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Doll Therapy: An Intervention for Nursing Home Residents With Dementia

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Abstract

The use of dolls as a therapeutic intervention for nursing home residents with dementia is relatively new. The current article describes a research study implemented with nursing home residents in Korea to examine the effects of doll therapy on their mood, behavior, and social interactions. A one-group, pretest-posttest design was used to measure the impact of doll therapy on 51 residents with dementia. Linear regression demonstrated statistically significant differences in aggression, obsessive behaviors, wandering, negative verbalization, negative mood, and negative physical appearance after introduction of the doll therapy intervention. Interactions with other individuals also increased over time. Findings support the benefits of doll therapy for nursing home residents with dementia; however, further research is needed to provide more empirical evidence and explore ethical considerations in the use of doll therapy in this vulnerable population. [Journal of Psychosocial Nursing and Mental Health Services, 53(1), 13-18.]. Copyright 2015, SLACK Incorporated.

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... Çünkü bu terapide oyuncak bebekler yaşlı kişi için bir bebekten ziyade ebeveyn, kardeş, eş gibi onlar için önemli diğer kişiler gibi bir rol oynamaktadır. Bebeklerin demanslı bireyler için terapötik kullanımı bağlanma kavramı üzerinden açıklanabileceği ve bu anlamda oyuncak bebeklerin bir "geçiş nesnesi" olarak hizmet ettikleri belirtilmiştir (27). Çalışmalarda, personele ve diğer bireylere yönelik davranışlar, zihinsel esenlik, benlik saygısı, etkinlik ve affektif durumlar ile ilgili olumlu etkilerden söz edilmiştir (27)(28)(29)(30)(31)(32). ...
... Bebeklerin demanslı bireyler için terapötik kullanımı bağlanma kavramı üzerinden açıklanabileceği ve bu anlamda oyuncak bebeklerin bir "geçiş nesnesi" olarak hizmet ettikleri belirtilmiştir (27). Çalışmalarda, personele ve diğer bireylere yönelik davranışlar, zihinsel esenlik, benlik saygısı, etkinlik ve affektif durumlar ile ilgili olumlu etkilerden söz edilmiştir (27)(28)(29)(30)(31)(32). Braden ve Gaspar (33) OBT'nin anlamlı bir fark yaratmasa da demanslı yaşlıların aktivite seviyesi veya canlılığını, bakıcılarla, diğer kişilerle veya sakinlerle etkileşime girmesini, kişisel bakım vermek kolaylığını artırdığını, ajitasyonu azalttığını ancak özellikle yaşlı bireylerin mutluluk düzeyinde anlamlı bir fark yarattığını bildirmiştir. ...
... Türkiye' de Alzheimer hastalarında uygulanarak geçerlilik ve güvenirliği test edilmiş, Cronbach-alfa iç tutarlılık katsayısı 0,82, test-tekrar test korelasyonu kuvvetli derecede anlamlı (p<0,001) bulunmuştur. Çalışmanın sonuçları, CMAE' nin Türkçe versiyonunun geçerli ve güvenilir olduğunu göstermiştir (37 (33,27,28). Bu ilkelere göre, yaşlı bireylerde sadece demans hastalığının değil bunamanın da birlikte olması kriteri aranmıştır. ...
... The main objective of most of the articles was to know the efficacy and benefits of doll therapy in the neuropsychiatric symptomatology of elders with severe dementia. Three studies out of the seven were randomized clinical trials [28][29][30] one a non-randomized clinical trial [31], another an exploratory study [32] one a pilot study [33] and the last, a before-and-after study [20]. The characteristics of each study are described in Table 1. ...
... Four out of seven studies [20,29,30,32] reported a reduction in SCPD, observing the decrease of disruptive and aggressive behaviors. The participants were less agitated and irritable while holding the doll (Cantarella Mdiff: −0.025, p < 0.001; Shin: t = 16.31, ...
... They verbalized fewer swear words, fewer shouts, and fewer obsessive behaviors. Three studies [20,30,32] found a higher number of interactions with the environment, increasing social contact and verbalization (t = −8.41, p < 0.01). ...
Article
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(1) Background: Behavioral and psychological symptoms of dementia (BPSD) are a threat for people with dementia and their caregivers. Doll therapy is a non-pharmacological person-centered therapy to promote attachment, company, and usefulness with the aim of minimizing challenging behaviors. However, the results are not clear. (2) Objective: To know the effectiveness of doll therapy in reducing behavioral and psychological symptoms of people with dementia at a moderate-severe phase. (3) Methodology: The systematic review was informed according to the criteria established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Searches were conducted in eight databases: Cochrane, PubMed, Web of Science, Cinahl, Embase, Lilacs, PeDro, and Scopus before October 2021. Studies were selected when they accomplished the simple majority of Consolidated Standards of Reporting Trials (CONSORT). The risk of bias was appraised with the Cochrane Collaboration Risk of Bias Tool. The review protocol was recorded in Inplasy:1539. (4) Results: The initial search strategy showed 226 relevant studies, 7 of which met the eligibility criteria. In the included studies, a total number of 295 participants (79% female) with a mean age of 85 years were enrolled. There was found to be a reduction in challenging and aggressive behaviors, the participants were less rough and irritable, and their communication skills and emotional state were also improved. (5) Conclusion: Our findings suggest that doll therapy improves the emotional state of people with dementia, diminishes disruptive behaviors, and promotes communication. However, randomized studies with a larger sample size and higher methodological rigor are needed, as well as follow-up protocols in order to reaffirm these results. Keywords: doll-therapy; dementia; behavioral and psychological symptoms of dement
... The efficacy of doll therapy in reduction of specific dementia-related signs and symptoms, including negative emotional experiences such as anger, anxiety, depression, or paranoia has been assessed through qualitative, quantitative, and combined research methods (Balzotti et al., 2019;Ellingford et al., 2007;Fraser & James, 2008;Pezzati et al., 2014); behavioral concerns such as wandering or aggression (Alander et al., 2015;Bisiani & Angus, 2013); and social isolation (Cantarella et al., 2018;Mackenzie et al., 2006). Researchers also have examined the effects of doll therapy on positive emotions, self-care behaviors such as food intake, and interpersonal responses (Braden & Gaspar, 2015;James et al., 2006;Shin, 2015). ...
