Daily patterns and prevalence of behavioral and psychological symptoms of dementia in Swedish nursing homes

Background Behavioral and psychological symptoms of dementia (BPSD) are among the principal observable expressions of psychological distress and unmet need in nursing home residents who can no longer reliably verbalize internal experiences, and recognizing their day-to-day variation underpins timely, person-centered care. Yet BPSD fluctuate across days, shifts, and contexts, while established instruments such as the Neuropsychiatric Inventory Nursing Home version (NPI-NH) assess them retrospectively over the preceding weeks or months. This mismatch leaves basic descriptive questions about the day-to-day symptom landscape in routine care unanswered. This study describes the prevalence, severity, co-occurrence, between-unit variation, and shift and weekday patterns of BPSD documented through structured daily registrations in nursing home care. Methods Descriptive longitudinal observational study of 230 individuals with dementia in six nursing homes across six Swedish municipalities, followed for a median observation period of 270 days (interquartile range 120 to 446). Care staff used a digital tool to rate the severity (0–3) of twelve common BPSD, adapted from the NPI-NH, at the end of every work shift, yielding over one million symptom registrations. Analyses were descriptive and person-weighted, giving each individual equal weight regardless of observation length. Results Cumulative symptom prevalence (at any point during observation) ranged from 90% (agitation) to 70% (euphoria). Each symptom’s mean daily prevalence was much lower (4–18%), and symptoms were predominantly of low severity. At least one symptom was recorded on a median of 43.5% of registered days, varying widely between individuals. Clinically related symptoms tended to occur together, consistent with established NPI-NH domain structures, and the mean number of symptoms per day varied more than twofold across the six units. Symptoms were most frequent on evening shifts and least frequent at night, except sleep disturbances, with little variation across weekdays. Just under half of all possible shift registrations were completed. Conclusions Daily registrations describe an intermittent and heterogeneous symptom landscape at a resolution that periodic assessments are not designed to provide. These findings provide an empirical baseline for future multilevel analyses and support BPSD monitoring that covers both individual symptoms and the daily number of symptoms in nursing homes. Clinical trial number Not applicable.