dementia: a secondary exploratory analysis of monthly recurrent deterioration data}},
  author = {Stefania Serban and Bogdan Neamtu and Daniela Viorica Mosoiu and Adrian Cosmin Ilie and Estera Boeriu and Maria-Mirabela Mihailescu-Marin},
  journal = {Frontiers in public health},
  year = {2026},
  month = sep,
  doi = {10.3389/fpubh.2026.1874583},
  url = {https://europepmc.org/article/PMC/PMC13664699},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Monitoring of palliative care outcomes for nursing home residents with dementia: a secondary exploratory analysis of monthly recurrent deterioration data
AU  - Stefania Serban
AU  - Bogdan Neamtu
AU  - Daniela Viorica Mosoiu
AU  - Adrian Cosmin Ilie
AU  - Estera Boeriu
AU  - Maria-Mirabela Mihailescu-Marin
PY  - 2026
DA  - 2026/09/30
JO  - Frontiers in public health
DO  - 10.3389/fpubh.2026.1874583
UR  - https://europepmc.org/article/PMC/PMC13664699
AB  - Background: 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.  Methods: 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 ≥0.5-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 14–45 days. Recurrent deterioration was defined as deterioration in >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 × DPII.  Results: 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 1.382–5.101, p = 0.003), as did older age (OR 1.055/year, 95% CI 1.006–1.107, p = 0.027). Mean-centered dDEBI reduced risk (OR 0.089, 95% CI 0.009–0.873, p = 0.038). DEBI × DPII was significant (OR 0.341, 95% CI 0.118–0.991, p = 0.048). Performance was reasonable (AUC 0.754; Brier 0.179).  Conclusion: 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.
SN  - 2296-2565
ER  -