... Studies have identified a range of emotions such as distress, frustration, sadness (Bisiani & Angus, 2013), anxiety (Braden & Gaspar, 2015), agitation , and panic attacks (Fraser & James, 2008) as difficult experiences for someone living with dementia. Literature indicates doll use by PWD may decrease dysphoric emotions (Alander et al., 2015;Cantarella et al., 2018;Shin, 2015) and increase positive emotions (Braden & Gaspar, 2015;Ellingford et al., 2007;James et al., 2006;Shin, 2015). Research where doll therapy did not show a clinically significant decrease in negative emotions still noted an increase in positive emotions (Moyle et al., 2019). ...
... Studies have identified a range of emotions such as distress, frustration, sadness (Bisiani & Angus, 2013), anxiety (Braden & Gaspar, 2015), agitation , and panic attacks (Fraser & James, 2008) as difficult experiences for someone living with dementia. Literature indicates doll use by PWD may decrease dysphoric emotions (Alander et al., 2015;Cantarella et al., 2018;Shin, 2015) and increase positive emotions (Braden & Gaspar, 2015;Ellingford et al., 2007;James et al., 2006;Shin, 2015). Research where doll therapy did not show a clinically significant decrease in negative emotions still noted an increase in positive emotions (Moyle et al., 2019). ...
Article
Prior studies have described positive behavioral, emotional, and social responses to dolls in persons with dementia (PWD), but most have examined formal doll therapy in institutional settings and primarily included women. This study describes two cases of spontaneous doll interactions in male veterans who were participating in a research study of a gentle group movement program at an adult day center. A doll was present at the study site, and two participants chose to interact with it. Researchers analyzed class videos and thematically coded behavioral, emotional, and social responses to the doll. Mr. B was a 90-year-old World War II-era veteran with moderate Alzheimer's disease. Behavioral responses (n = 83) toward the doll included gazing, holding, and caressing. Emotional responses (n = 46) included chuckles, smiles, and laughter. Social responses (n = 59) involved conversations about the doll in which his ability to communicate verbally was markedly improved. Mr. C was a 68-year-old Vietnam veteran with mild Lewy body dementia. He also exhibited frequent behavioral (n = 10), social (n = 11) and emotional (n = 8) responses toward the doll. In addition, he reported having an intense, cathartic dream about the doll, crying "it brings me back to holding my son or my daughter." These case studies add to the literature supporting the benefits of doll use by PWD by describing the effects of spontaneous doll use in two male veterans. Results suggest that having dolls available and providing a nonjudgmental environment where doll use is encouraged and supported may have profound beneficial effects to diverse populations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Furthermore, most studies were conducted on Caucasian females (when demographics were included), and only 1 study specified the inclusion of 1 African 22 This calls attention to the need for further research involving the impact of DT for male patients with MNCD, as well as for patients of different ethnic backgrounds. ...
... Methods/outcome measurements. Four studies [18][19][20]22 utilized guidelines for DT as outlined by Mitchell 8 (TABLE 2). 8,9,29,30 The studies primarily examined the effect of DT on 2 common behavioral and psychological symptoms of dementia: anxiety and agitation. ...
... Seven studies incorporated qualitative descriptions from caregivers and staff on the observed effect of DT on resident behavior. 18,19,21,22,24,25,28 Psychotropic medications. Two of the studies included patients taking some form of psychotropic medication, 17,26 while the remainder of the studies did not explicitly mention this. ...
Article
Background: The management of major neurocognitive disorder (MNCD), formerly known as dementia, is of increasing concern as the elderly population continues to grow. Doll therapy (DT) is a controversial method observed in clinical practice that has both promising benefits and potential ethical concerns. To date, little research has been done on this therapy. Methods: A PubMed search was performed using the keywords "dementia," "elderly," "dolls," "doll therapy," and "Alzheimer's disease." A list of pertinent articles was assembled, with irrelevant articles excluded. References from these articles were also reviewed and additional articles were included in the final list. Results: Research on the utility of DT for patients with MNCD is limited. Current literature suggests that DT may be beneficial in decreasing the use of pharmacologic interventions and alleviating symptoms such as agitation and anxiety. However, most studies consisted of small, unrepresentative sample populations. Conclusions: Preliminary studies favor DT as an effective management strategy for behavioral symptoms of MNCD. However, the few existing randomized controlled trials are limited in size and demographics. Further research involving larger, more diverse study samples with more male patients is needed. Additionally, the exact parameters to guide this therapy have not been established and require investigative study.
... This includes contact between residents and family members, residents and staff and between residents. Alternatives to human physical contact such as soft toys and dolls have been suggested as ways to provide comfort and reduce distress (Mitchell et al., 2016;Ng et al., 2017;Shin, 2015). Pet therapy and animal robots were discounted as impractical at this time. ...
... Evidence suggests that where doll therapy has been introduced in care homes it can help to alleviate behavioural and emotional symptoms. Doll therapy can reduce distress, agitation, wandering (walking with purpose) and increase engagement, communication, well-being, mood and appetite (Mitchell et al., 2016;Ng et al., 2017;Shin, 2015). Dolls can provide companionship, attachment, ownership and inclusion (Alander et al., 2015). ...
Article
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Context: The work presented in this paper was undertaken during the first three months of the COVID-19 crisis in the UK. Objectives: The project is aimed to respond to questions and concerns raised by front-line care staff during this time, by producing research-based ‘Top Tips’ to complement emerging COVID-19 policy and practice guidelines. Methods: Eight rapid, expert reviews of published, multidisciplinary research evidence were conducted to help answer care home workers’ questions about ‘how’ to support residents, family members and each other at a time of unprecedented pressure and grief and adhere to guidance on self-distancing and isolation. A review of the emerging policy guidelines published up to the end of April 2020 was also undertaken. Findings: The rapid reviews revealed gaps in research evidence, with research having a lot to say about what care homes should do and far less about how they should do it. The policy review highlighted the expectations and demands placed on managers and direct care workers as the pandemic spread across the UK. Implications: This paper highlights the value of working with the sector to co-design and co-produce research and pathways to knowledge with those who live, work and care in care homes. To have a real impact on care practice, research in care homes needs to go beyond telling homes ‘what’ to do by working with them to find out ‘how’.
