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Peng Y, Liu Y, Guo Z, Zhang Y, Sha L, Wang X, He Y. Doll therapy for improving behavior, psychology and cognition among older nursing home residents with dementia: A systematic review and meta-analysis. Geriatr Nurs 2024; 55:119-129. [PMID: 37980780 DOI: 10.1016/j.gerinurse.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE To explore the effectiveness of doll therapy (DT) on behavior, psychology and cognition among older nursing home residents with dementia. METHODS A systematic review and meta-analysis was conducted. Subgroup analyses were performed to determine whether the intervention characteristics influenced effect sizes. RESULTS Ten studies met the inclusion criteria and were selected for qualitative and quantitative synthesis. The overall methodological quality was relatively high. DT significantly improved all behaviors [SMD=-0.42, P=0.01], including agitation [SMD=-0.94, P<0.001], apathy, irritability and wandering, and psychological states (i.e., pleasure, anxiety and depression). However, there was no significant difference in the improvement of cognition. Subgroup analyses revealed that the DT process employing empathy dolls and coordinating with caregivers was more beneficial for improving all behaviors (P=0.01; P=0.02). CONCLUSION DT significantly reduced behavioral and psychological disturbances among older nursing home residents with dementia. Specifically, administering empathy dolls and coordinating with caregivers may be the most appropriate and effective option.
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Affiliation(s)
- Yu Peng
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yang Liu
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Zhongxian Guo
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yuhan Zhang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Liyan Sha
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Xiaorun Wang
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yang He
- School of Nursing, Dalian Medical University, Dalian, Liaoning, China
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Vaillant-Ciszewicz AJ, Lantermino L, Quin C, Cuni A, Guerin O. [Setting up, running and evaluating NMIs as part of the "ageing well" project]. SOINS. GERONTOLOGIE 2023; 28:13-23. [PMID: 37977760 DOI: 10.1016/j.sger.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Non-drug interventions (NDIs) are recommended as a first-line treatment in gerontology to address the psychological and behavioral symptoms of dementia. This article illustrates the NMIs implemented, how they are carried out and how they are evaluated as part of the Bien vieillir project at Nice University Hospital.
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Affiliation(s)
| | | | - Cassandra Quin
- Projet Bien vieillir, Laboratoire CoBTeK EA 72-76, France
| | - Alice Cuni
- Projet Bien vieillir, Laboratoire CoBTeK EA 72-76, France
| | - Olivier Guerin
- Inserm U1081, IRCAN, CNRS UMR 7284, Université Côte-d'Azur, CHU de Nice, 4 avenue Reine-Victoria, 06000 Nice, Alpes-Maritimes, France
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Martínez-Contreras CA, Moreno-Fergusson ME. [Quality of life in institutionalized older adults with moderate to severe major neurocognitive disorder: Effect of Doll therapy]. Rev Esp Geriatr Gerontol 2023; 58:101410. [PMID: 37826931 DOI: 10.1016/j.regg.2023.101410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 07/22/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Major neurocognitive disorder is characterized by progressive cognitive impairment, a decrease in the person's ability to perform activities of daily living and the appearance of psychological and behavioral symptoms that lead to a deterioration in the quality of life and progression towards institutionalization. The most common management of major neurocognitive disorder is pharmacological therapy that mitigates or slow progressive deterioration and symptom control. The objective of this study was to establish the effect of a nursing intervention based on Doll therapy, compared to conventional care on the quality of life of older adults with moderate to severe major neurocognitive disorder institutionalized in nursing homes in the city of Medellín, Colombia. METHODS Pilot experimental study with two groups and pretest post-test measurement. The sample consisted of 26 institutionalized elderly adults with advanced-stage major neurocognitive disorder, randomly assigned to each group. The experimental group received Doll therapy, based nursing therapy, while the comparison group continued to receive conventional therapy according to the institution's protocol. The QUALID instrument was used, which was evaluated by professionals external to the care centers. RESULTS The comparison of the groups, before and after the intervention, indicates that the experimental group showed a positive effect on quality of life, supported by the statistical significance of the data, with a moderate effect. CONCLUSIONS The Doll therapy as a non-pharmacological therapy has a positive effect on the quality of life of patients with moderate to severe major neurocognitive disorder, which constitutes a contribution to strengthen the knowledge associated with the effects or this intervention.
