The doll therapy as a first line treatment for behavioral and psychologic symptoms of dementia in nursing homes residents: a randomized, controlled study

Francesca Santagata, Massimiliano Massaia, Patrizia D'Amelio, Francesca Santagata, Massimiliano Massaia, Patrizia D'Amelio

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.

Keywords: Behavioral and psychologic symptoms of dementia; Delirium; Dementia; Doll therapy; Non-pharmacological approach; Nursing home.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Empathy dolls. The pictures show the dolls used in the study (panel A), interaction between patient and doll (panel B)
Fig. 2
Fig. 2
Study flow chart. The diagram shows the study design with the number of patients at each visit
Fig. 3
Fig. 3
Doll therapy is effective in the control of BPSD. Effect of DT versus ST on the control of BPSD measures by A.Di.CO (panel A), NPI global score (Panel B), NPI score for agitation (panel C), NPI score for dysphoria (panel D), NPI score for apathy (panel E), NPI score for wandering (panel F). Results of two-way ANOVA for repeated measurements are shown in the box, significant differences versus baseline are indicated by the star (*)
Fig. 4
Fig. 4
Doll therapy is effective in reducing the caregiver burden and the incidence of delirium. Effect of DT versus ST on the caregiver burden measured with the Greutzner scale (panel A) the results of two-way ANOVA for repeated measurements are shown in the box in panel A, significant differences versus baseline are indicated by the star (*). Incidence of delirium in DT group (panels B) and in ST group (panel C), both absolute number and percentage of patients is shown. Results for the χ2 test for trends are shown in the box