... Bisiani and Angus [10] reported a single case with advanced Alzheimer's disease, in which DT intervention reduced the level of anxiety and agitation. Shin [11] reported that the improvement of aggression, obsessive behaviors, and negative mood were observed after a DT intervention from a one-group study of 51 nursing home residents with dementia, supporting the benefits of DT for this patient population. Balzotti et al. [12] also reported that DT ameliorated the symptoms of agitation compared with a gesture-verbal treatment intervention group after 12 weeks. ...
... This finding is consistent with previous reports. Shin [11] examined the effects of DT on 51 nursing home residents with dementia. After DT intervention, the following symptoms of these residents were significantly improved, aggression, wandering, negative mood, and negative physical appearance, and so on. ...
Article
Wandering is a neuropsychiatric symptom of dementia, and it is associated with adverse consequences. Doll therapy (DT) is a non-drug intervention for reducing distressing behaviors among people with dementia. The current study was conducted to determine the effects of DT on wandering in patients with dementia. A one-group including 40 patients with severe dementia was included to measure the impact of DT. The Chinese Revised Algase Wandering Scale-Community Version (CRAWS-CV) was used to evaluate patients each weekend. Results revealed that patients exhibited a clear improvement in CRAWS-CV scores over 4 weeks, especially eloping behavior, meal time walking, pacing, random pattern and aimless pattern scores. The current findings indicate that DT is beneficial for dementia patients with wandering.
... 3,4 Μια σύγχρονη, νέα, καινοτόμος, αλλά και μη επαρκώς μελετημένη εναλλακτική μέθοδος είναι και η χρήση παιδικής κούκλας. Αν και η επιστημονική κοινότητα παρουσιάζεται διχασμένη, τα οφέλη της χρήσης της παιδικής κούκλας παρουσιάζονται ενθαρρυντικά, τόσο για τους ασθενείς, όσο και για τους συνοδούς-φροντιστές. 3,5 Η παρούσα μελέτη επιχειρεί να καταγράψει μετρήσιμα, αλλά και ποιοτικά αποτελέσματα της χρήσης παιδικής κούκλας σε ασθενείς πάσχοντες από σύνδρομα άνοιας, ασθενείς με μετρίου προς σοβαρού βαθμού άνοια. Καταγράφονται οι αλλαγές στον χαρακτήρα, τη συμπεριφορά, τη διάθεση αλλά και τις διαπροσωπικές σχέσεις και την επικοινωνία. ...
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ABSTRACT Specialized centres for the treating of patients with Alzheimer’s disease and related dementia syndromes have been proposed in recent years as a first-line treatment of non-pharmaceutical therapeutic interventions, such as the doll therapy. AIM Our study investigates the use of a child’s doll in female patients with moderate to severe dementia. ΜATERIAL-METHODS In the study, being contacted for a 21 day period, questionnaires-scales for the measurement of various factors were given to chronic institutionalized female patients with moderate to severe dementia, having been answered with the help of the staff and the attendants-carers. RESULTS Indicators for the OPTICAL SCALE PAIN (P<0.0005), HAD-D (P=0.014), HAD-A (P<0.0005), AIS (P=0.002) showed all statistical significantly improvement, regardless of the type of disease (Alzheimer Disease vs Vascular Dementia). The monitoring and recording of the quality behavioural characteristics, showed significant improvement in communication and loyalty and significantly reduce in agitation and aggression. Significant reduction of the drug administration (planned or emergency) such as paracetamol, clobazam, bromazepam, olanzapine and zolpidem was observed. CONCLUSIONS Despite the ethical dilemmas that may arise during the use of the doll therapy, this therapeutic
... Effective interventions for the person with dementia are, for example, those supporting the person to adapt to, and cope with, their changing abilities and limitations, including cognitive rehabilitation therapies, such as goal-oriented tailored cognitive rehabilitation therapy, cognitive stimulation group therapy, cognitive training, and exercise and psychomotor therapy (Bahar-Fuchs et al., 2013; Dr€ oes et al., 2011); case management based on the model of empowerment (MacNeil Vroomen et al., 2015), and other interventions aimed to enhance a person's strengths and capabilities (from care for basic needs, to support to participate in a community, taking stock of one's life through reminiscence, and providing opportunities to gain new skills); staff awareness training, which aims to enable professional caregivers to better identify signs of awareness in people with dementia to improve their quality of life and that of their caregivers ; and support groups (Toms, Clare, Nixon, & Quinn, 2015). Other beneficial interventions are those aimed at recognizing care needs (Miranda-Castillo, et al., 2013) and at providing meaningful activities creating stimulating, positive experiences, like green care farms (de Boer et al., 2015;Verbeek, 2015) and horticultural activities (Gonzalez & Kirkevold, 2015), and when dementia is more advanced, non-verbal communication methods, like doll therapy, snoezelen and Namaste (Shin, 2015;Stacpoole, Hockley, Thompsell, Simard, & Volicer, 2015;van Weert, van Dulmen, Spreeuwenberg, Ribbe, & Bensing, 2005). ...
