Frontiers in public health · 2026
Monitoring of palliative care outcomes for nursing home residents with dementia: a secondary exploratory analysis of monthly recurrent deterioration data.
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Serban Stefania, Neamtu Bogdan, Mosoiu Daniela Viorica, Ilie Adrian Cosmin, Boeriu Estera, Mihailescu-Marin Maria-Mirabela
Аннотация
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.
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.