This story is about “Snoezelen” rooms that include flashing lights, bubble tubes, disco balls, and other stimulations that are meant to soothe patients with cognitive impairment.
Our main suggestions for improvement:
Innovative methods are needed to treat behavioral problems associated with dementia and many other medical conditions. The Snoezelen rooms are innovative, but we need evidence that there is a benefit before large scale investments can be made. Money for health care isn’t unlimited and there is an opportunity cost to allocating resources to ineffective treatments.
According to the story, a basic sensory room costs $15,000, and a portable cart with Snoezelen devices is sold for under $5,000. While this is adequate for a satisfactory, this doesn’t completely describe the costs involved since the room and equipment will need to be staffed, supplied with utilities, and maintained.
There wasn’t quite enough detail to satisfy this criterion. The story says that fewer doses of drugs were needed to calm patients after Snoezelen, and provides the data to substantiate this claim. It also notes that falls dropped from 17 in the month prior to the intervention to 5 in the month after. However, it didn’t quantify the reduction in agitation or depression scores apparently observed in the study. And it didn’t provide any data to back up the claim that grandkids “can have a better visit with their faltering grandparents” because of Snoezelen. Overall, the types of studies described in this story are hypothesis generating (they suggest that Snoezelen might be beneficial), but not adequate to determine benefit.
The story hits on at least one potential harm from these rooms — that unscrupulous nursing home staff members might be tempted to hold patients inside until they fall asleep. Another possibility is that some patients might find the stimulation in these rooms to be upsetting rather than relaxing.
The story does a good job of emphasizing the lack of research on this approach, quoting an expert who bemoans the dearth of controlled studies and noting that the Dutch developers of the Snoezelen concept were adamantly opposed to researching it. With that being said, the story could have done more to orient the readers to previous research on Snoezelen, which includes a Cochrane review as well as a much larger, better designed study than the one that is the focus of this story. The story also could have been more thorough in its exploration of the evidence offered in the new study. While it acknowledges that the 15-person study was small, the story failed to caution that the researchers didn’t include a control group for comparison. The story also didn’t include important details such as whether the researchers evaluating the study participants knew what was happening in the study. If they weren’t blinded to the interventions, the researchers assessing the patients may have harbored an unconscious expectation of benefit, which could have biased their assessments of agitation. Similarly, if staff members who knew about the study were also responsible for prescribing medication, they may have prescribed fewer doses of medicine(an apparent benefit of Snoezelen) based on biased clinical judgment.
Great sourcing for this story. We get quotes from one of the study authors, another independent researcher who has studied Snoezelen, an official with a company that sells Snoezelen, a consultant who designs multi-sensory rooms, and a staff member at the institution where the Snoezelen study was conducted.
There is no mention of other approaches that might be helpful for managing agitation in patients with dementia, such as:
– treating common physical sources of agitation (e.g. pain from arthritis or other sources, bladder infections; dehydration)
– managing medications to reduce agitation (e.g. avoiding medication interactions and overmedication)
– taking measures to improve sleep
– treating psychological sources of agitation (e.g. depression, anxiety).
Even a line briefly mentioning these alternatives would have satisfied our criterion.
There are also data on massage with lavender and other non-traditional approaches that appear to have some benefit in patients with dementia.
The story notes that “Snoezelen” brand sensory rooms and products are available in North America from a New Jersey distributor, and that competitors sell similar equipment. It also gives an estimate of the number of nursing homes in the U.S. that have bought Snoezelen brand sensory products (1350), suggesting that the use of these aids is fairly widespread.
The story traces the idea for Snoezelen rooms back to Dutch researchers in the 1970s. The story also comments that the reporter couldn’t find an academician at any local teaching hospital with enough knowledge to even discuss the intervention — further evidence that it is novel.
This story was not based on a news release.
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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