Article
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Background: Because the pattern of illnesses changes in an aging population and many people manage to live well with chronic diseases, a group of health care professionals recently proposed reformulating the static WHO definition of health towards a dynamic one based on the ability to physically, mentally and socially adapt and self-manage. This paper is the result of a collaborative action of the INTERDEM Social Health Taskforce to operationalize this new health concept for people with dementia, more specifically the social domain, and to formulate directions for research and practice to promote social health in dementia. Method: Based on the expertise of the Social Health Taskforce members (N = 54) three groups were formed that worked on operationalizing the three social health dimensions described by Huber et al.: (1) capacity to fulfil potential and obligations; (2) ability to manage life with some degree of independence; (3) participation in social activities. For each dimension also influencing factors, effective interventions and knowledge gaps were inventoried. After a consensus meeting, the operationalizations of the dimensions were reviewed by the European Working Group of People with Dementia (EWGPWD). Results: The social health dimensions could be well operationalized for people with dementia and are assessed as very relevant according to the Social Health Taskforce and EWGPWD. Personal (e.g. sense of coherence, competencies), disease-related (e.g. severity of cognitive impairments, comorbidity), social (support from network, stigma) and environmental factors (e.g. enabling design, accessibility) that can influence the person with dementia's social health and many interventions promoting social health were identified. Conclusion: A consensus-based operationalization of social health in dementia is proposed, and factors that can influence, and interventions that improve, social health in dementia identified. Recommendations are made for research and practice.
... According to our knowledge, no other RCT has been conducted to find efficient combinations of non-pharmacological interventions for wandering. One study from Korea [45] examined the effect of doll therapy (a recognised intervention to help address cases of agitation and depression in PwD). Dolls were proven to provide a source of comfort or meet the patient's need to care for someone else in 51 PwD, and this study found that this intervention can effectively reduce wandering, among other negative behaviours (aggression, obsessions, negative verbalizations, etc.). ...
Article
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Background: Aberrant motor behaviour or wandering refers to aimless movement without a specific purpose. Wandering is common in patients with dementia and leads to early institutionalization and caregivers' burden. Non-pharmacological interventions should be also considered as a first-line solution for the wandering because current pharmacological treatment has serious side-effects. Methods: A cross-over randomised controlled trial (RCT) with 60 participants of all stages and different types of dementia was conducted in Greece. The sample was randomly assigned in 6 different groups of 10 participants each. Every intervention lasted for 5 days, and there were 2 days as a wash-out period. There was no drop-out rate. The measurements used were the Mini Mental State Examination (MMSE), Addenbrooke's Cognitive Examination Revised (ACE-R), Geriatric Depression Scale (GDS), Functional Rating Scale for Symptoms in Dementia (FRSSD), and Neuropsychiatric Inventory (NPI). The interventions that were evaluated were reminiscence therapy (RT), music therapy (MT), and physical exercise (PE). Results: NPI scores were reduced in the group receiving PE (p = 0.006). When MT (p = 0.018) follows PE, wandering symptoms are reduced further. RT should follow MT in order to reduce wandering more (p = 0.034). The same combination was effective for the caregivers' burden as well; PE (p = 0.004), MT (p = 0.036), RT (p = 0.039). Conclusions: An effective combination that can reduce wandering symptoms in all stages and types of dementia was found: The best order was PH-MT-RT. The same combination in the same order reduced caregivers' burden.
... Several studies, including clinical trials, have shown the effectiveness of staff training on quality of life, life span of residents, and improved interactions between staff and residents living in different long-term care settings. 1e8 Studies have included diverse interventions such as person-centered care, 4,8e10 reminiscence therapy, 10e13 doll therapy, 14,15 and music and dance-based psychomotor therapy. 16e19 However, similar studies in middle-income countries like Mexico are scarce, and practically no evidence-based implementation studies have been conducted in this area. ...
Article
Objectives To evaluate the feasibility outcomes of implementing a multicomponent staff training intervention (PROCUIDA-Demencia) to promote psychosocial interventions and reduce antipsychotic prescription in Mexican care homes and study its effect on staff's care experience and residents' quality of life. Design A mixed-methods 2-arm cluster randomized controlled pilot study of a 2-day staff training program with baseline, 12 weeks, and 24 weeks of the PROCUIDA-Demencia intervention vs treatment as usual (TAU). Setting and Participants Eight care homes in Mexico City were selected, from which 55 residents and 126 staff were recruited. Intervention In situ staff training consisting of evidence-based manualized psychosocial interventions of person-centered activities, reminiscence therapy, doll therapy, psychomotor dance therapy, and antipsychotic prescription review. Fidelity to protocol was supervised once a week. Methods Cluster-level feasibility measures included views of staff, residents, and relatives on acceptability, satisfaction, adherence, and fidelity to the intervention. Staff outcome measures were Maslach Burnout Inventory (MBI), Approaches to Dementia Questionnaire, and Sense of Competence in Dementia Care Staff. Residents' outcome measures included Quality of Life–Alzheimer's Disease scale (QoL-AD), and Neuropsychiatric Inventory–Nursing Home Version (NPI-NH). Staff distress was measured using the NPI-NH occupational disturbance scale. Feasibility was elicited through a focus group, and hierarchical linear mixed effects models were used to assess the adjusted effects of the respective measures. Results Observed medical practice showed the prescription of at least 1 antipsychotic in 41% of participants in the intervention group. Overall, 39% of residents reported discontinuation, and 15% reduction of antipsychotics, following the 12-week medical review in parallel with psychosocial interventions. Clinical outcomes contributed positively to the reduction in baseline staff burden according to the MBI after the intervention [mean difference −8.9, 95% confidence interval (CI) −17.7, −0.1, P = .049] and to the reduction in severity and frequency of behavior as per NPI-NH in residents (mean difference −9.4, 95% CI –17.5, −1.3, P = .025). Conclusions and Implications PROCUIDA-Demencia is a feasible intervention for Mexican care homes. Results contribute to the Mexican Dementia Plan optimizing dementia care by supporting the need for staff training to implement psychosocial interventions prior to prescribing antipsychotic medication.
... Doll therapy in residential care homes has identified that older individuals benefit from having to care for the dolls and feel that their ownership is important [8,9]. ...
... Until now DT has been mainly evaluated in nursing homes, reviewed in [25,31] , overall the studies reported an amelioration of BPSD, with improvement of wellbeing, reduction of the use of antipsychotic drugs [34] and increase in the therapeutic alliance between the patients and the professional caregivers [25,35] . However the majority of the studies on DT were cohort, casecontrol and observational studies [25] . ...
