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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Yilmaz CK, Aşiret GD. The Effect of Doll Therapy on Agitation and Cognitive State in Institutionalized Patients With Moderate-to-Severe Dementia: A Randomized Controlled Study. J Geriatr Psychiatry Neurol 2021; 34:370-377. [PMID: 32552299 DOI: 10.1177/0891988720933353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
ClinicalTrials.gov, ID: NCT04120103 Retrospectively registered on 8 April 2019.
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Affiliation(s)
- Cemile Kütmeç Yilmaz
- Nursing Department, Faculty of Health Science, 175169Aksaray University, Aksaray, Turkey
| | - Güler Duru Aşiret
- Nursing Department, Faculty of Health Science, 175169Aksaray University, Aksaray, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Moyle W, Murfield J, Jones C, Beattie E, Draper B, Ownsworth T. Can lifelike baby dolls reduce symptoms of anxiety, agitation, or aggression for people with dementia in long-term care? Findings from a pilot randomised controlled trial. Aging Ment Health 2019; 23:1442-1450. [PMID: 30474401 DOI: 10.1080/13607863.2018.1498447] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objectives: To compare a lifelike baby doll intervention for reducing anxiety, agitation, and aggression in older people with dementia in long-term care (LTC), with usual facility care; and explore the perceptions of care staff about doll therapy. Method: Pilot, mixed-methods, parallel, randomised controlled trial, with follow-up semi-structured interviews. Thirty-five residents from five LTC facilities in Queensland, Australia were randomised to the lifelike baby doll intervention (three, 30-minute, individual, non-facilitated sessions per week) or usual care. Outcomes were changes in levels of anxiety, agitation, and aggression after the 3-week intervention, and short-term effects at week 1. Following intention-to-treat principles, repeated measure MANOVA was undertaken. Qualitative interviews involved five staff. Results: The doll intervention did not significantly reduce residents' anxiety, agitation, or aggression when compared to usual care at weeks 3 (primary outcome) and 1 (secondary outcome). However, there was a significant group-by-time interaction for the outcome of pleasure - the doll group showed a greater increase in displays of pleasure at week 3 compared to baseline than usual care (F(1,31) = 4.400, p = 0.044; Cohen's d = 0.74). Staff perceived benefits for residents included emotional comfort, a calming effect, and providing a purposeful activity. Perceived limitations were that doll therapy may only be suitable for some individuals, some of the time, and the potential for residents to care for the doll at the expense of their health. Conclusions: Doll therapy can provide some residents with enjoyment and purposeful engagement. Further research should focus on understanding the individual characteristics and circumstances in which residents most benefit.
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Affiliation(s)
- Wendy Moyle
- a Menzies Health Institute Queensland, Griffith University , Nathan , Brisbane, Queensland , Australia.,b School of Nursing and Midwifery, Nathan Campus, Griffith University , Nathan , Brisbane, Queensland , Australia
| | - Jenny Murfield
- a Menzies Health Institute Queensland, Griffith University , Nathan , Brisbane, Queensland , Australia
| | - Cindy Jones
- a Menzies Health Institute Queensland, Griffith University , Nathan , Brisbane, Queensland , Australia.,b School of Nursing and Midwifery, Nathan Campus, Griffith University , Nathan , Brisbane, Queensland , Australia
| | - Elizabeth Beattie
- c School of Nursing, Queensland University of Technology, Kelvin Grove , Brisbane , Queensland , Australia
| | - Brian Draper
- d School of Psychiatry, University of New South Wales , Sydney , Australia
| | - Tamara Ownsworth
- a Menzies Health Institute Queensland, Griffith University , Nathan , Brisbane, Queensland , Australia.,e School of Applied Psychology, Mt Gravatt Campus, Griffith University , Brisbane , Queensland , Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
BACKGROUND There are a number of therapies currently available to assist healthcare professionals and carers with non-pharmacological treatment for people living with dementia. One such therapy that has been growing in clinical practice is doll therapy. Providing dolls to some people living with dementia has the potential to enhance personal well-being through increased levels of communication and engagement with others. Despite its potential for benefits, the practice is currently under-developed in healthcare literature, probably due to varied ethical interpretations of its practice. AIM To undertake a critical review of the published literature on doll therapy, using the Critical Appraisal Skills Programme Checklist (CASP) tool, in order to determine the potential benefits and challenges of this therapy for people living with dementia. DESIGN A comprehensive literature search, incorporating the CINAHL, Medline, Embase, PubMed, Joanna Briggs, Cochrane Library and PsycINFO data bases, was conducted. CONCLUSIONS Despite many commentaries and anecdotal accounts of the practice, this review identified only 11 empirical studies that were eligible. The majority of studies found that the use of dolls could be therapeutic for some people living with dementia by reporting increased levels of engagement, communication and reduction in episodes of distress. Some studies identified limitations to the therapy including; confusion over the ownership of the doll and healthcare professional uncertainty about issues pertaining to autonomy. RELEVANCE TO CLINICAL PRACTICE According to this review, doll therapy has the potential to increase the well-being of some people living with dementia. This review illuminates that some healthcare professionals feel uncomfortable about its use in clinical practice. The operationalisation of doll therapy in clinical practice has been shown to be inconsistent with different approaches to the practice being advocated. This highlights the need for further empirical research to identify best practice and education to increase awareness in both healthcare professional and carer populations.
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Affiliation(s)
- Gary Mitchell
- Dementia Services Northern Ireland & Wales, Four Seasons Health Care, Northern Ireland, United Kingdom; School Of Nursing And Midwifery, Queen's University Belfast, United Kingdom
| | - Brendan McCormack
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom; Buskerud Vestfold University College, Drammen, Norway; University of Technology, Sydney, Australia; School of Medicine & Dentistry, University of Aberdeen, United Kingdom; Department of Nursing, University of Pretoria, South Africa
| | - Tanya McCance
- Institute of Nursing and Health Research, School of Nursing, University of Ulster, Newtownabbey, United Kingdom
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