Doll Therapy Efficacy for People With Dementia Living in Nursing Homes: a Randomized Single-blind Controlled Trial
NCT ID: NCT03224143
Last Updated: 2017-07-21
Study Results
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Basic Information
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UNKNOWN
NA
128 participants
INTERVENTIONAL
2017-02-16
2020-02-16
Brief Summary
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The first hypothesis regards the 30 days-effectiveness efficacy of the Doll Therapy intervention in reducing symptoms of behavioral disorders (BPSD) that appear in stressful situations (as in the case of a separation from a professional caregiver) and in reducing stress as perceived by the treating physician. Another issue to be investigated is whether the typical way in which a person manifested attachment behaviors during own life (classified in three types of mental states: secure, insecure and unresolved) is associated, once this person is in an advanced stage of dementia, with caregiving behaviors of the PWD during the doll presentation (i.e. caressing the object, talking to it and smiling).
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Detailed Description
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We will also assess the efficacy of DTI versus SI, on professional caregivers distress ratings related to behavioral and psychiatric symptoms of PWD. It will be measured with the Italian version of NPI-NH. It is expected an improvement in terms of a decrease in NPI-NH distress total score.
It will also assess the efficacy of DTI versus SI, on cognitive and physiological status of PWD. The first will be recorded as the presence or absence of exploratory and caregiving behaviors on an observational grid expressly conceived for this purpose (Grid 2, Appendix). It is expected an improvement in terms of an increase of the number and duration of exploratory and caregiving behaviors. The efficacy of DTI versus SI on physiological status of PWD will be measured by assessing blood pressure (systolic and diastolic), heart rate, and salivary cortisol that are biomarkers of acute stress. It is expected an improvement in terms of a decrease in these parameters.
All evaluations will be performed at baseline (T0) and thirty days later (T1). Secondary goal The secondary goal is to evaluate the stability of attachment behaviors of the PWD through the adminstration of the Adult Attachment Interview to the patients' offspring after conclusion of interventions. It is expected to find an association between the attachment style of the PWD and caregiving behaviors during the doll presentation (i.e. caressing the object, talking to it and smiling). Such behaviors are recorded in an observational grid expressely conceived for this purpose.
These observations will allow the investigators to test wether a relationship between present and past attachment style of PWD and between attachment styles and participant response to doll therapy exist. Investigators expect that PWD with a previous secure attachment style will accept the doll and will show caregiving behaviors, while the PWD with insecure attachment style will show, especially during the first contacts, rejection, avoidance of the doll or excessive caregiving reactions towords the doll. Investigators also expect that PWD with unresolved attachment style will show inconsistent responses to the presentation of the doll, with approaching and rejecting behaviors.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
SUPPORTIVE_CARE
SINGLE
Study Groups
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Doll Therapy Intervention (DTI)
The DTI involves the presentation of a doll produced by a Swedish brand and conceived for Doll Therapy use. It is designed to recreate the sensation of touching, looking and holding a child in the arms. The doll presentation involves five standard steps:
1. A nurse (whom the patient knows) accompanies the patient in the room and invites her to sit on the chair.
2. The nurse presents the object (doll or cube) to the patient.
3. The nurse leaves the patient alone with the object.
4. Interaction with the object: it lasts 3 minutes starting from the moment when the nurse leaves the room. This phase is interrupted if the patient drops the object before the time limit.
5. The nurse returns into the room and takes back the object.
Doll Therapy Intervention
Daily sessions, lasting an hour, will take place in a room known to patients (P). The only people in the room will be a nurse (N) and the researcher with video-tape, never interacting with P. The procedure is: the N will accompany the P in the room and the P will take a seat. The N will put the doll in front of the P and will say "Good morning Mr./Mrs....look", with a quiet voice. If the P will not take it at the first attempt, the N will sit down in front of her holding the doll in the arms and will wait for 2 minutes. The N will invite the PWD again. If the P will not take the doll after the second request, the N will not insist and she will leave. If the doll will be taken, the N will leave the P and say "I have to go, goodbye Mr./Mrs. . . ..". The gaze will always be upon the P.