... 17 The doll could be used as a target stimulus for the purpose of initiating and encouraging interaction, fulfilling attachment needs, and providing sensory stimulation through activity. 12 To date, 17 studies (see Table 1) have been published on DT for older adults with dementia. Since the literature review on this topic by Mitchell, McCormack, and McCance (2016), 33 6 more recently published studies clearly confirmed that, after DT, people with dementia were more engaged in proposed activities, 20 and more communicative with their caregivers. ...
... Previous literature provided some direction on how to use dolls as a nursing instrument [2][3][4][5][6]. Observational studies have shown the benefits of DT in reducing BPSD such as agitation, aggression and wandering [7,8]. They have also shown the benefits of DTS in increasing communication between patients and caregivers due to the fact that dolls stimulate conversation on topics related to motherhood and caregiving [9,10]. ...
Article
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Background: Doll therapy is a non-pharmacological intervention for people with dementia aimed to reduce distressing behaviours. Reliable results on efficacy of Doll therapy for people with dementia are needed. The concept of attachment theorized by Bowlby has been proposed to explain the Doll therapy process, but it has not been proven to influence the response to doll presentation. Methods: This randomized single-blind controlled trial will involve people with dementia living in nursing homes of the Canton Ticino (Switzerland). Participants will be randomized to one of two interventions: Doll Therapy Intervention or Sham Intervention with a non-anthropomorphic object, using a 1:1 allocation ratio. The two interventions will consist of 30 daily sessions lasting an hour at most, led by a trained nurse for an hour at most. We will enrol 64 participants per group, according to power analysis using an estimated medium effect size (f=0.25), alpha level of 0.05, and power of 0.8. The primary goal is to test the efficacy of Doll Therapy Intervention versus Sham Intervention as the net change in the following measures from baseline to 30-days (blinded outcomes): the Neuropsychiatric Inventory-Nursing Home administered by a trained psychologist blinded to group assignment, the professional caregivers’ perceived stress scale of the Neuropsychiatric Inventory-Nursing Home, patients’ physiological indices of stress (salivary cortisol, blood pressure and heart rate) and interactive behaviours. The secondary goal is to assess the relationship between attachment styles of people with dementia (detected by means of the Adult Attachment Interview to the patients’ offspring) and their caregiving behaviours showed during the Doll therapy Intervention. Discussion: This is the first randomized single-blind controlled trial on efficacy of Doll therapy for dementia and explanatory model of the response of people with dementia to doll presentation. Trial registration: Retrospectively registered on 21 July 2017 at ClinicalTrials.gov with the trial number: NCT03224143 (https://clinicaltrials.gov/ct2/show/NCT03224143).
... This attachment can be provided by the doll. A study carried out with 51 residents in a nursing home in Korea showed positive changes in aggression, obsessive behaviours and negative moods when dolls were used (Shin, 2015). ...
Article
The rapidly expanding aging population presents an urgent global challenge cutting through just about every dimension of worldly life, including the social, political, cultural, and economic. Developing innovations in health and assistive technology (AT) are poised to support effective and sustainable health care in the face of this challenge, yet there is scant (but growing) discussion of the ethical issues surrounding AT for older persons with dementia. Demands for ethical frameworks that can respond to frontline dilemmas regarding AT development and provision, and how the needs of aging persons themselves are defined throughout this development process, are increasing. This article suggests that fulfilling the promises of AT to provide effective and ethically informed solutions may demand shifting away from standard bioethical analyses that centralize the principle of respect for autonomy. An autonomy-centric paradigm is dubiously equipped to theorize the foundational ethical issues in dementia care and to effectively guide AT development and implementation. An agency-centered approach to dementia care, which could engage more adaptively with the perspectives and choices of older persons themselves while offering strong support to AT research and stakeholders, may offer an attractive alternative.
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Background Depression is a common psychological symptom associated with dementia. Pharmacological approaches are often used despite two large negative trials of efficacy. This meta-analysis examines nonpharmacological (i.e., psychosocial) approaches for symptoms of depression in people living with dementia and reports statistical and clinical significance. Methods Relevant studies published between 2012 and 2020 were sourced by searching electronic databases: MEDLINE, EMBASE, PsychINFO, Social Work Abstracts and the Cochrane Central Register of Controlled Trials. Studies were assessed for methodological quality. Random-effects meta-analysis was performed to calculate a pooled effect size (ES) and 95% confidence intervals (CI). Results Overall, 37 nonpharmacological studies were identified including 2,636 participants. The mean quality rating was high (12/14, SD=1.4). Meta-analysis revealed that nonpharmacological approaches were significantly associated with reduced symptoms of depression with a medium effect size (ES=-0.53, 95%CI [-0.72, -0.33], p<.0001). There was considerable heterogeneity between studies. Meta-regression revealed this was not driven by intervention type or residential versus community setting. Conclusions Nonpharmacological approaches, reminiscence, cognitive stimulation/ rehabilitation, therapeutic, music-based approaches and education/ training, have the potential to reduce symptoms of depression in dementia.
Article
Objectives: To assess the quality of research evidence for the different activity components for the psycho-social Namaste Care intervention for care home residents with advanced dementia. Design: Namaste Care is a multi-component intervention delivered on a daily basis to people living with advanced dementia or people at end of life with dementia. A significant part of its operationalisation within care homes is the delivery of a number of activities delivered by trained in-house Namaste Care workers to a group of residents with similar high dependency needs. The Namaste Care workers focus on touch, music, nature, sensory experience, aromas and interactions with objects delivered in a way to enhance feelings of enjoyment and wellbeing. This review evaluated the evidence for using these activities with people living with advanced dementia. A systematic search of peer-reviewed research articles was conducted between November 2016 and September 2018 using search terms of activities used in Namaste Care. The quality of each accepted article was rated using the Rapid Evidence Assessment scale. Results: The initial literature search returned 1341 results: 127 articles including 42 reviews were included. The majority of activity interventions yielded between 10 and 20 peer-reviewed papers. The use of smells and aromas, interacting with animals and dolls, the use of various forms of music (e.g. background music, singing, personalised music), nature, lighting, various forms of touch/massage and sensory interventions (including Snoezelen) all appear to have proven efficacy with people living with advanced dementia. Conclusions: There is generally a limited number of research papers and reviews in this area, but overall there is a good evidence base for including these activities within Namaste Care for people living with advanced dementia.
