Childrens activities for people with dementia?

doll-groupDoll therapy, Montessori, childish Apps on iPads and a whole range of other children’s activities that are encouraged for people with dementia seem to me to miss the point. Using activities that children engage in to ‘amuse’ us – and then call them meaningful activities –  is something I tend to think is patronising and insulting.

Why not engage us with real activities, those we loved in our pre diagnosis lives. Child-appropriate activities are demeaning and infantilising. In my heart, I suspect the only reason Montessori has been found to be so useful, is people with dementia are for the most part still not being treated with the respect and individualised care they deserve, and in reality there is very little person centred care in action in their care. I still see good care as the exception, not the norm.

A couple of years ago I was asked to be a research participant in a research project at Flinders University involving iPads and apps. It was targeted towards people in the early stages of dementia, at any age. It involved 30 minutes per day of using the 8 apps, and they were so juvenile my then 18 month year old great nephew could do them. Feeding a giraffe on an app is not meaningful activity, especially so when it makes a cartoon noise when it gets fed. I constantly wonder, what is wrong with people thinking children’s that activities are appropriate for adults…

Perhaps when I spend more time researching things like doll therapy and Montessori in dementia care, I might become more excited about them… I hope so.

One of my blog readers has sent me some papers she has done on doll therapy and which she is in favour of, which I’ve not had time to read yet (I promise I will Leah)… but in my heart, I still think it is generally undignified to introduce children’s activities to adults, unless it is part of some intergenerational work where you have children engaging with adults with dementia in some way.

Ps. I’ve just had a quick read on doll therapy, and have read that perhaps in the late stage of the disease it might be very appropriate, but for some reason the thought of it still offends me.

37 thoughts on “Childrens activities for people with dementia?

  1. I agree, there still is not enough emphasis on finding out about a persons pre-diagnosis likes and dislikes. There’s plenty of opportunity to ask these questions prior to admission to a care facility, but instead we still concentrate on what the ‘behaviour history’ entails. Negativising (is that a word?) the person from the beginning of their life in care.

  2. I agree that so many activities for people with dementia can appear to be child like. However doll therapy when handled sensitively and when people have appropriately assessed the situation can be a great way to engage the person with dementia, or sooth and calm the person. As others have said our natural instinct is to pick up the doll and to cradle and rock it. At the latter stages of dementia we need to focus our interventions on working with those ‘natural instincts’ things we do as a matter of course. It is often families who need support to come to terms with the use of a doll in their loved ones care, so making sure families understand why a doll might be introduced and the benefits is best done before a doll is introduced. Like all activities this might prove effective for some people but definitely not for all!!

  3. My mother, as a teacher and grandmother, who had dementia, always loved when real children and babies would visit her. She was resentful if you tried to engage her with a doll-baby; she knew the difference.

    • Thanks Mariarose… I am sure I would know the differrence too with the result possibly being some challenging behaviour, in the same way as if I was made to play Bingo (!!!), but as others have said, it works for some.

  4. Person-centred caring can naturally occur even when in an advanced stage – it is more about communication and being creative, respectful and really connected with the person. My mother is very engaged with fluffy toy animals – particularly white fluffy ones that remind her of her maltese (deceased a couple of years ago) with whom she shared a very special bond. No-one ‘introduced her’ to activities with these fluffy toys – her relationship with them naturally evolved from her love of animals and a beautiful way of caring that she expresses with animals and children. We have accepted her emotional connection with these toys because of how much they mean to her, the joy she experiences when talking to them and caring for them and the opportunity she has to continue to express her very caring nature. She is also involved in other enjoyable activities. I think it is really about keeping ‘person-centred’ at the heart of the relationship, and being creative with what works for the individual.

    • thanks for sharing your thoughts and your mother’s relationship with her fluffy toys, as you say, it is very individual, and up to others to accept what people with dementia want.

  5. jlhede and elhijodeveronica and Judy – I just reread your comments as well and sooooooo agree. This is what everything I wrote was about.
    Thank you for saying so succinctly what I was thinking.

    May I also just add that when mentioning that a doll may provide control and meaning, that my paper was based on attachment theories, so linked very much into the maternal, nurturing needs, personal sense of value etc that may appear in some people, as well as the joy of tapping into and reliving happy carefree times, if that’s what works for the individual.

    I also, during the research, was amazed to see the incredibly touching responses of other people living with dementia, males as well as females, and the wonderful interactions that came from such a simple tool.

    When I lecture, I hand the doll around to the audience and to observe doctors, nurses, gerontologists, psychiatrists etc sitting and nursing the doll as if its a baby, stroking its hair, and jiggling it, instinctively, makes a serious point in the responses of even those who do not have dementia. These moments always make me smile as it seems to provide that sense of peace to even those who don’t expect it to.

