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

Non-pharmacological management of wandering in persons with dementia: an integrative review

BACKGROUND

Wandering behaviour affects a significant portion of dementia patients, ranging from 15% to 80%, presenting a serious safety concern and adding to caregivers' burden. Recent studies emphasise the effectiveness of non-pharmacological interventions over pharmacological ones due to their minimal side effects. Consequently, in current literature there has been a surge of interest in exploring non-pharmacological methods for managing wandering.

PURPOSE

This integrative literature review aims to deepen comprehension of wandering behaviour, presents recent studies on non-pharmacological approaches, and inspires further research in this field.

METHODS

Electronic data collection spanned from 2019 to 2024, sourcing 20 relevant articles from PubMed and Scopus databases using search terms such as 'dementia', 'Alzheimer's disease', 'wandering', and 'management'. A thematic analysis methodology was employed to identify non-pharmacological treatment themes for managing wandering. This approach involves scrutinising and synthesising themes within the dataset. Qualitative data analysis focused on significant phrases and keywords, grouping them to derive relevant themes.

RESULTS

Recent literature extensively explores non-pharmacological methods for managing wandering. These include understanding behaviours, identifying and targeting high-risk groups, facilitating safe wandering, addressing environmental factors, promoting exercise and activity, and offering caregiver support.

CONCLUSIONS

This study significantly advances understanding of wandering behaviour and highlights recent research on non-pharmacological interventions. The findings suggest the potential for providing safe and effective treatment to wandering dementia patients, thereby alleviating stress for both patients and caregivers.

The treatment of behavioural and psychological symptoms in dementia: pragmatic recommendations

Behavioural and psychological symptoms of dementia (BPSD) are a clinical challenge for the lack of a sound taxonomy, frequent presentation with comorbid BPSD, lack of specific pharmacologic interventions, poor base of methodologically sound evidence with randomized clinical trials, contamination from the treatment of behavioural disturbances of young and adult psychiatric conditions, and small efficacy window of psychotropic drugs. We present here a treatment workflow based on a concept-driven literature review based on the notions that (i) the aetiology of BPSD can be mainly neurobiological (so-called 'primary' symptoms) or mainly environmental and functional ('secondary' symptoms) and that this drives treatment; (ii) the clinical efficacy of psychotropic drugs is driven by their specific profile of receptor affinity; (iii) drug treatment should follow the rules of 'start low-go slow, prescribe and revise'. This article argues in support of the distinction between primary and secondary BPSD, as well as their characteristics, which until now have been just sketchily described in the literature. It also offers comprehensive and pragmatic clinician-oriented recommendations for the treatment of BPSD.

Interventions for mitigating occupational stress for professional dementia caregivers in residential aged care: A systematic review with meta-analysis

OBJECTIVE

Occupational stress in professional dementia caregivers in residential aged care facilities has adverse effects on care quality, caregivers' health, and workforce sustainability. The purpose of this study was to examine the evidence regarding interventions to mitigate occupational stress for this population.

METHODS

A systematic review of CINAHL, PsycINFO, PubMed and MEDLINE databases was conducted to identify original RCT research reporting on stress interventions, published in English between 1995 and March 2022. Search results were screened by two independent reviewers. Quality and risk of bias were appraised using the Downs and Black Checklist and Risk of Bias by two reviewers. Meta-analysis and subgroup analysis examined the pooled intervention effects on stress compared to control.

RESULTS

10 studies met the inclusion criteria, and these reported on 15 interventions and 28 outcomes from 92 facilities, involving 1,397 caregivers. We found a small and insignificant effect of interventions on caregiver stress (g = -.27, p = .16). Heterogeneity was partially explained by subgroup analysis. Interventions can mitigate stress and burden not attributed to client behaviour (n = 3) (g = -.85, p < .001), and improve caregivers' self-efficacy (n = 4) (g = -.35, p = .07). We were unable to determine the most effective type of intervention, although organisation focused interventions showed the greatest potential (g = -.58, p = .08).

CONCLUSION

Interventions that improve caregivers' personal and organisational resources can reduce non-client associated stress and burden and increase self-efficacy. Aged care providers are recommended to prioritise education with organisational support interventions. Research on longitudinal effects and high-risk caregivers is required. Limitations are discussed.

PROSPERO REGISTRATION NUMBER

CRD42022313715 (registered April 2022).

Doll therapy for improving behavior, psychology and cognition among older nursing home residents with dementia: A systematic review and meta-analysis

OBJECTIVE

To explore the effectiveness of doll therapy (DT) on behavior, psychology and cognition among older nursing home residents with dementia.

METHODS

A systematic review and meta-analysis was conducted. Subgroup analyses were performed to determine whether the intervention characteristics influenced effect sizes.

RESULTS

Ten studies met the inclusion criteria and were selected for qualitative and quantitative synthesis. The overall methodological quality was relatively high. DT significantly improved all behaviors [SMD=-0.42, P=0.01], including agitation [SMD=-0.94, P<0.001], apathy, irritability and wandering, and psychological states (i.e., pleasure, anxiety and depression). However, there was no significant difference in the improvement of cognition. Subgroup analyses revealed that the DT process employing empathy dolls and coordinating with caregivers was more beneficial for improving all behaviors (P=0.01; P=0.02).