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Affiliation(s)
- Carmen Alicia Martínez-Contreras
- Enfermería, Universidad de La Sabana; Enfermería, Universidad de Sucre, Medellín, Antioquia, Colombia; Facultad de Enfermería y Rehabilitación, Universidad de La Sabana, Chía, Cundinamarca, Colombia.
| | - María Elisa Moreno-Fergusson
- Facultad de Enfermería y Rehabilitación, Universidad de La Sabana, Chía, Cundinamarca, Colombia; Enfermería, Universidad de la Sabana; Facultad de Enfermería y Rehabilitación, Universidad de La Sabana, Chía, Cundinamarca, Colombia
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Koh WQ, Vandemeulebroucke T, Gastmans C, Miranda R, Van den Block L. The ethics of pet robots in dementia care settings: Care professionals' and organisational leaders' ethical intuitions. Front Psychiatry 2023; 14:1052889. [PMID: 36756218 PMCID: PMC9899814 DOI: 10.3389/fpsyt.2023.1052889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Pet robots are gaining momentum as a technology-based intervention to support the psychosocial wellbeing of people with dementia. Current research suggests that they can reduce agitation, improve mood and social engagement. The implementation of pet robots in care for persons with dementia raises several ethical debates. However, there is a paucity of empirical evidence to uncover care providers' ethical intuitions, defined as individuals' fundamental moral knowledge that are not underpinned by any specific propositions. OBJECTIVES Explore care professionals' and organisational leaders' ethical intuitions before and when implementing pet robots in nursing homes for routine dementia care. MATERIALS AND METHODS We undertook a secondary qualitative analysis of data generated from in-depth, semi-structured interviews with 22 care professionals and organisational leaders from eight nursing homes in Ireland. Data were analysed using reflexive thematic analysis. Ethical constructs derived from a comprehensive review of argument-based ethics literature were used to guide the deductive coding of concepts. An inductive approach was used to generate open codes not falling within the pre-existing concepts. FINDINGS Ethical intuitions for implementing pet robots manifested at three levels: an (1) individual-relational, (2) organisational and (3) societal level. At the individual-relational level, ethical intuitions involved supporting the autonomy of residents and care providers, using the robots to alleviate residents' social isolation, and the physical and psychosocial impacts associated with their use. Some care providers had differing sentiments about anthropomorphizing pet robots. At the organisational level, intuitions related to the use of pet robots to relieve care provision, changes to the organisational workflow, and varying extents of openness amongst care providers to use technological innovations. At the societal level, intuitions pertained conceptions of dementia care in nursing homes, and social justice relating to the affordability and availability of pet robots. Discrepancies between participants' ethical intuitions and existing philosophical arguments were uncovered. CONCLUSION Care professionals and organisational leaders had different opinions on how pet robots are or should be implemented for residents with dementia. Future research should consider involving care practitioners, people with dementia, and their family members in the ethics dialogue to support the sustainable, ethical use of pet robots in practice.
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Affiliation(s)
- Wei Qi Koh
- College of Nursing, Medicine, and Health Sciences, University of Galway, Galway, Ireland
| | - Tijs Vandemeulebroucke
- Sustainable AI Lab, Institut für Wissenschaft und Ethik, University of Bonn, Bonn, Germany
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Rose Miranda
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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Molteni V, Vaccaro R, Ballabio R, Ceppi L, Cantù M, Ardito RB, Adenzato M, Poletti B, Guaita A, Pezzati R. Doll Therapy Intervention Reduces Challenging Behaviours of Women with Dementia Living in Nursing Homes: Results from a Randomized Single-Blind Controlled Trial. J Clin Med 2022; 11:jcm11216262. [PMID: 36362489 PMCID: PMC9654994 DOI: 10.3390/jcm11216262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Doll therapy (DT) is a non-pharmacological intervention for the treatment of the behavioural and psychological symptoms of dementia (BPSD). We designed a single-blind randomized controlled trial of the 30-day efficacy of DT in reducing the BPSD, professional caregivers’ distress and patients’ biomarkers of stress, and in improving the exploration and caregiving behaviours. Methods: We randomly assigned 134 women with moderate-to-severe dementia living in nursing homes (NHs) to a DT intervention (DTI, 67) or a sham intervention with a cube (SI, 67). Results: From the first to the 30th session, the DTI group showed a significant decrease in the Neuropsychiatric Inventory-NH (NPI-NH) total score and in the NPI-NH-Distress score compared to the SI group (both p < 0.001). We observed a greater interest in the doll than in the cube, a greater acceptance of a separation from the nurse among DTI participants, and caregiving and exploratory behaviours towards the doll. There were no differences between the groups in the stress biomarkers. Conclusions: Consistent with attachment theory, our findings support the 30-day efficacy of DT, as this non-pharmacological intervention promotes perceptions of security by creating a situation in which patients feel confident and engaged in a caregiving relationship with the doll and reduces the challenging behaviours that are stressful for professional caregivers.