Article
This study is aimed at identifying the effect of doll therapy on agitation and cognitive state in institutionalized patients with moderate-to-severe dementia. This randomized controlled experimental study was conducted from April 8, 2019, to October 30, 2019, in a nursing home in Aksaray, Turkey. In total, 29 people with dementia participated in this study, 15 of whom comprised the intervention group. The control group, in which no intervention was made, was composed of the remaining 14 individuals. Data were collected using the introductory information form and the Standardized Mini-Mental State Examination (SMMSE) to evaluate cognitive status, and the Neuropsychiatric Inventory (NPI) and Cohen-Mansfield Agitation Inventory (CMAI) to evaluate behavioral disturbances. Patients with dementia in the intervention group received doll therapy for 8 weeks. We found that there was no statistically significant change between fourth- and eighth-week SMMSE scores for either the intervention or control groups ( P > .05), while there was a significant change in the CMAI and NPI scores of the intervention group ( P < .05). This study found that doll therapy was effective in decreasing agitation and behavioral problems in people diagnosed with moderate-to-severe dementia. Trial registration ClinicalTrials.gov , ID: NCT04120103 Retrospectively registered on 8 April 2019.
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Over the past two decades, a new body of knowledge has emerged that seeks to understand the psychosocial aspects of dementia and Alzheimer’s disease (AD). Such knowledge mainly focuses on comprehending the lived experience of individuals living with dementia as well as that of their formal and informal caregivers. The evidence that transpires supports the development and implementation of a number of psychosocial interventions aimed at enhancing the quality of life in such individuals and in those who are likely to be impacted by this neurodegenerative syndrome—namely informal and formal caregivers. This chapter seeks to provide an overview of the psychosocial perspectives of living with dementia and AD with particular reference to the effect of caregiving on family dynamics and the influence of gender on the effectiveness of psychosocial interventions in the management and care of these individuals.
Article
Interest has grown in the use of doll therapy, particularly in geropsychiatric and dementia care settings. In a long-term state psychiatric hospital, a dollhouse-play activity was implemented in an effort to engage an acutely disturbed, middle-aged woman undergoing medication trials and whose symptoms had been refractory to conventional treatments. A schedule of nondirective dollhouse-play activities was implemented over an 8-week period. Measures of behavioral change were tracked. Dramatic clinical improvements were seen, including significant reductions in verbal and physical aggression, use of as-needed medications, and need for close one-to-one monitoring. Improvements were seen prior to achievement of therapeutic drug levels. The patient was successfully discharged from the hospital. Doll play has recently been associated with clinical benefits in the care of patients with dementia and has long been deployed in childhood mental health treatment. The current findings suggest doll play may have applications as a time-limited intervention in the treatment of major psychiatric disorders in adults and warrants consideration when achieving therapeutic alliance has proven particularly challenging. [Journal of Psychosocial Nursing and Mental Health Services, 53(5), 22-27.]. Copyright 2015, SLACK Incorporated.
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Recent advancements in dementia care have moved away from a custodial type of care where people have been considered well cared for if they were clean, dry, fed, quiet and not at any risk. This type of care often failed to recognize the person with dementia as an adult human being with a right to lead a dignified and meaningful life. In this new culture of care, which promotes a person-centered approach (Kitwood and Bredin, 1992), infantilization can be seen as inappropriate.
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Over the past two decades the collaborative care model within primary care has proved to be effective in improving care quality, efficiency, and outcomes for older adults suffering from dementia and depression. In collaboration with community partners, scientists from Indiana University have implemented this model at the Healthy Aging Brain Center (HABC), a memory care clinic that is part of Eskenazi Health, an integrated safety-net health care system in Indianapolis, Indiana. The HABC generates an annual net cost savings of up to $2,856 per patient, which adds up to millions of dollars for Eskenazi Health's patients. This article demonstrates the financial sustainability of the care processes implemented in the HABC, as well as the possibility that payers and providers could share savings from the use of the HABC model. If it were implemented nationwide, annual cost savings could be in the billions of dollars.
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Background and purpose The mechanisms underlying the success of doll therapy are poorly understood. The aims of this study were to explore how people in care, doll users and non-users, make sense of doll use in their settings. Methodology A grounded theory approach was used, recruiting participants from three residential care homes involving four male and 12 female residents. Data collection occurred in two phases; five participants took part in a focus group and later 11 participants were interviewed individually. Eight of the 11 participants had dementia, and four participants were actively using dolls. Results and conclusion The results are presented as themes, and sub-themes, consisting of four main categories (intrapersonal features, interpersonal features, behavioural benefits, ethical and moderating factors). This thematic analysis shows that residents generally support the use of dolls, believing that dolls can have a positive impact on some users. The mechanisms by which this impact is achieved are discussed together with the ethical concerns.
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In recent years there has been increasing interest in how different aspects of object relations theory might apply to dementia. While attachment theory in dementia has been well studied, there have been no systematic investigations of the way in which transitional objects are used by people with dementia. This study explores the relationship people with dementia have with physical objects using a focussed ethnographic method. Twenty-one residents and the staff of a care home for people with dementia were observed over a two-month period. Observations were recorded and analysed in light of Winnicott's criteria for transitional objects and incorporated the work of other key theorists. The ethnography found evidence that people with dementia have varied relationships with objects and can employ objects in a transitional way. The paper then explores the implications of this research for understanding the function of transitional objects for people with dementia. The findings suggest that that Winnicott's theory of transitional objects can provide a framework for understanding some of the processes of dementia.