Active control group (SI)
The SI involves the presentation of a non-anthropomorphic object, a soft foam rubber cube covered with a coloured and velvety textile. The procedure is the following:
1. A nurse (whom the patient knows) accompanies the patient in the room and invites her to sit on the chair.
2. The nurse presents the cube to the patient.
3. The nurse leaves the patient alone with the cube.
4. Interaction with the cube: it lasts 3 minutes starting from the moment when the nurse leaves the room. This phase is interrupted if the patient drops the object before the time limit.
5. The nurse returns into the room and takes back the cube.
active control group (SI)
Daily sessions, lasting an hour, will take place in a room known to patients (P). The only people in the room will be a nurse (N) and the researcher with video-tape, never interacting with P. The procedure is: the N will accompany the P in the room and the P will take a seat. The N will put the cube in front of the P and will say "Good morning Mr./Mrs....look", with a quiet voice. If the P will not take it at the first attempt, the N will sit down in front of her holding the cube in the arms and will wait for 2 minutes. The N will invite the PWD again. If the P will not take the cube after the second request, the N will not insist and she will leave. If the cube will be taken, the N will leave the P and say "I have to go, goodbye Mr./Mrs. . . ..". The gaze will always be upon the P.
Interventions
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Doll Therapy Intervention
Daily sessions, lasting an hour, will take place in a room known to patients (P). The only people in the room will be a nurse (N) and the researcher with video-tape, never interacting with P. The procedure is: the N will accompany the P in the room and the P will take a seat. The N will put the doll in front of the P and will say "Good morning Mr./Mrs....look", with a quiet voice. If the P will not take it at the first attempt, the N will sit down in front of her holding the doll in the arms and will wait for 2 minutes. The N will invite the PWD again. If the P will not take the doll after the second request, the N will not insist and she will leave. If the doll will be taken, the N will leave the P and say "I have to go, goodbye Mr./Mrs. . . ..". The gaze will always be upon the P.
active control group (SI)
Daily sessions, lasting an hour, will take place in a room known to patients (P). The only people in the room will be a nurse (N) and the researcher with video-tape, never interacting with P. The procedure is: the N will accompany the P in the room and the P will take a seat. The N will put the cube in front of the P and will say "Good morning Mr./Mrs....look", with a quiet voice. If the P will not take it at the first attempt, the N will sit down in front of her holding the cube in the arms and will wait for 2 minutes. The N will invite the PWD again. If the P will not take the cube after the second request, the N will not insist and she will leave. If the cube will be taken, the N will leave the P and say "I have to go, goodbye Mr./Mrs. . . ..". The gaze will always be upon the P.
Eligibility Criteria
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Inclusion Criteria
* presence of at least one behavioral and psychiatric symptom (BPSD) in addition to depression or apathy (Lai, 2014) assessed with the NPI-NH;
* female gender;
* admission in the nursing home at least 3 months before;
* no previous Doll Therapy exposure;
* presence of a daughter or a son, as a family caregiver
Exclusion Criteria
* presence of previous comorbid mental disorders, such as major depression, bipolar disorders and schizophrenia;
* inability to sit comfortably on a chair or limitations in mobility of the arms;
* presence of acute clinical conditions interfering with the participation to the study
FEMALE
No
Sponsors
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Fondazione Golgi Cenci
OTHER
University of Turin, Italy
OTHER
Gruppo Doll Therapy Ticino
UNKNOWN
Case per Anziani Canton Ticino
UNKNOWN
Centro di Terapia Cognitiva, Como
UNKNOWN
University of Applied Sciences and Arts of Southern Switzerland
OTHER
Responsible Party
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Principal Investigators
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Rita Pezzati
Role: PRINCIPAL_INVESTIGATOR
University of Applied Sciences and Arts of Southern Switzerland
Locations
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SUPSI
Manno, , Switzerland
Countries
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References
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Ainsworth, M., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment. Hills-dale. NJ Eribaum.
Bradley JM, Cafferty TP. Attachment among older adults: current issues and directions for future research. Attach Hum Dev. 2001 Sep;3(2):200-21. doi: 10.1080/14616730126485.
Browne CJ, Shlosberg E. Attachment theory, ageing and dementia: a review of the literature. Aging Ment Health. 2006 Mar;10(2):134-42. doi: 10.1080/13607860500312118.
Ellingford, L., Mackenzie, L., & Marsland, L. (2007). Using dolls to alter behavior in people with dementia. Nursing Times, (103), 36-37.