References

    1. Lyketsos CG, Carrillo MC, Ryan JM, Khachaturian AS, Trzepacz P, Amatniek J, Cedarbaum J, Brashear R, Miller DS. Neuropsychiatric symptoms in Alzheimer’s disease. Alzheimers Dement. 2011;7(5):532–539. doi: 10.1016/j.jalz.2011.05.2410.
    1. Geda YE, Schneider LS, Gitlin LN, Miller DS, Smith GS, Bell J, Evans J, Lee M, Porsteinsson A, Lanctôt KL, Rosenberg PB, Sultzer DL, Francis PT, Brodaty H, Padala PP, Onyike CU, Ortiz LA, Ancoli-Israel S, Bliwise DL, Martin JL, Vitiello MV, Yaffe K, Zee PC, Herrmann N, Sweet RA, Ballard C, Khin NA, Alfaro C, Murray PS, Schultz S, Lyketsos CG, Neuropsychiatric Syndromes Professional Interest Area of ISTAART Neuropsychiatric symptoms in Alzheimer’s disease: past progress and anticipation of the future. Alzheimers Dement. 2013;9(5):602–608. doi: 10.1016/j.jalz.2012.12.001.
    1. Ismail Z, Smith EE, Geda Y, Sultzer D, Brodaty H, Smith G, Agüera-Ortiz L, Sweet R, Miller D, Lyketsos CG, ISTAART Neuropsychiatric Symptoms Professional Interest Area Neuropsychiatric symptoms as early manifestations of emergent dementia: provisional diagnostic criteria for mild behavioral impairment. Alzheimers Dement. 2016;12(2):195–202. doi: 10.1016/j.jalz.2015.05.017.
    1. Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ. 2015;350(mar02 7):h369. doi: 10.1136/bmj.h369.
    1. Petrovic M, Hurt C, Collins D, Burns A, Camus V, Liperoti R, Marriott A, Nobili F, Robert P, Tsolaki M, Vellas B, Verhey F, Byrne EJ. Clustering of behavioural and psychological symptoms in dementia (BPSD): a European Alzheimer’s disease consortium (EADC) study. Acta Clin Belg. 2007;62(6):426–432. doi: 10.1179/acb.2007.062.
    1. Deborah Koder GEH. Staff’s views on managing symptoms of dementia in nursing home residents. Nurs Older People. 2014;26(10):31–36. doi: 10.7748/nop.26.10.31.e638.
    1. van den Kieboom R, Snaphaan L, Mark R, Bongers I. The Trajectory of Caregiver Burden and Risk Factors in Dementia Progression: A Systematic Review. J Alzheimers Dis. 2020;77:1107–1115. doi: 10.3233/JAD-200647.
    1. Gulla C, Selbaek G, Flo E, Kjome R, Kirkevold Ø, Husebo BS. Multi-psychotropic drug prescription and the association to neuropsychiatric symptoms in three Norwegian nursing home cohorts between 2004 and 2011. BMC Geriatr. 2016;16(1):115. doi: 10.1186/s12877-016-0287-1.
    1. Maher AR, Maglione M, Bagley S, Suttorp M, Hu J-H, Ewing B, Wang Z, Timmer M, Sultzer D, Shekelle PG. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. JAMA. 2011;306(12):1359–1369. doi: 10.1001/jama.2011.1360.
    1. Bergh S, Selbæk G, Engedal K. Discontinuation of antidepressants in people with dementia and neuropsychiatric symptoms (DESEP study): double blind, randomised, parallel group, placebo controlled trial. BMJ. 2012;344(mar09 1):e1566. doi: 10.1136/bmj.e1566.
    1. Helvik A-S, Høgseth LD, Bergh S, Šaltytė-Benth J, Kirkevold Ø, Selbæk G. A 36-month follow-up of decline in activities of daily living in individuals receiving domiciliary care. BMC Geriatr. 2015;15(1):47. doi: 10.1186/s12877-015-0047-7.
    1. Bierman EJM, Comijs HC, Gundy CM, Sonnenberg C, Jonker C, Beekman ATF. The effect of chronic benzodiazepine use on cognitive functioning in older persons: good, bad or indifferent? Int J Geriatr Psychiatry. 2007;22(12):1194–1200. doi: 10.1002/gps.1811.
    1. Gedde MH, Husebo BS, Mannseth J, Kjome RLS, Naik M, Berge LI. Less is more: the impact of Deprescribing psychotropic drugs on behavioral and psychological symptoms and daily functioning in nursing home patients. Results from the cluster-randomized controlled COSMOS trial. Am J Geriatr Psychiatry. 2021;29(3):304–315. doi: 10.1016/j.jagp.2020.07.004.
    1. Abraha I, Rimland JM, Trotta FM, Dell’Aquila G, Cruz-Jentoft A, Petrovic M, et al. Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ Open. 2017;7(3):e012759. doi: 10.1136/bmjopen-2016-012759.
    1. Lyketsos CG, Colenda CC, Beck C, Blank K, Doraiswamy MP, Kalunian DA, Yaffe K, Task Force of American Association for Geriatric Psychiatry Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer disease. Am J Geriatr Psychiatry. 2006;14(7):561–572. doi: 10.1097/01.JGP.0000221334.65330.55.
    1. Seitz DP, Brisbin S, Herrmann N, Rapoport MJ, Wilson K, Gill SS, et al. Efficacy and feasibility of nonpharmacological interventions for neuropsychiatric symptoms of dementia in long term care: a systematic review. J Am Med Dir Assoc. 2012;13:503–506. doi: 10.1016/j.jamda.2011.12.059.
    1. Ng QX, Ho CYX, Koh SSH, Tan WC, Chan HW. Doll therapy for dementia sufferers: a systematic review. Complement Ther Clin Pract. 2017;26:42–46. doi: 10.1016/j.ctcp.2016.11.007.
    1. Green L, Matos P, Murillo I, Neushotz L, Popeo D, Aloysi A, Samuel J, Craig E, Porter C, Fitzpatrick JJ. Use of dolls as a therapeutic intervention: relationship to previous negative behaviors and pro re nata (prn) Haldol use among geropsychiatric inpatients. Arch Psychiatr Nurs. 2011;25(5):388–389. doi: 10.1016/j.apnu.2011.05.003.
    1. Mitchell G, McCormack B, McCance T. Therapeutic use of dolls for people living with dementia: A critical review of the literature. Dementia. 2014;15(5):976–1001. doi: 10.1177/1471301214548522.
    1. 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(7):915–925. doi: 10.1002/gps.4872.
    1. Pezzati R, Molteni V, Bani M, Settanta C, Di Maggio MG, Villa I, et al. Can doll therapy preserve or promote attachment in people with cognitive, behavioral, and emotional problems? A pilot study in institutionalized patients with dementia. Front Psychol. 2014;5:342. doi: 10.3389/fpsyg.2014.00342.
    1. Browne CJ, Shlosberg E. Attachment theory, ageing and dementia: a review of the literature. Aging Ment Health. 2006;10(2):134–142. doi: 10.1080/13607860500312118.
    1. Miesen BML. Alzheimer’s disease, the phenomenon of parent fixation and bowlby’s attachment theory. Int J Geriatr Psychiatry. 1993;8(2):147–153. doi: 10.1002/gps.930080207.
