Author: Thomas Baird, LCSW, MDiv
Quick reminder: In this space, we will regularly be writing about topics pertinent to dementia care, while focusing on articles, books, or online publications that have caught our attention.  See our first post for more details.
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"Dolls bring comfort and offer the ability to nurture. They aren't something I would offer to someone newly diagnosed with dementia but rather for someone in the latter stages of the disease. Seeing your parent interact with a doll as if it were a real baby might make you, the child or caregiver, uncomfortable, but this is usually not the case for your parent." (Activities to do with your Parent who has Alzheimer's Dementia, Judith A. Levy, EdM, OTR; p. 55)

"Consider purchasing a doll and leaving it on your parent's bed as a decoration. He or she will choose to hold it or not when he or she is ready. Whether to interact with the doll will be your parent's decision, but you will have provided the opportunity." (Activities to do with your Parent who has Alzheimer's Dementia, Judith A. Levy, EdM, OTR; p. 56)

This subject is a very controversial one. Dr. Levy is not alone in her suggestion to provide people with dolls, as many Memory Care communities have used dolls to promote a sense of responsibility, nurture, and attachment for their residents. Her method is purposeful, as well. She specifically asks that the doll be left in a public place so that the individual can choose whether or not to take it.  Several studies have revealed positive outcomes for residents that interact with dolls. On the other hand, some family members and dementia care professionals will question the effect doll therapy has on a patient's dignity.  As Dr Levy mentions, it may be extremely difficult to see a distinguished, accomplished, adult playing with a child's toy. This article explores the ways that doll therapy may be perceived as inappropriately childish. Other articles will point to pet therapy as a more dignified alternative, as it allows individuals to exercise their need to nurture while not evoking child-related themes.

There are many congruent and competing psychosocial interventions for individuals with dementia. This integrative review of psychosocial interventions, by Bridget Johnston and Melanie Narayanasamy, categorizes the varying goals of each intervention. It identifies legacy, personhood, and engagement as three essential themes that caregivers wish to instill in their caregiving work. In my brief eight-year experience in this field, I have found these three categories to be consistently reflected in care. Johnston and Narayanasamy found in their review that psychosocial interventions will  often do one or more of the following: 1) promote one's legacy, 2) reinforce their personhood, or 3) encourage engagement/comfort among our patient population. These interventions thus appropriately honor the history and ongoing legacy of our patients, while also acknowledging the needs caused by their cognitive impairment. 

I personally find that our interventions should be measured collectively rather than individually. We should make efforts to reinforce personhood, provide engagement, and promote legacy through a combination of interventions. With all that said, these decisions come down to what family and patient find most appropriate and engaging. None of these themes should be deemed unimportant.

In closing, I leave the decision regarding Doll Therapy to our readers and their families. There are certainly documented benefits, but there are also emotional costs for loved ones, and possible dignity concerns. Feel confident in your educated decisions, and know that people may disagree with you.  Diversity in care will only improve how we as a society continue to view individuals with dementia. We must above all remain open-minded, continually educated, and focused on the continued well being of our loved ones.

By Thomas Baird, LCSW, MDiv

Quick reminder: In this space, we will regularly be writing about topics pertinent to dementia care, while focusing on articles, books, or online publications that have caught our attention.  See our first post for more details.

​From Creating Moments of Joy Along the Alzheimer’s Journey by Jolene Brackey:  
When a loved one with dementia states that they want to go home, “Give them the hope that they can go home, but give them a reason to stay a little bit longer.” (p 68)
 
Brackey presents one of the most common dilemmas faced by residential care facilities serving individuals in the early stages of dementia; these residents often do not want to stay at the facility.  This is also prevalent for individuals living at home with caregivers. The home might be their own, but it is currently unrecognizable, and they wish to leave.
 
Although they may consistently enjoy being with their caregivers and peers, they will have moments in which they insist on leaving. They will often talk about going home and being with their family. Please know that they are rarely referring to their most recent home. They are often thinking of their childhood home. Sometimes, they describe a fluid amalgamation of their childhood home and other houses in which they’ve resided. They will ask to be with their family members, but the particular family members might change throughout the conversation.  The individual may change their focus from parents to a spouse and maybe even to children. They are less focused on a particular person (“father” becomes “brother”), or a particular place (“home” is a fluid concept), but it is important that they know they can get there and be around people they love. I often assure individuals that their families know where they are. I use their family members' names and their own personal stories to show my familiarity with their life. 
 
For example, a caregiver could say “Yes, I know your brother Joe. He’s the architect right? Yes, he was worried you might be nervous without him and wanted me to let you know where he was. Also, he and I talked earlier, and he told me that you had piano lessons as a child.”  This statement validates the individual’s anxiety, reinforces their sense of safety, and attempts to establish the caregiver as a familiar ally. The reference to the piano lessons gives the individual an opportunity to change the topic if they wish to do so.
 
Offering hope is an essential task for the caregiver. We are obligated to help the individual feel hope for the future as they adjust to the new norm. Whether a patient is living in their own home with a caregiver, in a skilled nursing facility, or in a fancy assisted living community, they have lost an immense amount of independence. Coping is complicated, but a caregiver can help the individual cope by giving that individual purpose (asking for help) and assigning tasks that will help the patient. When a patient has to complete physical therapy regularly, or take care of a pet, they are building toward some kind of future.

Quick reminder: In this space, we will regularly be writing about topics pertinent to dementia care, while focusing on articles, books, or online publications that have caught our attention.  See our first post for more details.

From Creating Moments of Joy Along the Alzheimer’s Journey by Jolene Brackey:  
“You were taught not to lie to your parents under normal circumstances, but these are not normal circumstances. This is a disease that has made this time (younger) in their life their truth. They cannot change their truth no matter how many times you correct them. All you have is this moment. What is the most loving thing to do in this moment? Make them feel better: ‘Mom will be right back.’ Or make them feel worse: ‘Your mom is no longer living.’ Keep changing your answer until you find the one that makes this person feel like everything is perfectly okay.” (p. 64)
 
Thomas: The last sentence is key. There is no correct answer for every person on every occasion. It is important, therefore, to know what could bring peace to this particular person. This is why memory care communities teach their staff to consistently communicate with one another regarding resident patterns and moods.  Communication is vital. If an individual could react with anxiety or agitation to a certain intervention, all involved staff should be aware.

Maggie: Remember that we are entering their world. Even if your words are not true when taken at face value, what you are conveying to them is true. You are conveying that they are safe and everything is okay. Dementia really shakes up everything we thought we knew about how to act, what to say, how to relate, etc. Also, you aren't always going to say or do the right thing. Sometimes no matter what intervention you try, you ultimately have to just sit with the anxiety and let them express it. They might feel like you are not taking them seriously if you brush off their concerns with a simple answer. There are also scary moments where the person with dementia knows they are being lied to and is upset about it, but still cannot accept or understand the truth. During these moments, it is especially important to show that you are listening to them and validating their emotions.