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The pros and cons of doll therapy in dementia care

Pros of doll therapy

For some people, the idea of their loved one who’s living with dementia having a doll or other soft toy as a comforter would be difficult to understand, yet there is evidence that it can be beneficial in certain circumstances. According to Dementia UK, “Holding or just being with a doll or soft toy animal, such as a cat or dog, can be particularly helpful for people who are withdrawn, restless, distressed or anxious, improving their wellbeing and ability to communicate.” This is because doll therapy is not ‘playing’, it is a legitimate drug-free therapy that can be effective in the later stages of dementia.

Some people living with dementia can experience ‘sundowning’, an enhanced state of agitation, distress and confusion that usually occurs in the evening, which can make the person want to ‘go home’ (even though they may already be there) or want to undertake a task that is no longer necessary (such as collecting their children from school, even though they are grown up). But by having a distraction away from the effects of sundowning the person may be able to remain calmer, as the doll or soft toy can provide a renewed sense of purpose for them.
Having a sense of purpose is one of the essential aspects of Thomas Kitwood’s ‘flower’ of needs, that can make the difference to the possibility of living well with dementia. Doll therapy may also be worth trying simply because it can provide comfort without the potential side effects of drug therapy. This means it is worth considering, as there will be no risk of it interacting with any of the medications the person may already be taking.

Doll therapy can also be an excellent opportunity to engage in reminiscence work, a very useful tool for better understanding a person’s world when they’re living with dementia. For instance, if they are willing to do so, and able to communicate verbally, the doll could be an excellent opportunity to ask them about their experiences raising their own babies, or to look at photographs together, where appropriate.

Cons of dementia dolls

Many of the objections to doll therapy surround the suggestion that interacting with dolls or soft toys may ‘infantilise’ the person and therefore be less dignified for them. An adult living with dementia should never be treated like a child, talked down to or demeaned in any way, and for some dementia professionals and family members it is inappropriate to see the person interacting with something that is usually considered a child’s toy. However, if the fact that they’re ‘toys’ can be moved past, and they’re instead considered therapy items, it may be easier for other people to accept the potential benefits. Very Well Health supports this by saying “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.”

Another concern around the use of doll therapy is attachment. There is a possibility that the person may become too attached to the doll and consequently neglect their own needs. Examples of this have included trying to feed the doll rather than eating food themselves or tucking the doll up in their bed and then sleeping in a chair. This desire to ‘look after’ the doll is borne out of a need to soothe and comfort them, as if they were a child or real animal. The soothing and calming aspects of doll therapy may also be negated if someone else tries to take the doll or handle it, so in an environment where this may happen a plan should be put in place to prevent it. This could be in a care home environment or where children may be present in the person’s own home.

Socialising may also be affected if the person only wants to spend time with the doll, as they may feel they can’t take part in activities unless there’s someone to ‘babysit’. A plan should also be put in place before the doll or soft animal is introduced in case it gets lost or damaged, to avoid the distress that this could cause to the person.

Doll therapy dementia research

Research has been carried out to determine whether doll therapy is affective in dementia, and while results have been encouraging, research is still ongoing. According to Very Well Health “Doll therapy was found to be associated with significant decreases in negative verbalizations and mood, wandering, aggression, and obsessions.” While there are healthcare professionals who feel that the ethical concerns around dignity and attachment still outweigh the potential benefits, there are others who are convinced of the use of doll therapy as a non-invasive, drug-free alternative in supporting people to live well with dementia.

Other positive results discovered during research include decreased anxiety and agitation, increased activity and social interaction, an improved ability to receive care, increased happiness and improved mood, fewer negative verbalisations, and improved food intake.

Why does doll therapy work?

Doll therapy is found to work because it can give people living with dementia a renewed purpose and opportunity to connect with the world around them. This can increase their energy levels and mood and support them to live well. Instead of them having to be the constant receiver of care and feeling they have little control over their own life, the doll presents an “opportunity for meaningful interaction that is directed by the person living with dementia” according to Very Well Health. This can be comforting for the person and is a distraction from their everyday situation where they may feel they can do nothing for themselves and have to rely on others. This inability to care for themselves, combined with the memory loss that is common in all types of dementia, can lead to frustration and anger that the person may struggle to express if they’ve lost the ability to verbalise. Due to associated cognitive decline, a person living with dementia may have ‘regressed’ to a time when they are a much younger person and feel that they don’t require care, so may express their feelings in the only way available to them, such as lashing out or creating a disturbance. This behaviour is often labelled as ‘challenging’, yet it is perfectly understandable once you step inside that person’s world and attempt to understand why they are frustrated. Doll therapy can therefore give them some control back in their life, by making them feel they have a renewed sense of purpose and occupation.

While it may feel uncomfortable at first for the person’s loved ones to interact with a doll, by stepping inside the person’s world and understanding why they need the comfort and security that it brings may allow for a renewed closeness to develop between them, allowing all of the family to have some much needed emotional comfort.

How Helping Hands can help with dementia care

Helping Hands have been supporting people living with dementia to remain in the comfort and familiarity of their own homes since we were established in 1989. Our carers receive special training and development around dementia, which is why we’re considered one of the UK’s foremost dementia care providers. We believe that everyone is an individual and deserves to receive person-centred care at all times, making us stand out amongst domiciliary care providers as a beacon for exceptional care delivery. We’re also fully regulated by the Care Quality Commission and Care Inspectorate Wales meaning both our visiting and live-in care services are amongst the best you’ll find. We were established as a family business and have now grown to have 150 branches across England and Wales, all of them owned and managed by us – so unlike other care companies we don’t sell franchises. This means all our customers, whether living with dementia or not, can be reassured that we insist upon a consistently high standard from each of our branches and regions, and we are constantly driving our teams to maintain it.