    I am soooooooooo going to stop talking now – shut me up Kate – lol. 🙂

    Cheers and smiles…….again. Leah.xx

  6. Thanks Carol and truthfulkindness, for expressing so beautifully with your lovely responses about what I have written. That using dolls is not about ever treating a person as a child, nor using dolls as a normal part of care. That if it meets an internal need for that specific person then we cannot turn away from this because ‘we’ feel embarrassed or that it would not work for us.

    If its a fluffy toy, if its a book, if its an easel and paints, if its gardening, or cooking or hanging out with children, its all the same to me as a caregiver. I suppose we need to stop looking at the ‘object’ or ‘activity’ and focus on the end result for that person, and if it works positively,enabling that person to continue to live a more enriching life.

    Using dolls is really no different to the use of any activity that we can possibly put into place, based on the persons specific and individual person centered care needs. n reality, the maintenance of personhood.

    It is so not about our own judgement calls here, it is only about assisting a person with dementia who may be suffering if we do not understand their inner need.

    If its a doll that allays that stress related response, then I believe we use it, despite how we personally feel about dolls. I advocate persons living with dementia giving us the guidance to let us know what THEY need always and if that person comes up with a doll as the solution for them, then this is what we should provide and we cannot ignore this because of how we feel about dolls.

    Thank-you too Kate for your wonderful ability to make us think outside the square – I hope that I can give another perspective to you when you read my paper., This is all I I ever want to achieve.
    I never expect everyone to agree – its more about seeing every person with dementia as their own entity deserving of nothing more than the best we can provide.

    I love the comments above – bingo creeps ME out – haha – so if anyone dares to put me in front of a bingo board, assuming its my type of game, I will be exhibiting behavioral expression to the max!!!!!!

    Look forward to your feedback on my paper Kate – eeekkk!!!! – I know you will be unfailingly honest and that is awesome. Your perspective is always inspiring to me in assisting me to visualize yet another aspect of understanding.

    Happy bedtime reading.

    Cheers and smiles. Leah.xx

  7. In my years of working with persons who have dementia, I have encountered one individual who had a doll which she carried around the facility with her. She responded quite negatively when it was taken away from her. I have given dolls to other women, who responded favorably for the short term. I do recall another woman who responded favorably, at least for the short term, when I gave her a doll. She would repeatedly call out when left alone in her room, and could no longer remember what a call light was for — or even that she had one. When I introduced the doll to her, and asked her if she would keep an eye on my baby for me, her eyes lit up and she acted as if she had suddenly found a purpose In her life. I saw her as a loving grandma who may well have served as the neighborhood babysitter. She eventually tired of the doll, but at least for the short term she was content. There was another woman in the same facility who had been given a doll by a family member wanting to be helpful, whose doll was “adopted” by another woman who would show an interest in it from time to time, but eventually reached the point where it sat in her room unattended.

    The one case I do recall most particularly was the woman who had been given a very realistic-looking cat. She carried the cat around with her all over the nursing facility for months, and became quite agitated if it was taken away from her for any reason. In fact, the staff had to slip the cat away from her at night to clean away the food from the cat’s mouth where the woman had attempted to feed it from her own plate. Everyone in the facility felt a sense of sadness when she no longer looked after her cat with such diligence, because we knew that was one sign of her regression.

    I agree whole-heartedly that we need to look for not only age-appropriate activities for these individuals, but also activities related to their previous lives and interests. But I also wonder if our evaluation of some of these activities reflects as much our own values as those of the individuals who are being asked to participate in them. And also the method by which they are introduced. I am equally troubled when those who are in the latter stages of dementia are given activities for which they no longer possess the cognitive capabilities. For example, I often see a group of residents seated around a table while an activities aide tries fruitlessly to walk them through a card game that they no longer remember how to play, or for which they lack the visual discrimination skills or the memory for. I think this reflects a couple of areas that I would like to see researched — the regression of play/leisure skills, as well as of object permanence, in the latter stages of dementia.

    • Thanks for your insightful comments, the good as well as the less ideal axamples of care and activities. It is so hard not to be biased by one’s own ideals and feelings, either when assessign things, or providing activites for others. x

  8. Hi Kate, you make a good point about the dangers of infantilising people with dementia. I have seen people totally miss the point about ‘doll therapy’ installing infantile sensory things around a care home, for example.

    The picking up of a doll has been seen to awaken(re-awaken) maternal feelings amongst people who are at a much more advanced stage. When waiting to meet with a manager of a care home I went to sit in the one available space on a sofa in reception where there was a doll. I picked it up and found myself sat down, cradling the doll as I have done many a time with my own children. As a 49 year-old man, it took me somewhat by surprise. I felt a weird sensation of calm. It took me back to the many hours spent with my own children (only a decade or so ago) sat with the most precious thing. all other worries would drain away as I knew I was unavailable for anything/anyone but my newborn child. Of course the presence of a real babe in arms would be even better. It is clearly something like any intervention something that should be tailored.