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Affiliation(s)
- Valentina Molteni
- Dipartimento di Economia Aziendale e Socio Sanitaria (SUPSI), Centro Competenza Anziani, 6928 Manno, Switzerland
- GINCO Ticino Association, 6802 Monteceneri, Switzerland
| | - Roberta Vaccaro
- GINCO Ticino Association, 6802 Monteceneri, Switzerland
- Golgi Cenci Foundation, 20081 Abbiategrasso, Italy
| | - Roberta Ballabio
- Dipartimento di Economia Aziendale e Socio Sanitaria (SUPSI), Centro Competenza Anziani, 6928 Manno, Switzerland
- GINCO Ticino Association, 6802 Monteceneri, Switzerland
| | - Laura Ceppi
- GINCO Ticino Association, 6802 Monteceneri, Switzerland
- School of Cognitive Therapy, 22100 Como, Italy
| | - Marco Cantù
- Ente Ospedaliero Cantonale, Istituto di Medicina di Laboratorio (EOLAB), 6500 Bellinzona, Switzerland
| | - Rita B. Ardito
- Department of Psychology, University of Turin, 10124 Turin, Italy
- Correspondence:
| | - Mauro Adenzato
- Department of Psychology, University of Turin, 10124 Turin, Italy
| | - Barbara Poletti
- Laboratory of Neuroscience, Department of Neurology, Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy
| | | | - Rita Pezzati
- Dipartimento di Economia Aziendale e Socio Sanitaria (SUPSI), Centro Competenza Anziani, 6928 Manno, Switzerland
- GINCO Ticino Association, 6802 Monteceneri, Switzerland
- School of Cognitive Therapy, 22100 Como, Italy
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Siniora DN, Timms O, Ewuoso C. Managing feeding needs in advanced dementia: perspectives from ethics of care and ubuntu philosophy. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2022; 25:259-268. [PMID: 35253096 DOI: 10.1007/s11019-022-10073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
The response to feeding needs in advanced dementia patients is a subject of ethical inquiry. Advanced dementia is the debilitating result of a range of neurodegenerative diseases. As this terminal illness progresses, patients develop mild to severe dysphagia that can make swallowing difficult. Of the two available options, artificial tube feeding or oral hand feeding, an estimated one-third of these patients will receive artificial tube feeding. However, observational studies have failed to validate the clinical benefits of tube feeding. Ethics of care, the feminist philosophical perspective, and Ubuntu philosophy offer arguments for the choice of oral hand-feeding as a preferrable first option by caregivers as far as possible. These moral theories acknowledge that human beings can be dependent for long periods, mostly early and later years of life. Both views reflect an approach that draws people into a system of interdependent caring relationships. They encourage hand feeding as a way of exhibiting solidarity and respecting human dignity even at the end of life.
