The therapeutic use of doll therapy in dementia

Abstract

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 nonpharmacological 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.

Ethical considerations of doll therapy for people with dementia

“…While there are a number of therapeutic intervention options for nursing professionals to choose from with regard to non-pharmacological treatments, there are perhaps few as contentious as doll therapy. 26 …”

“…27,28 Despite this, there has been limited rigorous empirical research carried out on the use of providing dolls to people with dementia and subsequently best practice guidelines currently do not exist. 26 While a plethora of anecdotal accounts on successful doll therapy interventions with people who have dementia pervade the literature, the first notable attempt to empirically study the phenomenon came from the Newcastle Challenging Behaviour Service (UK) in 2006/2007. [29][30][31] The Newcastle Challenging Behaviour Service (UK) carried out three separate studies throughout a variety of healthcare settings in England.…”

“…[30][31][32][33] Additional therapeutic gains of doll therapy for people with dementia included reduction in agitation or behaviour that challenges, a reduction in wandering, an increased number of opportunities to engage, a higher receptivity to interactions with other people, an improvement of dietary intake and a general visible increased well-being. 26,[28][29][30][31][32][33] While there is some evidence to suggest that providing a doll to some people with dementia has the potential for considerable therapeutic gain, barriers for its use have also been identified. As already alluded to, there are no 'best practice' clinical guidelines on the use of doll therapy for people with dementia in the United Kingdom and globally.…”

“…As already alluded to, there are no 'best practice' clinical guidelines on the use of doll therapy for people with dementia in the United Kingdom and globally. 26 So, even though there is some support for using dolls therapeutically for people with dementia that may improve their well-being, owing to varied styles of dolls used, 29,31,34,35 nursing professionals face a challenge in determining which type of doll to use and how to use it effectively. Figure 1, the empathy doll, and Figure 2, the anatomically correct doll (reproduced with permissions) illustrate the two most common types of dolls used in therapeutic doll therapy for people with dementia.…”

“…On the one hand, it is a therapy that has been practised throughout the United Kingdom, Australia, Japan and the United States for over a decade. 26 Yet, on the other hand, there is an absence of clear and robust best practice guidelines and arguably a lot of confusion about the application of psychological theory to explain how the phenomenon is conceptualised. While there is potential for these limitations to be addressed in the future, it could be argued that in spite of the potential for improvement in well-being for people with dementia, there are some ethical issues that may impede its practice.…”