    • Thanks for joining the conversation. Your last ocmment about holding real babies is a wonerful idea, and the idea of intergenerational work, and facilities might make this a reality. In Victoria during the last week, the health service there is considering building a child care facility right next to the residentiual aged care one, with the idea of some activities being connected in some way.

      • Thanks Kate, it shouldn’t take much consideration. Certainly here in England I’m not aware of any home that is not next door to or over the road from an infant school. Yet these resources remain relatively untapped
        Best wishes
        Damian

      • I had substantial concerns with my infant son in the hands of even my own great-grandmother, when she was in late stages. Lacking the physical abilities & reasoning abilities can be a very dangerous combination for an infant. Required very VERY careful vigilance and extremely careful actions and wording in assistance. OBVIOUSLY she knew how best to care for an infant! We didn’t respect her abilities when we tried to provide assistance. Benefits were obvious, but so was the precarious combination of circumstances. I very much respect Dr. Nader Robert Shabahangi, and the way he consistently combines children with his “Elders” at the various Age-Song Care Facilities. … But I believe they are consistently OLDER children — not infants. And an older child evokes completely different emotions in the “patient” than that of an infant, so I can totally see the therapeutic application of realistic “baby” doll for some Persons With Dementia in late stages.

  9. Doll therapy is not necessarily about just playing with dolls but connecting with the past. I have seen a lady with advanced dementia in high care treat the doll like her baby. The love she bestowed on her ‘baby’ was very touching and she had a cot in her room and a high chair too. She did not recognise her own grown children and the baby allowed her to reignite her mothering instincts, which was very strong in her past as she had 6 children. Most of the women weren’t interested in the dolls, but for Nora her baby was a god send. Montessori and doll therapies are not only about amusing, but are an attempt to engage and calm the person with dementia. If that can reduce the use of anti psychotics then that must be good.

    • I agree Judy… I think the point I was trhying to make around that was if person centred care was being delivered as the norm, the industry would not have had to resort to hildrens activities and programs… who knows, also I have seen doll therapy work well, for some women in the later stages of dementia. Reducing anti psychotics is of course, an excellent result, so if Montessori or Doll therpay works for some, then of course I would never disagree with it. xx

  10. Hi Kate, this is a subject which has many people talking, and I agree with you. I do however have very graphic nightmares, which can go on for hours. When this happens I do have a cuddly dog beside the bed as a relaxation tool. We don’t have a cat these days but this does work the same way, and although I do not talk about this very much, I have found it helpful. Saying that it is very different to doll therapy. Ken

      • My Mum, like another lady I knew, bought herself a teddy when widowed, just to sit in a chair and take to bed. When we lived together in her last years she would often say grumpily, “Come on Ted, let’s go to bed, you’re the only one who makes any sense here.”
        I think it’s how we are taught empathy: “Ah, love Teddy,” I can remember my Mum saying to her tiny grandchildren (so, I suspect, to me too). She did “grown down” (as opposed to growing up) and it was a privilege for me to know something of the child she had been. When I realised how it was working in her case (everyone is different) that made it easier to work out what would make her feel safe and secure. Having the bear around went without saying. This lovely book has many stories on the value of bears. http://www.amazon.co.uk/Bear-Me-Peter-Bull/dp/0090987306 So my Mum loved opera and she loved bears; she was my child and she was my Mum. I was very proud of her.

  11. I think Leahs response was very insightful. I do see doll therapy has its place. I have come across a lady in late stages where the doll therapy seems to be effective. I have also come across people in early stages that hate being helped when it comes to activities. I too would be interested to see what activities we should be giving them in early stages. My mother hates bingo as she finds it mindless (but others love it) as they feel it keeps there minds active. I have noticed that the OT has picked a few very basic and childlike activities, but maybe its because of arthritis and eyesight issues and the ever lack of staff to help with anything slightly challenging.

    • Other activities for people in the earlier stages of dementia I thnk need to align with their current interests… definitely not necessarily prior interests. I certainly know I am interested in very different things now to the time of my youth and early 20’s. Having the ratio of staff (or volunteers) to help provide person centred activities is possibly the biggest challenge. thanks for joining this conversation, which has certainly brought others out to chat! x

  12. “Doll therapy” was an unplanned accident in our family’s life. It was embarrassing for ME to see my grandmother’s response to a “baby” doll when she was late-stage. But I think that embarrassment was selfishness on my part, because the activity was so very fulfilling for her. … Something Grammy’s dog, cat, or other people in her life could not fulfill. If someone offers me a doll in late stage, I hope it is in a private setting — but in that stage I suspect it will be very fulfilling for me also.

