This news release describes a feasibility study of just 36 patients with dementia who were given computer tablets loaded with a variety of apps, and observed by staff members at McLean Hospital in Boston. Without using much measurement, the study concluded that the apps provided some reduction in symptoms of agitation for these residents. Although the release offered little in the way of quantification, it took pains to explain that the study was a pilot to demonstrate feasibility and that the intervention is “potentially effective” in addressing agitation in residents of nursing care facilities.
Care for people with dementia ranks as one of the most expensive health care outlays in the United States, according to the National Institute on Aging. It also says between 4 and 5 million Americans have dementia.
Among the U.S.’s 1.4 million nursing home residents, more than half have dementia, according to a report in the Journal of Clinical Outcomes Management. And among those, disruptive behaviors (“wandering, aggressive, and agitated behaviors”) occur in about 40% or more of residents. After decades of documentation on the over-medication of nursing home residents, in recent years there’s been a positive shift toward more non-pharmacological treatment of these patients. This small study describes another possible tool for treating agitation besides drugs. While far from being definitive, the release is transparent about the study limitations.
The news release doesn’t mention the price of the computer tablet used. It does note that the apps used were free to download on iTunes.
We applaud the release writers for noting this was a “pilot” study only, and just intended to get the research started. But we have to quibble with this statement about benefits because it has no quantifiable metric.
“The study also found that the tablets demonstrated significant effectiveness in reducing symptoms of agitation, particularly–but not exclusively–among patients with milder forms of dementia.”
We aren’t given any metric for “significant” — did it cut symptoms of agitation by half? And when they call out “milder” dementia, why aren’t we given a definition for that? In the published study the authors clearly state: “We did not perform standardized diagnostic assessments or use objective measures of agitation before and after each episode of tablet use.”
The release addressed harms by saying “researchers found that tablet use was safe for every patient, regardless of the severity of their dementia, and that with proper supervision and training, the engagement rate with the devices was nearly 100 percent.”
The release clearly states that the study is a “pilot,” which means it is not expected to generate much evidence beyond safety and feasibility. The release also notes that researchers plan to expand use of the tablets in order to gather more data on the intervention’s usefulness.
We would have liked some more detail on the study protocol such as how long did it last? Was it days, weeks or months?
There is no disease mongering. But the release didn’t provide us with any context about the size of the population of people with dementia with agitation either. We won’t dock points but will instead rate this Not Applicable.
The release does not mention who funded the study.
The release mentions that art and music therapy, for example, are alternatives but that tablets may require fewer staff members and provide more variety for each individual patient.
It also mentions that tablets were used as a “nonpharmalogic intervention,” which might suggest to many readers that it’s a good idea to try non-drug interventions before drugs with all their side effects and limited effectiveness for this problem.
It’s common knowledge that computer tablets are widely available, and at ever-diminishing costs. The release explained that all of the 70 apps used were available for free on iTunes.
The release addresses novelty, but indirectly. First, it states that the research “builds upon previous studies demonstrating that art, music, and other similar therapies can effectively reduce symptoms of dementia without medication. It also notes: “Our preliminary results are a first step in developing much-needed empirical data for clinicians and caregivers on how to use technology such as tablets as tools to enhance care and also for app developers working to serve the technologic needs of this population.”
The study itself was more explicit about novelty when the authors wrote that “to our knowledge this is the first study to examine such an intervention in this cohort.” That would have been a good line to include in the release.
The release doesn’t rely on unjustifiable, sensational language.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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