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Affiliation(s)
| | - Olinda Timms
- Division of Health and Humanities, St Johns' Research Institute, Bangalore, India
| | - Cornelius Ewuoso
- Steve Biko Centre for Bioethics, University of Witwatersrand, Gauteng, South Africa
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Martín-García A, Corregidor-Sánchez AI, Fernández-Moreno V, Alcántara-Porcuna V, Criado-Álvarez JJ. Effect of Doll Therapy in Behavioral and Psychological Symptoms of Dementia: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10030421. [PMID: 35326899 PMCID: PMC8950087 DOI: 10.3390/healthcare10030421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 01/25/2023] Open
Abstract
(1) Background: Behavioral and psychological symptoms of dementia (BPSD) are a threat for people with dementia and their caregivers. Doll therapy is a non-pharmacological person-centered therapy to promote attachment, company, and usefulness with the aim of minimizing challenging behaviors. However, the results are not clear. (2) Objective: To know the effectiveness of doll therapy in reducing behavioral and psychological symptoms of people with dementia at a moderate-severe phase. (3) Methodology: The systematic review was informed according to the criteria established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Searches were conducted in eight databases: Cochrane, PubMed, Web of Science, Cinahl, Embase, Lilacs, PeDro, and Scopus before October 2021. Studies were selected when they accomplished the simple majority of Consolidated Standards of Reporting Trials (CONSORT). The risk of bias was appraised with the Cochrane Collaboration Risk of Bias Tool. The review protocol was recorded in Inplasy:1539. (4) Results: The initial search strategy showed 226 relevant studies, 7 of which met the eligibility criteria. In the included studies, a total number of 295 participants (79% female) with a mean age of 85 years were enrolled. There was found to be a reduction in challenging and aggressive behaviors, the participants were less rough and irritable, and their communication skills and emotional state were also improved. (5) Conclusion: Our findings suggest that doll therapy improves the emotional state of people with dementia, diminishes disruptive behaviors, and promotes communication. However, randomized studies with a larger sample size and higher methodological rigor are needed, as well as follow-up protocols in order to reaffirm these results.
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Affiliation(s)
| | - Ana-Isabel Corregidor-Sánchez
- Faculty of Health Sciences, University of Castilla la Mancha, 45600 Talavera de la Reina, Spain;
- Correspondence: ; Tel.: +34-902904100
| | | | - Vanesa Alcántara-Porcuna
- Faculty of Health Sciences, University of Castilla la Mancha, 45600 Talavera de la Reina, Spain;
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Virameteekul S, Bhidayasiri R. Doctor Hope; Calming and Comforting Loneliness in Parkinson’s Disease. Clin Park Relat Disord 2022; 6:100131. [PMID: 35072053 PMCID: PMC8760705 DOI: 10.1016/j.prdoa.2022.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/07/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022] Open
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Santagata F, Massaia M, D'Amelio P. The doll therapy as a first line treatment for behavioral and psychologic symptoms of dementia in nursing homes residents: a randomized, controlled study. BMC Geriatr 2021; 21:545. [PMID: 34641791 PMCID: PMC8507228 DOI: 10.1186/s12877-021-02496-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Patients living with dementia are severely affected by the development of behavioral and psychologic symptoms (BPSD) which represent a burden for patients and caregivers. The use of psychotropic drugs in the control of BPSD is widely diffused, however the use of a first line non-pharmacologic approach is highly recommended. Here we evaluate the effect of doll therapy (DT) in the management of BPSD, on the reduction of caregiver burden and delirium incidence in nursing home residents by a randomized controlled trial. Methods We enrolled fifty-two nursing homes residents living with dementia and BPSD. Subjects were randomized to DT (26) or standard treatment (ST, 26), we measured BPSD, caregiver burden and delirium with standard clinical scales at baseline, after 45 and 90 days. In order to evaluate the presence of BPSD we used Neuropsychiatric Inventory (NPI) scale and the A.Di.CO scale, the caregiver burden was measured by the Greutzner scale and delirium by the Confusion Assessment Method (CAM) scale. Results DT was more effective in reducing agitation and aggressiveness as respect to ST. Moreover DT globally reduced the presence of BPSD as dysphoria, wandering and apathy. We observed a significant reduction of the professional caregiver burden and the incidence of delirium was significantly reduced in subjects treated with DT. Conclusions We show that DT is more effective that ST in the control of BSPD in patients affected by moderate to severe dementia. Moreover we suggest that DT may effective in reducing the incidence of delirium. Trial registration Retrospectively registered in ClinicalTrials.gov the 10th June 2, 2021 trial registration number NCT04920591.