    1. Bisiani L, Angus J. 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. Dementia (London) 2013;12(4):447–462. doi: 10.1177/1471301211431362.
    1. Bowlby J. The making and breaking of affectional bonds: I. Aetiology and psychopathology in the light of attachment theory. Br J Psychiatry. 1977;130(3):201–210. doi: 10.1192/bjp.130.3.201.
    1. Stephens A, Cheston R, Gleeson K. An exploration into the relationships people with dementia have with physical objects: An ethnographic study. Dementia. 2012;12(6):697–712. doi: 10.1177/1471301212442585.
    1. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P, CONSORT group Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148(4):295–309. doi: 10.7326/0003-4819-148-4-200802190-00008.
    1. Tamura T, Nakajima K, Nambu M, Nakamura K, Yonemitsu S, Itoh A, Higashi Y, Fujimoto T, Uno H. Baby dolls as therapeutic tools for severe dementia patients. Gerontechnology. 2001;1(2):111–118. doi: 10.4017/gt.2001.01.02.004.00.
    1. Kim J, Shin W. How to do random allocation (randomization) Clin Orthop Surg. 2014;6(1):103–109. doi: 10.4055/cios.2014.6.1.103.
    1. Efficacy of Doll thErapy compared with standard treatment in the control of behavioral and psychologic Symptoms and CaRegIver Burden in dEmentia: DESCRIBE a randomized, controlled study - eSciPub Journals. . Accessed 10 May 2021.
    1. Cohen-Mansfield J, Marx MS, Dakheel-Ali M, Regier NG, Thein K. Can persons with dementia be engaged with stimuli? Am J Geriatr Psychiatry. 2010;18(4):351–362. doi: 10.1097/JGP.0b013e3181c531fd.
    1. Braden BA, Gaspar PM. Implementation of a baby doll therapy protocol for people with dementia: innovative practice. Dementia (London) 2015;14(5):696–706. doi: 10.1177/1471301214561532.
    1. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308–2314. doi: 10.1212/WNL.44.12.2308.
    1. Wing L, Leekam SR, Libby SJ, Gould J, Larcombe M. The diagnostic interview for social and communication disorders: background, inter-rater reliability and clinical use. J Child Psychol Psychiatry. 2002;43(3):307–325. doi: 10.1111/1469-7610.00023.
    1. Fenzio F. Manuale di consulenza pedagogica in ambito familiare, giuridico e scolastico. 2017.
    1. Cummings JL. The neuropsychiatric inventory: assessing psychopathology in dementia patients. Neurology. 1997;48(5 Suppl 6):10S–16S. doi: 10.1212/WNL.48.5_Suppl_6.10S.
    1. Swinnen N, Vandenbulcke M, de Bruin ED, Akkerman R, Stubbs B, Firth J, Vancampfort D. The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial. Alzheimers Res Ther. 2021;13(1):70. doi: 10.1186/s13195-021-00806-7.
    1. Olin K. Perceived caregiver burden as a function of differential coping strategies: (410202005–016) 1995.
    1. Inouye SK. Clarifying confusion: the confusion assessment method: a new method for detection of delirium. Ann Intern Med. 1990;113(12):941–948. doi: 10.7326/0003-4819-113-12-941.
    1. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients†. J Am Geriatr Soc. 1975;23(10):433–441. doi: 10.1111/j.1532-5415.1975.tb00927.x.
    1. Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist. 1970;10(1 Part 1):20–30. doi: 10.1093/geront/10.1_Part_1.20.
    1. Faul F, Erdfelder E, Lang A-G, Buchner A. G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–191. doi: 10.3758/BF03193146.
    1. Salari SM. Intergenerational partnerships in adult day centers: importance of age-appropriate environments and behaviors. Gerontologist. 2002;42(3):321–333. doi: 10.1093/geront/42.3.321.
    1. James IA, Mackenzie L, Mukaetova-Ladinska E. Doll use in care homes for people with dementia. Int J Geriatr Psychiatry. 2006;21(11):1093–1098. doi: 10.1002/gps.1612.
    1. 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(9):1308–1315. doi: 10.1002/gps.4961.
    1. 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(10):1442–1450. doi: 10.1080/13607863.2018.1498447.
    1. 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. 2020;34:891988720933353.
    1. Cohen-Mansfield J, Thein K, Dakheel-Ali M, Regier NG, Marx MS. The value of social attributes of stimuli for promoting engagement in persons with dementia. J Nerv Ment Dis. 2010;198(8):586–592. doi: 10.1097/NMD.0b013e3181e9dc76.
    1. Ellingford J, James I, Mackenzie L, Marsland L. Using dolls to alter behaviour in patients with dementia. Nurs Times. 2007;103:36–37.
    1. Hirakawa Y, Chiang C, Aoyama A. A qualitative study on barriers to achieving high-quality, community-based integrated dementia care. J Rural Med. 2017;12(1):28–32. doi: 10.2185/jrm.2927.
    1. Davis DHJ, Skelly DT, Murray C, Hennessy E, Bowen J, Norton S, Brayne C, Rahkonen T, Sulkava R, Sanderson DJ, Rawlins JN, Bannerman DM, MacLullich AMJ, Cunningham C. Worsening cognitive impairment and neurodegenerative pathology progressively increase risk for delirium. Am J Geriatr Psychiatry. 2015;23(4):403–415. doi: 10.1016/j.jagp.2014.08.005.
    1. Witlox J, Eurelings LSM, de Jonghe JFM, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443–451. doi: 10.1001/jama.2010.1013.
    1. Hipp DM, Ely EW. Pharmacological and nonpharmacological Management of Delirium in critically ill patients. Neurotherapeutics. 2012;9(1):158–175. doi: 10.1007/s13311-011-0102-9.
    1. Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–922. doi: 10.1016/S0140-6736(13)60688-1.
    1. Johnson K, Fleury J, McClain D. Music intervention to prevent delirium among older patients admitted to a trauma intensive care unit and a trauma orthopaedic unit. Intensive Crit Care Nurs. 2018;47:7–14. doi: 10.1016/j.iccn.2018.03.007.
    1. Inouye SK, Baker DI, Fugal P, Bradley EH. HELP dissemination project. Dissemination of the hospital elder life program: implementation, adaptation, and successes. J Am Geriatr Soc. 2006;54(10):1492–1499. doi: 10.1111/j.1532-5415.2006.00869.x.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere