Doll Therapy for Dementia Patients: Good or Bad?

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. 

Figure 2 From "Exploring psychosocial interventions for people with dementia that enhance personhood and relate to legacy- an integrative review"

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.