George, C., Kaplan, N., & Main, M. (1985). Adult Attachment Interview. (U. of C. Department of Psychology, Ed.)Unpublished manuscript. Berkeley.
James IA, Mackenzie L, Mukaetova-Ladinska E. Doll use in care homes for people with dementia. Int J Geriatr Psychiatry. 2006 Nov;21(11):1093-8. doi: 10.1002/gps.1612.
Miesen, B., & Jones, G. (2010). Care-giving in dementia: Contours of a curriculum. Dementia, 9(4), 473-489. http://doi.org/10.1177/1471301210381680
Lupien SJ, Lepage M. Stress, memory, and the hippocampus: can't live with it, can't live without it. Behav Brain Res. 2001 Dec 14;127(1-2):137-58. doi: 10.1016/s0166-4328(01)00361-8.
Mitchell G, McCormack B, McCance T. Therapeutic use of dolls for people living with dementia: A critical review of the literature. Dementia (London). 2016 Sep;15(5):976-1001. doi: 10.1177/1471301214548522. Epub 2014 Aug 25.
Pezzati R, Molteni V, Bani M, Settanta C, Di Maggio MG, Villa I, Poletti B, Ardito RB. 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 Apr 21;5:342. doi: 10.3389/fpsyg.2014.00342. eCollection 2014.
van IJzendoorn MH. Adult attachment representations, parental responsiveness, and infant attachment: a meta-analysis on the predictive validity of the Adult Attachment Interview. Psychol Bull. 1995 May;117(3):387-403. doi: 10.1037/0033-2909.117.3.387.
Vreeburg SA, Zitman FG, van Pelt J, Derijk RH, Verhagen JC, van Dyck R, Hoogendijk WJ, Smit JH, Penninx BW. Salivary cortisol levels in persons with and without different anxiety disorders. Psychosom Med. 2010 May;72(4):340-7. doi: 10.1097/PSY.0b013e3181d2f0c8. Epub 2010 Feb 26.
Tamura, T., Nakajima, K., Nambu, M., Nakamura, K., Yonemitsu, S., Itoh, A., … Uno, H. (2001). Baby dolls as therapeutic tools for severe dementia patients. Gerontechnology, 1(2), 111-118.
Tsigos C, Chrousos GP. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res. 2002 Oct;53(4):865-71. doi: 10.1016/s0022-3999(02)00429-4.
Quirin M, Gillath O, Pruessner JC, Eggert LD. Adult attachment insecurity and hippocampal cell density. Soc Cogn Affect Neurosci. 2010 Mar;5(1):39-47. doi: 10.1093/scan/nsp042. Epub 2009 Dec 9.
Lai CK. The merits and problems of Neuropsychiatric Inventory as an assessment tool in people with dementia and other neurological disorders. Clin Interv Aging. 2014 Jul 8;9:1051-61. doi: 10.2147/CIA.S63504. eCollection 2014.
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 Oct;25(5):388-9. doi: 10.1016/j.apnu.2011.05.003. Epub 2011 Jul 12.
Consedine NS, Magai C. Attachment and emotion experience in later life: the view from emotions theory. Attach Hum Dev. 2003 Jun;5(2):165-87. doi: 10.1080/1461673031000108496.
Baranzini F, Grecchi A, Berto E, Costantini C, Ceccon F, Cazzamalli S, Callegari C. [Factor analysis and psychometric properties of the Italian version of the Neuropsychiatric Inventory-Nursing Home in an institutionalized elderly population with psychiatric comorbidity]. Riv Psichiatr. 2013 Jul-Aug;48(4):335-44. doi: 10.1708/1319.14631. Italian.
Vaccaro R, Ballabio R, Molteni V, Ceppi L, Ferrari B, Cantu M, Zaccaria D, Vandoni C, Ardito RB, Adenzato M, Poletti B, Guaita A, Pezzati R. Doll therapy intervention for women with dementia living in nursing homes: a randomized single-blind controlled trial protocol. Trials. 2020 Feb 3;21(1):133. doi: 10.1186/s13063-020-4050-8.
Other Identifiers
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CE3140 BASEC2016-01992
Identifier Type: -
Identifier Source: org_study_id
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