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Over the next 15 years, the number of people with dementia in the UK will increase significantly. There are clear limitations associated with the sole use of pharmacological interventions to address the cognitive decline and related problems that people with dementia and their carers will experience. As a result, health professionals, including nurses, need to consider the development and use of non-pharmacological therapies to help resolve the distress and decline in social function that people with dementia can experience. The use of doll therapy in dementia care appears to be increasing, even though there is limited empirical evidence to support its use and therapeutic effectiveness. It is suggested by advocates of doll therapy that its use can alleviate distress and promote comfort in some people with dementia. Despite these encouraging claims, the theoretical basis for the use of doll therapy in dementia is poorly understood and morally questionable. The purpose of this article is to provide healthcare professionals with a succinct overview of the theory behind the therapeutic use of dolls for people with dementia, a presentation and appraisal of the available empirical evidence and an appreciation of the potential ethical dilemmas that are involved.
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Background Typically, dementia involves progressive cognitive and functional deterioration, leading to death. A palliative approach recognizes the inevitable health decline, focusing on quality of life. The approach is holistic, proactive, supports the client and the family, and can be provided by the client's usual care team. In the last months of life, distressing symptoms, support needs, and care transitions may escalate. This project trialed a strategy intended to support a consistent, high quality, palliative approach for people with dementia drawing close to death. The strategy was to implement two communities of practice, drawn primarily from service provider organizations across care sectors, supporting them to address practice change. Communities comprised practitioners and other health professionals with a passionate commitment to dementia palliative care and the capacity to drive practice enhancement within partnering organizations. Project aims were to document: (i) changes driven by the communities of practice; (ii) changes in staff/practitioner characteristics during the study (knowledge of a palliative approach and dementia; confidence delivering palliative care; views on death and dying, palliative care, and a palliative approach for dementia); (iii) outcomes from perspectives of family carers, care providers, and community of practice members; (iv) the extent to which changes enhanced practice and care continuity; and (v) barriers to and facilitators of successful community of practice implementation. Methods/design This action research project was implemented over 14 months in 2010/11 in metropolitan Perth, Western Australia and regional Launceston, Tasmania. Each state based community of practice worked with the researchers to scope existing practice and its outcomes. The research team compiled a report of existing practice recommendations and resources. Findings of these two steps informed community of practice action plans and development of additional resources. Change implementation was recorded and explored in interviews, comparisons being made with practice recommendations. Changes in staff/practitioner characteristics were evaluated using survey data. Findings from semi structured interviews and survey administration established outcomes from perspectives of family carers, care providers, and community of practice members. Consideration of processes and outcomes, across the two state based settings, informed identification of barriers and facilitators. Community of practice reflections also informed study recommendations.
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To develop a valid and reliable instrument for rating quality of life in persons with late-stage Alzheimer's disease and other dementing illnesses. A group of clinicians with extensive experience in dealing with dementia patients developed by consensus the Quality of Life in Dementia Scale (QUALID), an 11-item scale. The window of observation for each subject was 7 days. A 5-point scale captured the frequency of each item (total score ranging from 11 to 55). Lower scores reflected a higher quality of life (QOL). Validity was assessed by comparison with other measures. Dementia special care unit. Professional caregivers of 42 patients. QUALID, Mini-Mental State Exam (MMSE), Physical Self-Maintenance Scale (PSMS), Neuropsychiatric Inventory (NPI), and Geriatric Depression Scale (GDS). QUALID scores ranged from 12 to 45 points and were skewed toward higher QOL (lower scores). Internal consistency of items was high, as were test-retest reliability and consistency across recorders. As expected, there was no relationship between QUALID and MMSE or PSMS scores, but there was a statistically significant, although moderate, relationship between QUALID and NPI, and GDS scores. The QUALID is a reliable and valid scale, administered to caregivers, for rating QOL in persons with late-stage dementing illness.
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Dolls and teddy bears were introduced into an Elderly Mentally Ill (EMI) home as part of a non-pharmacological intervention. Thirteen residents from a population of 33 chose to use a doll and one chose a teddy bear. The impact of the toys was assessed on five domains over a 12-week period and the findings were generally positive, which was consistent with previous observations (Mackenzie et al., in press). The investigation also attempted to determine whether staff were able to predict which residents would chose a toy. In terms of the dolls, out of the 16 residents predicted to use a doll, nine did so (56% accuracy). Despite the benefits outlined in this largely descriptive study, a number of problems were observed and some of these difficulties are outlined below.
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This chapter argues that communication should be central to how we think about dementia and how we work with those who live with it. As for the emerging concept of 'supportive care' for people with dementia, it offers some thoughts about this idea generally, and about where communication should fit in. It explores three main ideas about what this thing called supportive care might look like, and where communication fits in. These ideas are illustrated with examples, quotations, and stories.
Article
Encouraging multiple stimulating experiences can help meet the attachment, comfort and occupation needs of people with dementia. Julie Heathcote and Moira Clare discuss the controversial use of doll therapy with examples from a care home in the UK
Article
Background: There are a number of therapies currently available to assist healthcare professionals and carers with non-pharmacological treatment for people living with dementia. One such therapy that has been growing in clinical practice is doll therapy. Providing dolls to some people living with dementia has the potential to enhance personal well-being through increased levels of communication and engagement with others. Despite its potential for benefits, the practice is currently under-developed in healthcare literature, probably due to varied ethical interpretations of its practice. Aim: To undertake a critical review of the published literature on doll therapy, using the Critical Appraisal Skills Programme Checklist (CASP) tool, in order to determine the potential benefits and challenges of this therapy for people living with dementia. Design: A comprehensive literature search, incorporating the CINAHL, Medline, Embase, PubMed, Joanna Briggs, Cochrane Library and PsycINFO data bases, was conducted. Conclusions: Despite many commentaries and anecdotal accounts of the practice, this review identified only 11 empirical studies that were eligible. The majority of studies found that the use of dolls could be therapeutic for some people living with dementia by reporting increased levels of engagement, communication and reduction in episodes of distress. Some studies identified limitations to the therapy including; confusion over the ownership of the doll and healthcare professional uncertainty about issues pertaining to autonomy. Relevance to clinical practice: According to this review, doll therapy has the potential to increase the well-being of some people living with dementia. This review illuminates that some healthcare professionals feel uncomfortable about its use in clinical practice. The operationalisation of doll therapy in clinical practice has been shown to be inconsistent with different approaches to the practice being advocated. This highlights the need for further empirical research to identify best practice and education to increase awareness in both healthcare professional and carer populations.
