Daily-BPSD - a digital tool for individualized, daily monitoring of BPSD in nursing homes

Daily-BPSD is a scalable and cost-effective tool for daily monitoring of Behavioral and Psychological Symptoms of Dementia (BPSD). By providing real-time data and integrating smoothly into care routines, it enables earlier interventions, improves residents’ quality of life, and reduces burden for staff and families.

Motivation for the study

• High prevalence and burden of BPSD (Behavioral and Psychological Symptoms of Dementia) : Up to 90% of people with dementia experience behavioral and psychological symptoms such as agitation, apathy, and hallucinations at some point of the disease progression. This reduces quality of life, increases caregiver stress, and often leads to institutionalization.
• Gaps in current practice: Existing tools (e.g., the Swedish BPSD Registry) rely on periodic assessments (every 3–12 months), which miss the fluctuating and dynamic nature of symptoms, leading to delayed or inappropriate care responses.
• Implementation gap in person-centered care: While person-centered care is the gold standard and part of national guidelines, it remains difficult to implement in daily routines due to fragmented documentation systems, lack of timely follow-up, and high staff turnover.
• Need for real-time, individualized monitoring: Daily and structured symptom tracking can improve continuity, enable faster interventions, and support more nuanced understanding of behaviors beyond “symptoms to be managed.”
• Digital innovation with practical relevance: Daily-BPSD is designed as a scalable and cost-effective tool, developed together with staff and relatives, to integrate smoothly into everyday dementia care workflows.
• Potential benefits for multiple stakeholders:

• For residents: earlier and more appropriate interventions, improved quality of life.
• For staff: reduced stress, better teamwork, and reflective practice.
• For families: improved communication and transparency in care.
• For society: more sustainable, person-centered dementia care in the face of growing demand.
• Timely contribution: With the rapid increase in dementia cases worldwide and strong policy emphasis on digital transformation in health and eldercare, this study provides urgently needed evidence on how to adapt, implement, and evaluate digital tools in real-life care settings.

Material and method

• Overall design: Multi-study thesis with four sub-studies (qualitative, mixed-methods, quantitative). Guided by the Medical Research Council (MRC) framework for complex interventions, which emphasizes four iterative phases:

• Development (designing and adapting interventions with stakeholders),
• Feasibility (testing acceptability and practicality),
• Evaluation (assessing outcomes and processes),
• Implementation (studying sustainability and scalability).

• Daily-BPSD tool:

• Web-based tool for daily documentation of BPSD.
• Includes core symptoms of BPSD + optional, person-centered variables e.g. about care .
• Registrations completed once per shift by staff; data available as real-time graphs for reflection and care planning.

• Phase I (Development):

• Interviews with staff + participatory research circles with dementia care staff, relatives, managers.
• Analysis: grounded theory–inspired coding, thematic analysis.

• Phase II (Feasibility):

• Pilot in dementia nursing homes (n=8 residents, 12 staff).
• Data: staff interviews + log data (registration time, symptom reporting).
• Analysis: qualitative content analysis, descriptive statistics, t-tests.

• Phase III (Evaluation, ongoing):

• Longitudinal mixed-methods across 19 wards, >200 residents.
• Data: Daily-BPSD logs (compliance, symptom patterns) + staff interviews.
• Analysis: descriptive statistics, thematic analysis, triangulation.

• Phase IV (Implementation, planned):

• Controlled, longitudinal comparison (≈200 intervention vs. ≈200 matched controls).
• Data: registry scores, care actions, medication use.
• Analysis: mixed-effects regression, latent growth curve modeling.

• Participants and settings:

• Swedish dementia-specific nursing homes (wards of 6–10 residents).
• Residents with moderate–severe dementia.
• Staff: primarily nursing assistants; nurses and physicians involved part-time.

Scientific publications

Malm, J., Bielsten, T., Odzakovic, E., Finkel, D., Nilsen, C., Kåreholt, I. (2022) Development & evaluation of a digital tool to track daily behavioral & psychological symptoms of dementia (abstract) Presented at Arizona State University, Phoenix, USA

Malm, J., Bielsten, T., Odzakovic, E., Finkel, D., Nilsen, C., Kåreholt, I. (2023) Co-production to Tailor a Digital Tool for Monitoring Symptoms of Dementia in Nursing Home Care in Sweden. The Gerontological Society of Amerika’s 2023 Annual Scientific Meeting November 7-12, Tampa, Florida, USA and Innovation in Aging, 7, S1, p 743. https://doi.org/10.1093/geroni/igad104.2404

Johannes Malm, Therése Bielsten, Elzana Odzakovic, Sofi Fristedt, Charlotta Nilsen, Deborah Finkel, Ingemar Kåreholt (2024) Daily-BPSD, co-production of a digital tool facilitating daily follow-up for persons with dementia (abstract). Presented at HAN University in Nijmegen, the Netherlands

Contacts

Agenda 2030 goals