    Am glad I was able to introduce my infant son to my great-grandmother during the last months before she died in 1978 (also late-stage dementia) – got photo of her face when she saw him and of her holding him. Her reaction was absolutely PRICELESS! But how often does that physical possibility occur? There were certainly no infants in our family 30 yrs later, during the years when Grammy was late-stage. So I am glad she happened to see the doll and we were able to see her reaction and start giving her opportunities to spend time with the doll.

  13. Hello dear Kate,

    I am so glad that you have bought up the subject of doll therapy, and voiced your concerns, as there have been so many people in the medical industry looking at doll interventions negatively for so long, I hoped to dispel the myth and maybe show another perspective. That of the specific personal individual needs of someone who does respond to their inner child, who does still maybe love dolls and in the case of my research, showed me as their witness, one of the most divine experiences. I really do hope that when you read my paper you will get an idea of where I am coming from in the use of dolls for some people living with dementia.

    I do agree with your viewpoint definitely when interventions are used that show no understanding of the person they are delivered to. This is then offensive and patronizing. This was not my intention in any way, thus out of 40 people I did a case study on the 1 person I felt the doll may be a successful method of assisting her to deal with her ongoing panic, distress and despair.
    I also very much agree that never should we treat any person as a child. This is extremely disrespectful and appalling behavior, and I totally support the fact that none of us should ever be rude enough to treat an older person as if they are a child..eg. that demeaning way of using baby talk with adults or older people – I cringe when I hear it.

    My view always has been, no matter what we do or use, if it caters to that persons individual needs and works for that person, then it is remiss of us not to link into that what will assist that person to live better and be happier. It would not in any way ever infantile that person nor would the provision of a doll be given to the person as if they were a child. It would only be an adult giving the doll to another adult who received it with great joy.
    Imagine in the case of an adult woman who has spent her adult life ‘collecting’ dolls??? Would this then be considered dehumanizing to her as a person in her own right, if this is what she chooses? Would we take that away from her because we personally don’t like dolls????

    My aim when I wrote the paper was not to ever suggest the use of doll therapy as a ‘normal’ addition to the lives of all people living with dementia. Personally I dislike dolls myself – lol. So they definitely would not work for me.
    No-one knows our-self better than yourself and I know I would not respond to a doll in any way – maybe a dog though, given pets are an important part of my life. :).
    We do need to be eternally flexible and understand that for some people dolls may be a vital catalyst to linking into positive emotion and mood for some individuals.

    This is again the reasoning behind why I conducted a case study – this lady I believed may respond to the doll to retain meaning in ‘her’ life – we didn’t know if it would be successful but ethically I would have been neglecting her if I did not try.
    This lady was in the advanced stages of AD – (as you mentioned people in the advanced stages of dementia may also be people dolls may be a positive influence with – :):) ).
    OMG – it was incredible Kate – this lady took the doll from me, looked up at me, and spoke the first words for 2 years – “This is what makes life beautiful”.

    In cases such as this very dear and special lady, the difference this made to her life was so dramatic, in so many unexpected ways, I hope that reading my paper may provide another view about the use of dolls in some cases for some individuals, where they may be considered beneficial and also life changing.

    I would love to hear what you think of it.

    Keep smiling and loving your blog every single day. 🙂

    Leah.xxxxx

    • Tahks Leah, and as mentioned in the blog, I promise to read it soon… when I write my chapter on activities for people with dementia for my book, I will definitely read it (can’t promise I will endorce it though)… thanks for always writing and working from your heart, and I do appreciate doll therapy can be wonderful for some, in the same way some people might like golf (as if!!!!!!)… x

    • “This is what makes life beautiful.” The ability to feel love. So long as you get to feel it, I don’t mind if it’s a doll, a teddy, a pet rate or spoon. “That’s my friend,” my Mum would say with a smile when I produced her very ancient camping spoon for breakfast every day. Because she remembered it and remembering is a joy. Brioche toast was also her friend. And she made a good number of human friends in her AD years too – often making them anew each time they arrived. But I’m sorry you feel that treating an AD person as a child is offensive and patronising. I guess it all depends what you think about children. To me they are people from the moment they are born; my Mum was a person till she died. Towards the end she had much in common with her beginning. Simple as.

  14. Kate, I am with you on this. I can’t explain to people why doll therapy creeps me out, it just makes me very uncomfortable. I do accept that for some people in the advanced stages of dementia, cuddling or holding a doll may have calming benefits…. But it’s not for everyone. Why are people living with dementia not coming up with their own activities and guiding activity staff? You are an amazing advocate for dignity And respect above all else. Keep it up!!

  15. Hi Kate I agree with you about the dolls. I know I am in the early stage of Alzheimer’s but I don’t want to be treated like a child. I still have a brain that works although I forget things sometimes, but I am an adult. Perhaps they should ask us first, not assume we will like playing with dolls.

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