Monday, January 28, 2019
Printer Friendly Version in PDF Format (6 PDF pages)
Using Tablet Devices for Management of Behavior Symptoms in Dementia
Ipsit V. Vahia, M.D.
Medical Director, Institute for Technology in Psychiatry
Medical Director, Geriatric Psychiatry Outpatient Programs,
McLean Hospital
Assistant Professor of Psychiatry,
Harvard Medical School
Late April 2013
- Dinner at Kensington Grill (fancy restaurant in San Diego) with friends and their hyperactive 4 year old
- iPhone used to keep him calm during dinner
| Can an iPad be used to control the behavior of someone functioning at the level of a 4 year old i.e. severe dementia? |
Tablets for Control of Behavioral Symptoms in Older Psychiatric Inpatients
- Conducted on UCSD Senior Behavioral Health Geriatric Psychiatry inpatient unit
- Patients with history of behavioral symptoms (agitation) that requires psychotropic medications (e.g. antipsychotics)
- All consented patients trained in iPad use by staff
- Menu of approximately 70 apps -- all available commercially for free on App Store
- When patients become agitated, iPads given by research staff.
- Outcome Measure: Subjective reduction in behaviors
Most Commonly Used Apps
- YouTube
- Safari/Chrome
- Pandora
- Amazing Dogs
- Google Maps/Google Earth
Rating App Complexity
| Rating | Application |
|---|---|
| 1 (least complex; requires passive attention) |
Pandora |
| 2 | Doodle buddy |
| 3 | Amazing dogs |
| 4 | ESPN |
| 5 | Google search |
| 6 | Piano |
| 7 | Word search |
| 8 | Backgammon |
| 9 | Match puzzles |
| 10 (most complex; involves higher order cognitive skills) |
Sudoku |
Tablet use among inpatients with dementia
| TABLE 1. Demographic and Psychiatric/Medical Characteristics of the Three Impairment Groups Based on MoCA Scores | ||||||
|---|---|---|---|---|---|---|
| Total (N = 36) |
Mildly Impaired (N = 13) |
Moderately Impaired (N = 7) |
Severely Impaired (N = 16) |
F(df) or X2(df) |
P | |
| Demographic characteristics | ||||||
| Mean age, y (SD) | 79.9 (8.2) | 75.3 (8.3) | 85.0 (6.1) | 81.4 (7.4) | F(2.33) = 4.4 | 0.02 |
| Mean education, y (SD) | 13.3 (4.2) | 13.2 (4.5) | 13.0 (5.0) | 13.6 (3.8) | F(2.30) = 0.05 | 0.95 |
| Gender (% female) | 61.1 | 92.3 | 85.7 | 25.0 | X2(2 = 15.9) | <0.001 |
| Prior tablet use experience, N (%) | 17 (47) | 7 (54) | 2 (29) | 8 (50) | X2(2) = 1.3 | 0.53 |
| Prior computer experience, N (%) | 13 (36) | 8 (61) | 0 (0) | 5 (31) | X2(2) = 7.8 | 0.02 |
| Psychiatric characteristics | ||||||
| Frequency of comorbid depression spectrum diagnosis, N (%) | 23 (64) | 12 (92) | 6 (86) | 5 (31) | X2(2) = 13.8 | <0.01 |
| Frequency of psychiatric symptoms, N (%) | 25 (69) | 6 (46) | 4 (57) | 15 (94) | X2(2) = 8.3 | 0.02 |
| Number of psychotropic medications (SD) | 1.8 (1.4) | 1.7 (1.3) | 1.3 (1.1) | 2.1 (1.5) | F(2.33) = 0.9 | 0.39 |
| Medical characteristics | ||||||
| Mean number of medical comorbidities (SD) | 4.91 (2.4) | 5.3 (2.9) | 4.85 (1.6) | 4.6 (2.2) | F(2.33) = 0.3 | 0.75 |
| Mean number of nonpsychotropic medications (SD) | 4.9 (2.5) | 4.8 (1.3) | 3.7 (1.2) | 5.3 (3.5) | F(2.33) = 0.8 | 0.45 |
| Tablet use characteristics | ||||||
| Median number of instances of tablet use per subject (IQR) | 3 (2.5) | 3 (2.6) | 2 (1.3) | 4 (3.5) | F(2.33) = 1.0 | 0.37 |
| Median number of unique apps used per subject (IQR) | 2 (1, 3) | 3 (1, 4.5) | 3 (1, 3) | 2 (1, 3) | F(2.33) = 1.2 | 0.54 |
| Median complexity of apps (IQR) | 2.8 (2, 6) | 5.3 (2, 8.4) | 3.0 (2.0, 8) | 2.14 (1.6, 3.5) | F(2.32) = 3.0 | 0.06 |
| Mean total amount of time using tablet, min (SD) | 101.8 (220.8) | 183.8 (350.8) | 53.3 (59.0) | 53.3 (38.0) | F(2.32) = 1.5 | 0.24 |
| Mean minutes per instance of tablet use (SD) | 18.3 (13.4) | 24.0 (19.0) | 19.2 (6.1) | 13.0 (7.3) | F(2.32) = 2.51 | 0.09 |
| Mean rating of magnitude of reduction in agitation (average across subject, SD | 3.4 | 3.9 | 3.5 | 2.8 | F(2.32) = 2.8 | 0.07 |
Tablet use among inpatients with dementia
| Mildly Impaired (N=13) |
Moderately Impaired (N=7) |
Severely Impaired (N=16) |
P-value | |
|---|---|---|---|---|
| Median Unique Apps/Subject (IQR) | 3 (1, 5) | 3 (1,3) | 2 (1,3) | 0.54 |
| Median complexity of Apps (IQR) | 5.3 (2,8.4) | 3.0 (2,8) | 2.14 (1.6, 3.5) | 0.06 |
| Mean total time using tablet (mins) (SD) | 183.8 (350.8) | 53.3 (59.0) | 53.3 (38.0) | 0.24 |
| Mean minutes/instance of tablet use (SD) | 24 (19.0) | 19.2 (6.1) | 13.0 (7.3) | 0.09 |
| Mean rating of magnitude of reduction in agitation (1(least) to 5(highest)) | 3.9 | 3.5 | 2.8 | 0.09 |
In the Media
 |
Fake News!
 |
"No one wants a drill. They just want the hole it makes"
- Theodore Levitt (most probably)
Acknowledgements
- University of California, San Diego
- Colin A. Depp, Ph.D.
- Danielle Glorioso, L.C.S.W.
- Ramesh Rao. Ph.D.
- Joseph Wang, Ph.D.
- Daniel D. Sewell, M.D.
- Dilip V. Jeste, M.D.
- McLeon Hospital / Harvard University
- Brent Forester, M.D.
- John Torous M.D.
- Justin Baker, M.D. Ph.D.
- Kerry Ressler M.D. Ph.D.
- Scott Rauch, M.D.