DEMENTIA GETS DOLLED UP Leah Bisiani – “Uplifting Dementia” – RN.1/Dementia Consultant/MHlthSc

AUTHOR:

“I promote uplifting and joyous environments for people living with dementia, so they continue to live their life as they know it, retaining the spark to live and to thrive during this fragment of the life journey”

Leah Bisiani –

DEMENTIA GETS DOLLED UP:

DEMENTIA GETS DOLLED UP:

Terminology:

• Doll therapy

• Child representation therapy

Focusing on and judging terminology too closely in this instance may be detrimental to the provision of positive care.

DEMENTIA GETS DOLLED UP:

“Imagine for a moment, searching for a distinct place within the world— the harder you search for that space to connect your need for inclusion, the tougher and more puzzling it becomes. Those around you just don’t seem to appreciate your reality, nor provide you with the pleasure or the companionship you so crave and desire. You feel utterly alone, with an overwhelming sense of core suffering and misery— you withdraw into yourself. It is as if you have lost your humanity in the unseeing eyes of those who constantly look through you.

Now, envisage searching desperately for other feelings that represent carefree times that you just know were once part of your existence, but never quite managing to grasp or relive those joyous feelings again.

You sit in the chair in your room, alone, feeling overpoweringly miserable, frustrated, anxious and afraid. You have panic attacks because no one seems to understand you anymore, and they just become annoyed when you try hard to communicate your unhappiness by actions. But you can no longer put these feelings into words. You feel disheartened and cry a lot because you do not feel your life has any meaning any more. Worthlessness intimidates you continually”.

RESEARCH AIMS:

• Examine & evaluate the impact of a doll, used as a therapeutic tool, to improve life

quality/support a person living with dementia’s specific reality

• Evaluate potential benefits of reducing/resolving behavioural expression

• Analyse association with past attachment needs

• Stimulate meaningful communication & social interaction opportunities

• Promote well being as opposed to ill being of an individual

• Dispel the myth

WHY??

Doll therapy supports the individual person, thus may:

• Maintain personhood/the place held in the world

• Enable, enrich & empower by providing meaning, control, symbolic significance

• Provide opportunities to stimulate and express positive emotion

eg. Nurturing, joy, pride, happiness, play

• Improve self worth & self esteem

• Stimulate long term memory, reminiscence & establish links to a long lived life – relive happy carefree times

DEMENTIA GETS DOLLED UP:

Never lose touch with your inner child

IMAGINE HOW IT MUST FEEL:

• Cognitive deficit

• Loss of validation of your humanity

• Searching for a distinct place in the world/isolated

• Craving companionship/attachment/focus

• Unable to communicate need/core suffering/despair

• Losing that spark of life

LITERATURE:

Kitwood, (1997)suggests:

meaning can be given to the lives of people living with dementia & they can definitely respond to favourable attachments related to long term memories.

Miesen’s, (1992) expansion of Bowlby’s, (1969) theories suggests:

those that cling to dolls and soft toys appear to be using these objects as a representation of the personal support they are searching for.

SUITABILITY & RESTRICTIONS:

Do not restrict suitability based on your:

• Cognitive viewpoint

• Assumptions

• Personal judgemental feelings

However use is suitable if the doll:

• is beneficial to the individual

• does not emotionally distress

• provides solace and joy

• improves communication

• reduces behavioural expression

• meets attachment needs

MINIMISING RISK:

Adherence to the philosophy of care underpinning Kitwood’s person centred care approach

Any sign of emotional trauma & the doll would be removed/withdrawn

METHODOLOGY:

Phase 1 – Pre introduction of Doll

• Selection criteria

• Observations for a week regarding behavioural expression

• Collection & analysing of data

• Journal information

• Staff & family involvement/information

• Assessment/Care planning

METHODOLOGY:

Phase 2 – Introduction of Doll

• Doll selection

• ‘Gifting’ of doll to participant

• Nil distractions

• Immediate reaction noted

• Staff/allied health involvement

• Family involvement

• Visitor involvement

METHODOLOGY:

Phase 3: Post introduction of doll

• Observations for a week re behavioural expression

• Collection & analysing of data/journal

• Establish benefit/change re behavioural expression

• Unexpected results – eg. Interaction/mobility

RESEARCH RESULTS:

• Considerable decline in behavioural expression

• Improved communication with staff, residents, family, visitors

• Improved intake & dining experience/weight management

• Improved mobility related to changed focus/decreased anxiety, tremor, tears, panic

• Reduced social isolation & withdrawal

• Improved well being& self worth – delight/joy

• Sense of control & comfort

• Personhood validated & quality of life enhanced

UNEXPECTED RESULTS:

Impact on other residents:

• Approached participant for a nurse

• Asked the infants name

• Initiated conversation - both

• Both men and women involved positively

• Improved community & interaction overall

• Crossed barriers of differing levels of cognitive decline

Staff:

• Reinforced the possibilities open to them as caregivers

• Stimulated further therapeutic interventions

CONCLUSION:

Substantial evidence to support the potential benefits of the use of doll therapy in:

• Reduced behavioural expression such as anxiety & agitation

• Meeting of attachment needs

• Stimulation of the nurturing instinct

• Conversion of ill being to well being

• Retention of personhood

• Improved interaction & maintenance of relationships

• Meeting of bio psychosocial & emotional needs

• Provision of comfort, peace, sense of control

• Resolution/prevention of depression

• Improved physical condition and independence

DISCUSSION:

Doll therapy:

• Has extended our understanding of the use of complementary therapies to inform professional practice

• Promotes opportunities for the exchange of knowledge

• Stimulates further research & promotes best practice

• Encourages change in attitude regarding many alternative therapeutic ways of meeting the specific individual requirements of a person living with dementia

• Demonstrates another valuable way forward in the provision of person centred dementia care

FURTHER INFORMATION:

This research project emerged out of a thesis as part of a Master of Health Science – Aged Services program at Victoria University, Melbourne

The published paper is titled:

“Doll therapy: A therapeutic means to meet past attachment needs and diminish behaviours of concern in a person living with dementia – a case study approach”

This paper supports Killick and Allan’s (2001), view that:

‘it is not the activity itself which dictates the nature and meaning of an experience, but rather the way it is carried out’ (p.115).

DEMENTIA GETS DOLLED UP:

“Be the change you want to see in the world”. Ghandi

REFERENCES:

Bisiani, L. & Angus, J. (2012). The use of doll therapy to meet past attachment needs and diminish behaviours of concern in people with dementia: A case study approach. Dementia, published online 15 February 2012: DOI: 10. 1177/1471301211431362.

Bowlby, J. (1969). Attachment and loss: Volume 1 Attachment. London: Hogarth Press.

Killick, J., & Allan, K. (2001). Communication and the care of people with dementia. Buckingham: Open

University Press.

Kitwood T (1997) Dementia reconsidered – the person comes first. Buckingham: Open University Press.

Miesen BML (1992) Attachment theory and dementia. In G. M. M. Jones, & B. M.