Today I want to talk about my experience using doll therapy with persons with dementia. I know a lot of people might think giving a doll to an older adult is demeaning or childish, and maybe 15 years ago, I might have agreed. But, as a Recreation Therapist witnessing the level of anxiety, fear and anger some people with dementia outwardly show on a day to day basis, I am willing to try anything to provide some peace and comfort.
I'd like to share a few stories first, with names changed, of course. I was carrying one of the therapy dolls down the hall to try with a particular patient and another patient (we'll call her Mary, who was 90) with mild dementia commented on how cute the doll was. Mary started to talk about her own mother who had dementia. She mentioned how her mom had a doll and would take the doll everywhere with her, even to her 100th birthday party. To Mary, the doll brought back lots of memories of her mother. I didn't really think she would be interested in the doll but I asked Mary if she wanted to hold the doll. She quickly said, "I'd love to". She held the doll lovingly so I asked her if she wanted to keep the doll for a while. She had the biggest smile and said, "Could I?" Mary ended up keeping the doll on her bed and days later told me she cuddled the doll every night. When she felt too anxious in the day, I suggested she hold the doll to decrease her anxiety and it worked really well for her. Mary was someone with mild dementia, yet, the doll provided memories and comfort for her. I was happy she saw me with the doll in the hallway that day since I never would have approached her with the doll due to her not having moderate or later stages of dementia.
Another story I want to share is about John. John was a person with advanced dementia who was often trying to get into the nursing station, was resistive with care and who would often be agitated and restless. I had offered the opportunity for him to hold a doll a few weeks before but he wasn't interested. When the doll was offered to him a few weeks later, it was a game changer. John held the doll lovingly and kissed the dolls cheeks and hands. John's usual behaviour was to wander the halls and hang around the nursing station. With the doll, John would sit for long periods, he needed less medication and he had something to keep him focused. He was definitely happier when he held the doll. One day I asked him how the baby doll was doing and he responded, "He's really good today". It was wonderful to see John enjoying the time taking care of someone, rather than someone taking care of him.
I want to point out it is always good to try therapeutic interventions a few times since the first or second time an intervention is tried, it might just not be a good time for the person. Now that I've shared a few stories, I want to talk about the pros of using doll therapy.
These are the pros I have witnessed and can definitely attest to:
decreases anxiety & stress
provides a distraction (for someone like John, the nursing staff had him hold the doll while he received personal care; this kept John's hands occupied and kept his mind focused on the doll rather than the personal care)
provides nurturing feelings of caring for a baby/child
gives the opportunity for the person to care for someone else rather than someone always taking care of him/her
decrease in wandering
decrease in medications/PRN's
decrease in agitation
improved mood and quality of life
Recommendations when purchasing a doll:
I would like to share a few recommendations when purchasing a doll for your loved one. Purchasing a doll that has a soft body (not a body that is plastic) makes the doll feel more real when cuddling or holding the doll. A doll with plastic hands and feet is great since they'll need to be sanitized and cleaned. The dolls that are 20" or larger feel more real and from my experience are more popular. It's best to purchase a doll that either keeps it's eyes open all the time or one that only closes the eyes when it is on its back. If the eyes are closed all of the time, the person can get very upset thinking the baby has died. Lastly, purchase a doll that doesn't cry or make noises. I made the mistake when I first started on a dementia unit by purchasing a doll that would cry and it didn't go over well with patients (or staff!). If the dolls are being purchased for a residence, purchase dolls to reflect the residents at the home. You can find dolls in a range of ethnicities including African-American, Asian, Caucasian and Hispanic. I have included a link to each of the dolls I have found to work the best. They are around the $40-70 range (the price changes depending on availability). I'm sure there are lots of other dolls that work well, too, but I found these to be the most affordable and popular. There are also dolls online you can find that look very real but are usually more expensive. I have not personally tried these simply because we don't have the budget for them at my workplace. But, they look incredibly real and might be worth trying if you have the budget to buy them. I will include a few for your reference so you understand which dolls I am referring to:
A few things to think about before trying doll therapy (and possible cons):
Before introducing a doll to the person, if possible, obtain family consent first. Some family members can find it difficult coming into the home to see their mom or dad holding a doll, especially if the family member hasn't come to terms with their parent reaching a later stage of the disease. Also, you want to make sure there are no traumatic experiences in their past related to a baby. To be safe, it is best to talk to the family member first and explain why you want to try a doll with the person and explain how it has worked well with other people. At times, obtaining consent first may not work out but do try. For example, where I work, we have lots of dolls on the unit and often times, patients will pick up a doll that someone else has left sitting on a couch. The person may start walking around with the doll and eventually go to sit down and hold the doll lovingly. This often happens which is actually the best way since they have taken the initiative to hold the doll and have shown it is what they want (not what we want).