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Affiliation(s)
- Francesca Santagata
- Department of Medical Science, Geriatric and Bone Diseases Unit, University of Turin, corso Dogliotti 14, 10126, Torino, Italy
| | - Massimiliano Massaia
- Department of Medical Science, Geriatric and Bone Diseases Unit, University of Turin, corso Dogliotti 14, 10126, Torino, Italy
| | - Patrizia D'Amelio
- Department of Medical Science, Geriatric and Bone Diseases Unit, University of Turin, corso Dogliotti 14, 10126, Torino, Italy. .,Department of Medicine, Service of Geriatric Medicine & Geriatric Rehabilitation, University of Lausanne Hospital (CHUV), Lausanne, Switzerland.
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Sumioka H, Yamato N, Shiomi M, Ishiguro H. A Minimal Design of a Human Infant Presence: A Case Study Toward Interactive Doll Therapy for Older Adults With Dementia. Front Robot AI 2021; 8:633378. [PMID: 34222346 PMCID: PMC8247474 DOI: 10.3389/frobt.2021.633378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/21/2021] [Indexed: 12/01/2022] Open
Abstract
We introduce a minimal design approach to manufacture an infant-like robot for interactive doll therapy that provides emotional interactions for older people with dementia. Our approach stimulates their imaginations and then facilitates positive engagement with the robot by just expressing the most basic elements of humanlike features. Based on this approach, we developed HIRO, a baby-sized robot with an abstract body representation and no facial features. The recorded voice of a real human infant emitted by robots enhances the robot’s human-likeness and facilitates positive interaction between older adults and the robot. Although we did not find any significant difference between HIRO and an infant-like robot with a smiling face, a field study showed that HIRO was accepted by older adults with dementia and facilitated positive interaction by stimulating their imagination. We also discuss the importance of a minimal design approach in elderly care during post–COVID-19 world.
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Affiliation(s)
- Hidenobu Sumioka
- Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Nobuo Yamato
- Japan Advanced Institute of Science and Technology, Ishikawa, Japan
| | - Masahiro Shiomi
- Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Hiroshi Ishiguro
- Advanced Telecommunications Research Institute International, Kyoto, Japan.,Graduate School of Engineering Science, Osaka University, Osaka, Japan
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Carcavilla González N, García Meilán JJ. [Design and validation of two scales about attitudes and knowledge regarding doll therapy in dementia]. Rev Esp Geriatr Gerontol 2020; 55:206-211. [PMID: 32249006 DOI: 10.1016/j.regg.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Non-pharmacological interventions are often the subject of debate in the scientific field. Therefore, it is essential to know the attitudes that health professionals have towards the novel Doll Therapy in Dementia (DTD). The objective of this study was to design and validate two questionnaires to find out the attitudes and knowledge on DTD in health professionals. MATERIAL AND METHODS A total of 120 Spanish-speaking Geriatrics and Gerontology professionals, with a mean age of 38.3 years (DT = 10.99), participated, mostly women (88.3%). A questionnaire (TCM_DEMCO) on knowledge about the DTD and a questionnaire (TCM_DEMAC) on attitudes towards the DTD were designed and applied. The construct validity was assessed by exploratory factor analysis, and reliability was calculated using Cronbach's α. RESULTS The exploratory factor analysis of the TCM_DEMCO questionnaire retained 10 items in 5 factors ("environment and dementia", "therapeutic application", "activities", "methodology" and "benefits and implications") that explained 70.1% of the total variability, giving a Cronbach α coefficient value > 0.50. The exploratory factor analysis of the TCM_DEMAC questionnaire retained 10 items in two factors ("positive attitudes" and "negative attitudes") that explained 61.2% of the total variability, giving a Cronbach α value > 0.85. CONCLUSIONS Both questionnaires are a brief tool to learn about the attitudes and knowledge of Spanish-speaking Geriatrics and Gerontology professionals in matters of DTD. The reliability and validity analyses performed showed good psychometric properties of these tools.