CONCLUSION

DT significantly reduced behavioral and psychological disturbances among older nursing home residents with dementia. Specifically, administering empathy dolls and coordinating with caregivers may be the most appropriate and effective option.

[Quality of life in institutionalized older adults with moderate to severe major neurocognitive disorder: Effect of Doll therapy]

BACKGROUND AND OBJECTIVES

Major neurocognitive disorder is characterized by progressive cognitive impairment, a decrease in the person's ability to perform activities of daily living and the appearance of psychological and behavioral symptoms that lead to a deterioration in the quality of life and progression towards institutionalization. The most common management of major neurocognitive disorder is pharmacological therapy that mitigates or slow progressive deterioration and symptom control. The objective of this study was to establish the effect of a nursing intervention based on Doll therapy, compared to conventional care on the quality of life of older adults with moderate to severe major neurocognitive disorder institutionalized in nursing homes in the city of Medellín, Colombia.

METHODS

Pilot experimental study with two groups and pretest post-test measurement. The sample consisted of 26 institutionalized elderly adults with advanced-stage major neurocognitive disorder, randomly assigned to each group. The experimental group received Doll therapy, based nursing therapy, while the comparison group continued to receive conventional therapy according to the institution's protocol. The QUALID instrument was used, which was evaluated by professionals external to the care centers.

RESULTS

The comparison of the groups, before and after the intervention, indicates that the experimental group showed a positive effect on quality of life, supported by the statistical significance of the data, with a moderate effect.

CONCLUSIONS

The Doll therapy as a non-pharmacological therapy has a positive effect on the quality of life of patients with moderate to severe major neurocognitive disorder, which constitutes a contribution to strengthen the knowledge associated with the effects or this intervention.

The Importance of Person-Centered Approaches to Managing Behavioral and Psychological Symptoms of Dementia: A Case Report

Behavioral and psychological symptoms of dementia (BPSD) are common and associated with increased morbidity and mortality in dementia. In this report, we describe a patient with severe BPSD who was effectively managed with a variety of non-pharmacologic strategies. A 70-year-old Navy veteran and retired commercial flooring business owner with a history of dementia was admitted to the hospital with aggressive behavior. He was no longer manageable by his family. He required intermittent use of restraints and multiple antipsychotics during hospitalization. He spent much of his time crawling on the floor, "working" on floor tiles, which was often difficult for staff to safely accommodate. However, with time, interprofessional staff identified signs of distress and developed strategies to safely engage the patient's current perception of his situation. This case highlights how BPSD may be driven by a person's identities and roles from earlier stages of life. Approaching and managing these symptoms flexibly can enhance dementia care.

Doll Therapy Intervention Reduces Challenging Behaviours of Women with Dementia Living in Nursing Homes: Results from a Randomized Single-Blind Controlled Trial

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.

Delirium in Nursing Home Residents: A Narrative Review

Delirium is an important component of the geriatric syndromes and has been recognized to negatively influence the prognosis of older people in hospital and in a post-acute setting. About 2–5% of older people world-wide live in nursing homes and are characterized by functional impairment, cognitive decline, dementia, comorbidities, and polypharmacotherapy, all factors which influence the development of delirium. However, in this setting, delirium remains often understudied. Therefore, in this narrative review, we aimed to describe the latest evidence regarding delirium screening tools, epidemiology characteristics, outcomes, risk factors, and preventions strategies in nursing homes.

Effect of Doll Therapy in Behavioral and Psychological Symptoms of Dementia: A Systematic Review

(1) Background: Behavioral and psychological symptoms of dementia (BPSD) are a threat for people with dementia and their caregivers. Doll therapy is a non-pharmacological person-centered therapy to promote attachment, company, and usefulness with the aim of minimizing challenging behaviors. However, the results are not clear. (2) Objective: To know the effectiveness of doll therapy in reducing behavioral and psychological symptoms of people with dementia at a moderate-severe phase. (3) Methodology: The systematic review was informed according to the criteria established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Searches were conducted in eight databases: Cochrane, PubMed, Web of Science, Cinahl, Embase, Lilacs, PeDro, and Scopus before October 2021. Studies were selected when they accomplished the simple majority of Consolidated Standards of Reporting Trials (CONSORT). The risk of bias was appraised with the Cochrane Collaboration Risk of Bias Tool. The review protocol was recorded in Inplasy:1539. (4) Results: The initial search strategy showed 226 relevant studies, 7 of which met the eligibility criteria. In the included studies, a total number of 295 participants (79% female) with a mean age of 85 years were enrolled. There was found to be a reduction in challenging and aggressive behaviors, the participants were less rough and irritable, and their communication skills and emotional state were also improved. (5) Conclusion: Our findings suggest that doll therapy improves the emotional state of people with dementia, diminishes disruptive behaviors, and promotes communication. However, randomized studies with a larger sample size and higher methodological rigor are needed, as well as follow-up protocols in order to reaffirm these results.