Article
The use of doll therapy for people with dementia has been emerging in recent years. Providing a doll to someone with dementia has been associated with a number of benefits which include a reduction in episodes of distress, an increase in general well-being, improved dietary intake and higher levels of engagement with others. It could be argued that doll therapy fulfils the concepts of beneficence (facilitates the promotion of well-being) and respect for autonomy (the person with dementia can exercise their right to engage with dolls if they wish). However, some may believe that doll therapy is inappropriate when applied to the concepts of dignity (people with dementia are encouraged to interact with dolls) and non-maleficence (potential distress this therapy could cause for family members). The absence of rigorous empirical evidence and legislative guidelines render this a therapy that must be approached cautiously owing to the varied subjective interpretations of Kitwood's 'malignant social psychology' and bioethics. This article suggests that by applying a 'rights-based approach', healthcare professionals might be better empowered to resolve any ethical tensions they may have when using doll therapy for people with dementia. In this perspective, the internationally agreed upon principles of the United Nations Convention on the Rights of Persons with Disabilities provide a legal framework that considers the person with dementia as a 'rights holder' and places them at the centre of any ethical dilemma. In addition, those with responsibility towards caring for people with dementia have their capacity built to respect, protect and fulfil dementia patient's rights and needs.
Article
Unlabelled: The aim of this research study was to examine the impact of the provision of a lifelike baby doll as a therapeutic tool on the behaviour of a person living with dementia. Specifically, this single case study assessed the potential benefits, if any, of the use of doll therapy in reducing behaviours of concern such as anxiety and agitation that may be associated with observed attachment needs of a person living with dementia. Method: A single case study of a female participant, with moderately advanced Alzheimer's disease, was the subject of this research. The case study used both qualitative and quantitative research design and methodology in data collection and analysis. Results: Demonstrated that doll therapy was a positive intervention for the person living with dementia who was the participant in this research. The findings indicate a reduction in behaviours of concern related to the need for attachment and a considerable decline in levels of anxiety and agitation. There was extensive ongoing improvement in social interaction and communication. Conclusion: This research supports doll therapy as a therapeutic intervention that may be utilized within the ongoing care of some persons with dementia to meet needs for attachment and to reduce behaviours of concern. Despite some controversy on this topic, doll therapy should be considered as a therapeutic approach to further dementia care in light of this positive outcome.
Article
This paper is drawn from a larger study based on traditional qualitative thematic methods, which explored the use of secondary biographical stories as a strategy in conversation with an older person who has dementia. The aim of this paper is to re-examine the data to facilitate further discussion in gerontology about the ways in which the ideals of Kitwood's (1997) personhood and narrative inquiry can be used keep life story of the person with dementia intact. By drawing upon narrative writers such as Mishler (1986), Gee (1991), Ramanathan (1995) and Riessman (2004, 2007), we describe a methodological approach utilising structural and thematic forms of narrative analysis to keep the person with dementia ‘centre stage’ in their own life story narrative. This paper demonstrates that by integrating a person-centred approach to interpretative and structural narrative analysis, people living with dementia can be the centre of their own story and communicate with their community what is important and why it is worth telling.
Article
The United Nations Convention on the Rights of Persons with Disabilities is a powerful international instrument which imposes significant responsibilities on signatories. This column discusses changes in the definition of legal capacity which will have significant impacts on decision-making related to people with dementia. Various restrictions and limitations on personal freedoms are discussed in light of the Convention. The main focus is on challenges to existing paradigms of substitute decision-making, which are in wide use through a guardianship model. Under Art 12 of the Convention, moves to supported decision-making will result in significant changes in ensuring the rights of people with dementia. There are challenges ahead in implementing supported decision-making schemes, not only due to tension with existing practices and legislation, but also the difficulty of developing and resourcing workable schemes. This is particularly so with advanced dementia, which is acknowledged as a pressing issue for Australia due to effective health care, an ageing population and changing expectations.
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Sooner or later many Alzheimer's disease (AD) patients behave as if their deceased parents are still alive. This phenomenon is called parent fixation (PF) and is considered within the theoretical framework of Bowlby's Attachment theory. The hypothesis is that PF is an expression of their need to feel safe and secure. Explorative research indicates that PF is correlated with the level of cognitive functioning and attachment behaviour. The results show that (1) AD can be considered as a "strange situation" which activates attachment behaviour; and (2) the PF which occurs in AD patients has different meanings for the different stages of dementia. The conclusion is that in Alzheimer's disease patients there is more to be taken into account than cognitive disabilities and neurobiological deficits. A great deal of their behaviour can be better perceived and understood as the result (eg aggression) of attachment behaviour in a situation that is experienced as insecure.
Alzheimer's Association 2013 Alzheimer's disease: Facts and fi gures Retrieved from http://www.alz.org/downloads/ facts_fi gures_2013
Alzheimer's Association. (2013). 2013 Alzheimer's disease: Facts and fi gures. Retrieved from http://www.alz.org/downloads/ facts_fi gures_2013.pdf JOURNAL OF PSYCHOSOCIAL NURSING @BULLET VOL. 53, NO. 1, 2015
Play therapy for individuals with dementia
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Wiley, J.S. (2003). Play therapy for individuals with dementia. New York, NY: Schaefer.
Bridges we need to build across the world of dementia care
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Cayton, H. (2001). Bridges we need to build across the world of dementia care. Journal of Dementia Care, 9(2), 16-18.
Using therapeutic dolls with psychogeriatric patients
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Ehrenfeld, M. (2003). Using therapeutic dolls with psychogeriatric patients. In C.E.
Communication and the care of people with dementia
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Killick, J., & Allan, K. (2001). Communication and the care of people with dementia. Buckingham, England: Open University Press.
Using dolls to alter behavior in patients with dementia
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Ellingford, J., James, I., & Mackenzie, L. (2007). Using dolls to alter behavior in patients with dementia. Nursing Times, 103(5), 36-37.