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Vaccaro R, Ballabio R, Molteni V, Ceppi L, Ferrari B, Cantù M, Zaccaria D, Vandoni C, Ardito RB, Adenzato M, Poletti B, Guaita A, Pezzati R. Doll therapy intervention for women with dementia living in nursing homes: a randomized single-blind controlled trial protocol. Trials 2020; 21:133. [PMID: 32014029 PMCID: PMC6998291 DOI: 10.1186/s13063-020-4050-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Doll therapy is a non-pharmacological intervention for people with dementia aimed to reduce distressing behaviours. Reliable results on the efficacy of Doll therapy for people with dementia are needed. The concept of attachment theorised by Bowlby has been proposed to explain the Doll therapy process, but it has not been proven to influence the response to doll presentation. METHODS/DESIGN This single-blind, randomised controlled trial will involve people with dementia living in nursing homes of the Canton Ticino (Switzerland). Participants will be randomised to one of two interventions: Doll Therapy Intervention or Sham Intervention with a non-anthropomorphic object, using a 1:1 allocation ratio. The two interventions will consist of 30 daily sessions lasting an hour at most, led by a trained nurse for an hour at most. We will enrol 64 participants per group, according to power analysis using an estimated medium effect size (f = 0.25), an alpha level of 0.05, and a power of 0.8. The primary goal is to test the efficacy of the Doll Therapy Intervention versus the Sham Intervention as the net change in the following measures from baseline to 30 days (blinded outcomes): the Neuropsychiatric Inventory-Nursing Home administered by a trained psychologist blinded to group assignment, the professional caregivers' perceived stress scale of the Neuropsychiatric Inventory-Nursing Home, patients' physiological indices of stress (salivary cortisol, blood pressure and heart rate) and interactive behaviours. The secondary goal is to assess the relationship between attachment styles of people with dementia (detected by means of the Adult Attachment Interview to the patients' offspring) and their caregiving behaviours shown during the Doll Therapy Intervention. DISCUSSION This is the first single-blind, randomised controlled trial on the efficacy of Doll therapy for dementia and an explanatory model of the response of people with dementia to doll presentation. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03224143. Retrospectively registered on 21 July 2017.
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Affiliation(s)
- Roberta Vaccaro
- Golgi Cenci Foundation, Corso San Martino 10, 20081, Abbiategrasso, Italy.
| | - Roberta Ballabio
- Dipartimento di Economia Aziendale e Socio Sanitaria (SUPSI), Centro Competenza Anziani, Manno, Switzerland
| | - Valentina Molteni
- Dipartimento di Economia Aziendale e Socio Sanitaria (SUPSI), Centro Competenza Anziani, Manno, Switzerland
| | | | - Benedetta Ferrari
- Dipartimento di Medicina di Laboratorio EOLAB, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Marco Cantù
- Dipartimento di Medicina di Laboratorio EOLAB, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Daniele Zaccaria
- Golgi Cenci Foundation, Corso San Martino 10, 20081, Abbiategrasso, Italy
| | | | - Rita Bianca Ardito
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | - Mauro Adenzato
- Department of Psychology, University of Turin, Turin, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Antonio Guaita
- Golgi Cenci Foundation, Corso San Martino 10, 20081, Abbiategrasso, Italy
| | - Rita Pezzati
- Dipartimento di Economia Aziendale e Socio Sanitaria (SUPSI), Centro Competenza Anziani, Manno, Switzerland.,School of Cognitive Therapy, Como, Italy
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Enhancing theory of mind in behavioural variant frontotemporal dementia with transcranial direct current stimulation. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2019; 18:1065-1075. [PMID: 29995274 DOI: 10.3758/s13415-018-0622-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Behavioural variant frontotemporal dementia (bvFTD) is a form of frontotemporal degeneration characterized by early changes in personality, emotional blunting, and/or loss of empathy. Recent research has highlighted that these features may be at least partially explained by impairments in the theory of mind (ToM; i.e., the ability to understand and predict other people's behaviour by attributing independent mental states to them). The aim of this randomized, double-blind, placebo-controlled study was to test the hypothesis that transcranial direct current stimulation (tDCS) over the medial frontal cortex (MFC) selectively enhances communicative intention processing, a specific ToM ability. Using a single-session online design, we administered a ToM task that measures the ability to represent other people's private and communicative intentions during active or sham tDCS to 16 bvFTD patients. To assess the impact of dementia on performance on the ToM task, we included 16 age-matched healthy volunteers who were asked to perform the entire experimental ToM task. BvFTD is characterized by an impairment in the comprehension of both communicative and private intentions relative to a healthy control group and by a disproportional impairment in communicative intention compared with private intention processing. Significant and selective accuracy improvement in the comprehension of communicative intentions after active stimulation was observed in patients with bvFTD. This is the first study that analyses ToM ability in patients with bvFTD using tDCS stimulation. Our findings could potentially contribute to the development of an effective, noninvasive brain stimulation treatment of ToM impairments in patients with bvFTD.
