Tuesday, 3 February 2009

Dementia spinning

The Dementia story has been flashed all over the news today, if one believed the government then their gimmicky plans for earlier diagnosis will have a dramatic impact. Dr Grumble cleverly interprets the story here. The lobbyists claim:

"Research has shown that a brief four or five-hour programme of support and counselling at diagnosis can reduce institutional care by an astonishing 28 per cent or an average of 557 days compared with those not receiving such interventions. This is particularly crucial considering that much of the cost associated with dementia results from expensive care home provision."

In actual fact the abstract of the research that the lobbyist is spinning is:

Mittleman, M.S., Haley, W. E., Clay, O.J., & Roth, D. L. (2006). Improving
Caregiver well-being delays nursing home placement of patients with Alzheimer’s disease. American Academy of Neurology 67, 1592-1599.
The purpose of this study was to determine the effectiveness of counseling and support intervention for spouse caregivers in delaying time to nursing home placement of persons with Alzheimer’s disease and to identify the mechanisms through which the intervention accomplished this goal. A randomized controlled trail of counseling (6 sessions of individual and family) and support (support group, ad hoc telephone counseling available) was compared to treatment as usual for 406 spouse caregivers of community-dwelling patients with AD over a 9.5 year study period. Patients who spouses received the intervention experienced a 28.3 % reduction in the rate of nursing home placement compared with treatment as usual. Median time to placement was 557 days. Improvement in caregivers’ satisfaction with social support, response to patient behavior problems, and symptoms of depression collectively accounted for 61.2 % of the intervention’s beneficial impact on placement. The authors concluded greater access to effective programs of counseling and support could yield considerable benefits for caregivers, patients with AD and society.

Even from quickly skimming the abstract one can see that this is not a study about just early diagnosis and a brief support programme, it is a long study over almost ten years in which carers were given a lot more counselling and support than they would otherwise have been given.

This quick case study is the perfect example of the way in which the modern media and lobby industry operates. Scientific evidence is spun by non-scientists and manipulated into saying things for which there is simply no evidence. It makes headlines for the government to launch its gimmicky new early diagnosis centres for a relatively small amount of money but they are the equivalent of pissing in the wind; as if there is not a substantial investment in carers, care homes, support systems for carers and other facilities then the point will have been completely missed and the urine will continue to fly into the carers' faces.

18 comments:

jayann said...

it is a long study over almost ten years

misleading? The carers received

(6 sessions of individual and family) and support (support group, ad hoc telephone counseling available)

as against treatment as usual (aka nothing?)

so

a brief four or five-hour programme of support and counselling at diagnosis

is not as wildly wrong as you want to suggest.

Anonymous said...

Another chance for the media to rubbish GPs as well as only 1/3rd know how to diagnose it according to the radio
Since the last referral I did for a dementing lovely old lady produced absolutely no help I would like to know what do they propose to do to aid the carers and patients once diagnosed?Anyone heard of the MMSE??

Garth Marenghi said...

It is Jayann,

the impression given by the lobbyist is that a short input after a quick diagnosis makes a big difference,

this is NOT suggested by the evidence,

a big difference is made after a more significant input is made in the long term, and early diagnosis is of no importance, it's to do with supporting carers,

I think the two messages are vastly different and the government's response of setting up these early diagnosis clinics reflects this as they will not provide a sustained amount of support to carers at all, hence they are unlikely to be of any benefit to anyone

jayann said...

Garth, my objection is to your suggestion (that is,the impression your post gives) that carers received ten years' help. We probably agree on the facts.

a big difference is made after a more significant input is made in the long term,

I don't think we can know this (I admit the report *may* show that carers were helped for a long time)

and early diagnosis is of no importance, it's to do with supporting carers,

this study may not be relevant to the importance of an early diagnosis. I think early diagnosis is important as a carer can then understand why certain things are happening (I don't mean the things that should lead anybody to suspect dementia albeit in some circumstances they may not, e.g., 'where am I going to sleep tonight' may seem a reasonable question), I mean the very early signs of (possible) dementia.

The Shrink said...

Oh my giddy aunt.

I've blogged this week about our National Dementia Strategy that was foisted 'pon us on Tuesday, than about media's meddling in how clinical care should be undertaken, and now this.

Some weeks I really, really want folk just to leave me alone to crack on and do my job . . .

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