What to do when introducing the doll:
I have read different articles online about what other people recommend and some people call it is a doll while others call it a baby. Personally, I have always introduced the doll by holding the doll like a real baby and gently offering the doll by saying, "Would you like to hold the baby doll?" This way I am not lying and I am not saying it is a baby or a doll. I am giving them the opportunity to call it what they want. I get many different reactions when offering the doll. Sometimes people will just look at me blankly, others will nod 'no', others will take the doll for a few seconds then pass it back, and then there are some people who ask about the doll/baby and hold it lovingly. I follow their lead and answer questions without lying to them. If they straight out ask me if it is a doll or baby, I always tell them it is a doll then take the opportunity to start a conversation about their children or whether they had dolls when they were younger.
When carrying the doll around where patients/residents can see you, make sure you hold the doll like you would hold a baby. If a person thinks the doll is real, it can be very upsetting to them to see you carrying the baby by a foot or dangling it by an arm. It is important to carry it gently and take it out of view when washing and sanitizing. Ensure other staff is trained about doll therapy as well.
When a person does show that they love having a doll to cuddle, it is wise to recommend to families to purchase a second doll to have on hand. If the doll gets broken, damaged or lost, it is very important to have another one available (one that looks identical). The person could become very upset if their doll goes missing or gets damaged.
What about stuffed animals or companion therapy?
Since we're on the topic of doll therapy, I wanted to mention companion pet therapy (not real dogs/cats) but companion pets created for people with dementia. I occasionally see families coming in with various dog or cat models. The pets are definitely more expensive than dolls but if a person always had a pet, the companion pets might work well. In my experience, the pets work best with people in moderate stages of dementia. I find once the person reaches a later stage, they no longer notice the pet and it just sits on a shelf. During moderate stages, I find the person notices the pet, will call it by name, pet the dog/cat and will talk about it. I don't find these to be as popular as the dolls. It could be due to the pets usually being made of hard plastic inside so they don't feel real. Some will move when they are stroked and some will make sounds. I'll add a link for a dog and cat which I have noticed to be the most popular. They are pricey so I would suggest trying a stuffed animal first to see how your loved one reacts. These are some other options I have seen used:(robotic silver gray cat, robotic orange tiger cat, puppy dog, black lab). Stuffed animals can also work well and should be considered and tried.
What are my thoughts as a Recreation Therapist on doll therapy?
Well, I think you already know my answer. I am definitely in favour of doll therapy. Why? Because I have witnessed hundreds of patients using the dolls over the past 15+ years and I have seen an improved quality of life for those who enjoy the dolls.
What is the harm in trying? If a person doesn't want the doll, they will simply pass it back, or say they don't want it. There is no harm at all in trying. Why would I want to deny smiles, an improved mood and an improved quality of life for a person with dementia? Do I want to see more persons with dementia being less anxious, agitated or scared? Of course! If I can provide a simple therapy like doll therapy to bring more happiness, then of course I want to do that. It requires little work for families or staff other than purchasing a doll, ensuring the doll is clean and giving the doll to the person throughout the day.
When I put myself in the shoes of a person with dementia, I would want my family and staff to do anything needed to ensure I felt loved, cared for and happy. I think about how much happiness my babies brought to me years ago as I held them in my arms. If you've had children, take a moment and think about how you felt as you held your children when they were babies. If I have dementia and a person gives me a doll, and I get to relive that same feeling looking at the doll that I felt looking at my babies then by all means, please give me the doll. To have that feeling of love as I stare at my child (or a doll), I would want that feeling all the time. Isn't the most important thing to make your family member feel loved and happy when they have dementia? I definitely think so.