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Balzotti A, Filograsso M, Altamura C, Fairfield B, Bellomo A, Daddato F, Vacca RA, Altamura M. Comparison of the efficacy of gesture-verbal treatment and doll therapy for managing neuropsychiatric symptoms in older patients with dementia. Int J Geriatr Psychiatry 2019; 34:1308-1315. [PMID: 30136743 PMCID: PMC6766963 DOI: 10.1002/gps.4961] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/25/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The prevalence of neuropsychiatric symptoms (NPS) diminishes the quality of life and increases the care burden in patients with dementia. Despite the clinical importance of dementia-associated NPS, no protocols for treating NPS are already well established. Attention has turned to the effectiveness of nonpharmacological treatments for NPS since their potential safe alternative to pharmacotherapy. OBJECTIVE This study is aimed to compare the effects in older individuals with dementia living in a residential care, of two intervention programs, the gesture-verbal treatment (GVT), a treatment implemented by us on a previous method for word retrieval in individuals with aphasia, and the better-known doll therapy (DT). The GVT would act on both receptive and expressive language skills, the DT on attachment and emotional connections. METHODS We evaluated NPS by the neuropsychiatric inventory in a total of 30 patients divided into 3 groups, the GVT, the DT, and control groups, using a pre-post design. The treatment groups completed 12-week nonpharmacological interventions in addition to standard rehabilitative therapies, while the control group participated only in standard rehabilitative therapies. RESULTS The DT group showed significant improvements in agitation, irritability, apathy, depression, and delusions relative to controls. The GVT group showed significant improvements in apathy and depression with respect to controls. The DT intervention ameliorated symptoms of agitation compared to the GVT intervention whereas the GVT intervention improved apathy compared to the DT intervention. CONCLUSION Improved understanding of the potential therapeutic benefits of different treatments for neuropsychiatric symptoms is crucial for establishing nonpharmacological interventions in dementia.
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Affiliation(s)
- Angela Balzotti
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
| | - Marianna Filograsso
- Residenza Sociosanitaria Assistenziale per Anziani “Aurelia e Silvestro Storelli”BisceglieItaly
| | - Claudia Altamura
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
| | - Beth Fairfield
- Department of Psychological, Health and Territorial SciencesUniversity of ChietiChietiItaly,Center of Excellence on Aging and Translational Medicine (CeSI‐MeT)University of ChietiChietiItaly
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
| | - Fabio Daddato
- Residenza Sociosanitaria Assistenziale per Anziani “Aurelia e Silvestro Storelli”BisceglieItaly
| | - Rosa Anna Vacca
- Institute of Biomembranes Bioenergetics and Molecular Biotechnologies, Italian National Research Council (CNR)BariItaly
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
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Cantarella A, Borella E, Faggian S, Navuzzi A, De Beni R. Using dolls for therapeutic purposes: A study on nursing home residents with severe dementia. Int J Geriatr Psychiatry 2018; 33:915-925. [PMID: 29671901 DOI: 10.1002/gps.4872] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Among the psychosocial interventions intended to reduce the behavioral and psychological symptoms of dementia (BPSD), doll therapy (DT) is increasingly used in clinical practice. Few studies on DT have been based on empirical data obtained with an adequate procedure; however, none have assessed its efficacy using an active control group, and the scales used to assess changes in BPSD are usually unreliable. The aim of the present study was to measure the impact of DT on people with severe dementia with a reliable, commonly used scale for assessing their BPSD, and the related distress in formal caregivers. Effects of DT on the former's everyday abilities (ie, eating behavior) were also examined. METHOD Twenty-nine nursing home residents aged from 76 to 96 years old, with severe dementia (Alzheimer's or vascular dementia), took part in the experiment. They were randomly assigned to an experimental group that used dolls or an active control group that used hand warmers with sensory characteristics equivalent to the dolls. Benefits of DT on BPSD and related formal caregiver distress were examined with the Neuropsychiatric Inventory. The effects of DT on eating behavior were examined with the Eating Behavior Scale. RESULTS Only the DT group showed a reduction in BPSD scores and related caregiver distress. DT did not benefit eating behavior, however. CONCLUSIONS This study suggests that DT is a promising approach for reducing BPSD in people with dementia, supporting evidence emerging from previous anecdotal studies.
