The Research Behind Doll Therapy in Alzheimer’s Disease
Doll therapy involves offering dolls to adults who are living with dementia and other medical conditions with the goal of improving their comfort, engagement, and quality of life. Doll therapy is typically used for people who are in the middle or late stages of dementia.
There are multiple companies the sell therapeutic dolls for people with dementia, as well as many caregivers who extol the virtues of a doll for adults, but not everyone is ready to jump on this bandwagon. Why not? Here are the arguments for and against doll therapy in dementia.
In Support of Therapeutic Dolls
Those in favor of offering dolls to people with Alzheimer’s and other types of dementia often cite benefits such as increased smiling and a decrease in challenging behaviors. They tell of situations where a loved one is dramatically calmed by holding a doll regularly, or interacts with the doll with such joy. Others also feel that it’s beneficial for someone with dementia to be able to serve as a caregiver for something since this might enhance her feelings of purpose.
Additionally, doll therapy is a non-pharmacologic way to address challenging emotions and behaviors that may develop in dementia. There are no medication side effects or drug interactions with doll therapy. Caregivers sometimes report that when a loved one is holding a doll, they are able to more easily provide care to their family member or resident because of the distraction and comfort the doll provides.
There are some clinicians who are concerned about the use of dolls for people with dementia. They cite the following factors as reasons for their concern:
Treatment With Dignity
Those against the use of dolls for people with Alzheimer’s often are concerned about the dignity of the person. They point out that an adult with memory loss is not a child and shouldn’t be treated as such. In dementia care, we emphasize not using approaches such as elderspeak with older adults, which involves treating the person like a child. Giving an adult a doll could work against this emphasis, causing people to respond with statements such as, “Oh, aren’t they cute?” This can cause the person with dementia to be viewed in a demeaning, “cute” way, instead of as an adult who is living with a memory problem.
Whether or not dolls are used, always be certain to treat all adults as adults, with respect for their life knowledge and contributions to those around them that they’ve made over the years. A diagnosis of dementia does not erase the need to be treated with dignity.
Some people also point out that if the doll is used in a facility without the family member’s awareness, the family might be distressed by the sight of their loved one with a doll when they come in to visit. They may feel that the facility is not valuing their loved one as a mature adult. They might also be unprepared to see the extent of their loved one’s cognitive impairment, which might be made more clear by seeing her play with a doll.
If facilities are considering using a doll with someone with dementia, contact the power of attorney or responsible party prior to introducing the doll to explain why this approach is being attempted and what the hope is in utilizing it.
There are also questions about how to present the doll to the person with dementia, possible confusion over whose doll belongs to whom, how staff should implement this approach, steps to take if the doll becomes lost or broken and the worry about who is “babysitting” the doll so the person with dementia can go drink tea with their friend. There have also been concerns about a doll that “sleeps” with its eyes closed and someone with dementia worrying that the doll has died.
If you’re planning to use doll therapy with a loved one or at a facility with the residents who live there, be sure to think through these questions prior to beginning a doll therapy program. It is generally recommended to place the doll in a location where it will be discovered by the person with dementia, rather than just handing the doll to her. This allows the resident to initiate engagement with the doll if she chooses.
Having a duplicate doll available to replace one that gets misplaced or broken is a very important step to take in order to eliminate the potential for significant resident distress. Educate your staff about being available to “babysit” the doll so that the feeling of caring for the doll doesn’t prevent the resident from engaging in other meaningful activities. When buying a doll, be sure it has eyes that are able to open so that someone with dementia doesn’t think that it has died.
Misleading the Person
Others are concerned that by offering doll therapy to older adults, we’re misleading them by letting them think that the doll is a real baby. As professionals who care for people living with dementia, the question of how to use doll therapy in an ethical manner is important.
The resident is unlikely to ask you a direct question about if the doll is real or not, and it’s not recommended to point out directly that their “baby” is a doll. If the person has questions about the doll, avoid lying to the resident if possible. Instead, use this as an opportunity to ask them about raising their own babies. A doll can present an excellent opportunity for the use of validation therapy and reminiscence.
Research on Doll Therapy
Multiple research studies have been conducted on the use of doll therapy for people with dementia. The researchers have been seeking scientifically-based answers on if, and how, doll therapy benefits those living with dementia.
While the ethical concerns noted above are often referenced in the research, the results of the studies demonstrate several benefits of doll therapy. These include:
- Decreased anxiety
- Decreased agitation
- Increased happiness levels
- Increased social interaction
- Increased activity level
- Improved ability to receive care
- Fewer negative verbal expressions
- Improved mood
- Decrease in wandering
- Decrease in obsessions
- Improved food intake
For example, a detailed case study involving one nursing home resident noted a decrease in challenging behaviors, as well as in the level of anxiety and agitation. The researchers also saw an improvement in her communication and level of interaction with others.
In another study, research on doll therapy was conducted with nursing home residents who had middle and late-stage dementia. The study found that using the dolls was associated with an increase in resident happiness, social interaction, activity level, and ability of others to provide care to the residents. Anxiety levels also decreased in these residents.
A third study involved 51 nursing home residents with dementia. Doll therapy was found to be associated with significant decreases in negative verbalizations and mood, wandering, aggression,and obsessions.
The British Journal of Nursing also published a review of the use of dolls for people with dementia. While acknowledging some of the concerns outlined above, it concluded that there are numerous anecdotal evidences of the benefits of doll therapy. It also points out that although there may be a lack of multiple scientifically replicated studies on the use of dolls, doll therapy has shown positive effects for people with dementia without the use of medications.
Some research even found increased food intake in nursing home residents who participated in doll therapy. This is an important benefit as dietary intake often declines as dementia progresses.
Why Might Doll Therapy Work?
Doll therapy potentially offers meaning and purpose for someone who is living with dementia. There is a familiarity with being a caregiver for the doll that can be comforting and purposeful. Instead of constantly being a receiver of assistance and care, a doll offers the opportunity for meaningful interaction that is directed by the person living with dementia.
Suggested Guidelines for the Use of Doll Therapy
- Follow the lead of the person with dementia. If she wants to hold the doll, let her. If she doesn’t, don’t continue to offer it to her. If she views it as a doll, let her. If she refers to it as her baby, treat it that way.
- Be prepared. Doll therapy can be extremely successful with people who are anxious and restless, but it also have the potential to make someone very upset about where the doll is and who is caring for it. Be aware that some people may become overly concerned about where the doll is sleeping and if it’s been well-fed.
- Be flexible. Doll therapy has been effective for some people, but it’s not for everyone. If it doesn’t provide a benefit to your loved one or patient, continue to try other non-drug interventions to reduce her anxiety and increase her quality of life.
- Facilitate interaction with children. There are many benefits from intergenerational communication and interactions. When possible, provide the chance for your loved one or facility residents to spend time with children. Research has shown that this interaction can be beneficial to both the older adult with dementia and the children.