Of all the nondrug interventions used to help people with Alzheimer’s dementia — such as art therapy, animal therapy, gardening therapy, and music therapy — doll therapy stands out as uniquely controversial.
Used in some nursing homes and memory-care units at senior living facilities, doll therapy involves giving a person with dementia a doll to hold as if it were a baby. Residents might rock the doll, sing to it, and cuddle it. Staff might bring out dolls for residents to share during supervised sessions or give a resident their own doll to keep nearby day and night.
Some residents, particularly those in the middle to late stages of Alzheimer’s dementia, believe the doll is a real baby.
Dolls Can Be a Calming Influence
“We have a special baby doll that one of our former nurses donated to us,” says Mandy Otto, the director of life enrichment for Cambrian Senior Living in Tecumseh, Michigan. “He’s a newborn, and he’s very lifelike. If the energy level for a day is a little higher than normal and the residents are a little more agitated, a lot of times we’ll pull out the special baby. And then we obviously have to be quiet, because he’s sleeping. It really does reduce agitation, not just with the women but also with the men.”
Otto adds, “Some residents have their own dolls, and some of them tuck their dolls into bed at night. We had one resident who was a mother — I think she had eight children. That particular lady would rock the baby, and then she would eventually fall asleep herself. It was very peaceful, very relaxing. I think we all need that.”
Research Shows Positive Benefits
The limited number of studies on doll therapy for dementia have found that it can reduce aggression, obsessive behaviors, wandering, and negative mood, among other benefits, and that it can also improve a person's ability to relate to others. A study published in July 2018 in the International Journal of Geriatric Psychiatry concluded that doll therapy significantly reduced the behavioral and psychological symptoms of dementia as well as caregiver distress.
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Caregivers’ Reactions Are Sometimes Less Than Positive
Still, many caregivers and family members have a viscerally negative reaction to doll therapy.
“There’s quite a bit of stigma, even among professionals, who think you’re treating people with dementia like children by giving them children’s toys to play with,” says Gary Mitchell, PhD, a lecturer at the School of Nursing and Midwifery at Queen’s University Belfast in Northern Ireland and the author of the 2016 book Doll Therapy in Dementia Care: Evidence and Practice.
“But that’s not really true at all,” he says. Living with Alzheimer’s dementia, he says, is like being lost in a sea of dangerous uncertainty. “You don’t really know people anymore. You don’t really know the days of the week. But when you have that doll with you, over a period of time, that can almost be your anchor. That’s the thing you’re responsible for, the thing you remember. And it brings a sense of comfort and attachment.”
The feeling of purpose that doll therapy can offer can be very powerful, Dr. Mitchell emphasizes. For caregivers and family members struggling to find a way to connect with people with dementia, he says, it can also open up an important channel of communication.
Getting Past the Stigma of Doll Therapy
Mitchell understands the stigma around doll therapy: When he first saw it in use about 10 years ago, he saw it as demeaning. “I had a bit of a problem initially with it,” he recalls. “I spent far too much time looking at the doll. My focus was on the doll and not on the person with dementia. But once you shift your gaze, you’ll see that the person who successfully engages in doll therapy will be happier, will be smiling; their communication will be enhanced.”
Since then, Mitchell has become a leading proponent of doll therapy. Some people with advanced Alzheimer’s, he says, are “very, very distressed, very, very unhappy, and prescribed very high doses of behavioral modifying medications.” These drugs, he explains, are strong sedatives that “strip the person of their true senses.” He’s observed that some people who respond well to doll therapy no longer need those medications “because they’re being pacified and sort of settled by their dolls.”
Dolls Can Make Daily Activities and Communication Easier
Having the comfort of a doll’s presence can make activities like bathing and dressing less stressful for both the resident and the caregiver, Mitchell says. It may even improve mealtimes because some people with dementia will eat and drink more when they sit at a table with their doll and attempt to feed it. Doll therapy can promote better sleep because the person tucks in the doll at night. “The thinking is, it’s bedtime for my doll, so it’s also bedtime for me,” Mitchell explains.
Doll therapy may also be able to help a person with advanced Alzheimer’s communicate any physical problems they may be experiencing. “I remember on one occasion, a lady said that her doll’s mouth was very sore and the doll couldn’t eat anything,” Mitchell says. “Later in the day we had a look at the lady’s mouth and realized that she had a dental abscess, which would have been incredibly painful. The lady denied that she herself was in pain, but she was able to communicate that through the doll.”
Getting Started: Let the Person with Dementia Lead the Way
When initiating doll therapy, it’s important to let the person with dementia take the lead. “If you’re presenting a doll to somebody, don’t tell them it’s a living baby if that’s not what they want or perceive,” Mitchell says. “Generally the way we introduce the therapy is we provide the dolls in a space that the person can access on their own, so they can go over and look at it. When we present the doll to the person directly, we would never say that it’s a human being, but we always hold and cradle it in a way that would not distress the person if they did think it was a baby.”
It’s important not to force the doll on anyone. “Often what we do is present the doll to one person and just watch their eyes to see if they’re interested,” notes Mitchell. “Some people, even at an advanced stage of dementia, will know it’s a doll and will not want it. But some people, their eyes light up, and we’ll ask, 'Do you want to have a hold?' You can tell in the first few minutes if there’s real joy.”
It can be very difficult to predict whether someone is going to attach to a doll or not, Mitchell says. The evidence seems to suggest that doll therapy is more effective in women in the middle to late stages of dementia, he adds, “but that’s not to say men can’t engage with it or that you need to have a strong maternal or paternal background. I’ve seen people engage with it who have never had any young family.”
Potential Complications of Doll Therapy
If the person does believe a doll to be a baby, caregivers and family members need to go along with that perception by handling the doll gently and delicately. “There have been occasions in my practice where I’ve seen people come to see their loved one in the retirement home and they would just lift the doll by the leg quite aggressively,” Mitchell says. “The person with dementia would become very upset by seeing this because they would perceive this as a person lifting a living baby by the leg.”
Mitchell points out that doll therapy needs to be carefully planned, evaluated, and monitored because of the potential complications: “There’s definitely evidence of fatigue, when the person is so tired caring for the baby that they cannot look after themselves.” One study, he says, found an association between dolls and an increase in falls, because fatigue made people less steady on their feet. He’s also found that people may become distressed if they can’t find a doll because a caregiver has taken it away to wash it, for instance. “Doll therapy provides a lot of stimulus and a lot of meaningful activity that a person can lead themselves,” Mitchell says, “but it can sometimes go the other way.”
Growing Interest, but More Funding Needed for Research
While Mitchell believes that more long-term care facilities are showing an interest in using doll therapy as another tool in their kit, the continuing stigma has made funders unwilling to support needed research that would help identify the most effective and safest approaches.
Still, family members who may initially have had their doubts about doll therapy often come to deeply appreciate it. Mitchell reports that some even choose to bury a loved one with a cherished doll, “as a sign of a real, everlasting sort of friendship.”