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Affiliation(s)
- A Cantarella
- Department of General Psychology, University of Padova, Italy
| | - E Borella
- Department of General Psychology, University of Padova, Italy
| | - S Faggian
- Centro Servizi Anni Sereni di Scorzé, Venezia, Italy
| | - A Navuzzi
- Department of General Psychology, University of Padova, Italy
| | - R De Beni
- Department of General Psychology, University of Padova, Italy
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Hu M, Zhang P, Leng M, Li C, Chen L. Animal-assisted intervention for individuals with cognitive impairment: A meta-analysis of randomized controlled trials and quasi-randomized controlled trials. Psychiatry Res 2018; 260:418-427. [PMID: 29268204 DOI: 10.1016/j.psychres.2017.12.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/10/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
The aim of this meta-analysis was to systematically examine the efficacy of animal-assisted intervention (AAI) for cognitive impairment patients. PubMed, Embase, the Cochrane library, PsycINFO, and Web of Science databases were searched up to June 2017 to collect studies related to AAI conducted in patients with cognitive impairment. Five randomized controlled trials (RCTs) and five quasi-randomized controlled trials (quasi-RCTs) involving 413 participants were included. Compared with control groups, AAI groups exhibited significantly fewer behavioral and psychological symptoms of dementia (BPSD), especially depression and agitation. In both the short and long term, AAI had beneficial effects on BPSD in cognitive impairment patients. However, no significant improvements were found in daily living activities, quality of life or cognitive score. The present meta-analysis showed that AAI can be effective in reducing BPSD in patients with cognitive impairment.
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Affiliation(s)
- Mingyue Hu
- College of Nursing, Jilin University, Changchun, China
| | - Ping Zhang
- College of Nursing, Jilin University, Changchun, China
| | - Minmin Leng
- College of Nursing, Jilin University, Changchun, China
| | - Chen Li
- College of Nursing, Jilin University, Changchun, China
| | - Li Chen
- College of Nursing, Jilin University, Changchun, China; Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun, China.
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Cognitive Training in a Large Group of Patients Affected by Early-Stage Alzheimer's Disease can have Long-Lasting Effects: A Case-Control Study. BRAIN IMPAIR 2016. [DOI: 10.1017/brimp.2016.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction: Cognitive training in Alzheimer's disease (AD) has recently started to demonstrate its efficacy. We used our ‘puzzle-like’ task (GEO) as training for a large group of early-stage AD patients, to detect its effects over time.Method: AD patients (N = 40) and healthy controls (N = 40) were involved. Participants were administered the Geographical Exercises for cognitive Optimization (GEO) task. Participants underwent individual sessions with GEO three times a week for 2 months, and then their performance was recorded again. Lastly, at the 12-month follow-up the GEO task was administered for the last time.Results: Patients’ scores were significantly worse than controls’ scores only on a few neuropsychological tests. We ran a repeated measures GLM by considering groups’ performance on the GEO task at the assessment points. Results showed a significant main effect of group, and a significant effect of the interaction between group and time: patients’ performances both at the end of the training and at the follow-up were virtually identical to controls’ performances.Conclusions: Patients effectively acquired new procedural abilities, and their achievements were stable at follow-up. This study suggests the GEO is a useful strategy for cognitive training in AD, and should prompt further investigations about the degree of generalisability of patients’ acquired skills.
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