The way people living with dementia experience the world can change as the disease progresses. Their sense of reality or place in time can become distorted, which can cause agitation and distress.

One of the best ways to support people experiencing changes in perception and behaviour is to manage their environment. This can have profound benefits including reducing the need for sedatives.

One such strategy is the use of dolls as comfort aids.

What is ‘doll therapy’?

More appropriately referred to as “child representation”, lifelike dolls (also known as empathy dolls) can provide comfort for some people with dementia.

Memories from the distant past are often more salient than more recent events in dementia. This means that past experiences of parenthood and caring for young children may feel more “real” to a person with dementia than where they are now.

Hallucinations or delusions may also occur, where a person hears a baby crying or fears they have lost their baby.

Providing a doll can be a tangible way of reducing distress without invalidating the experience of the person with dementia.

Some people believe the doll is real

A recent case involving an aged care nurse mistreating a dementia patient’s therapy doll highlights the importance of appropriate training and support for care workers in this area.

For those who do become attached to a therapeutic doll, they will treat the doll as a real baby needing care and may therefore have a profound emotional response if the doll is mishandled.

It’s important to be guided by the person with dementia and only act as if it’s a real baby if the person themselves believes that is the case.

What does the evidence say about their use?

Evidence shows the use of empathy dolls may help reduce agitation and anxiety and improve overall quality of life in people living with dementia.

Child representation therapy falls under the banner of non-pharmacological approaches to dementia care. More specifically, the attachment to the doll may act as a form of reminiscence therapy, which involves using prompts to reconnect with past experiences.

Interacting with the dolls may also act as a form of sensory stimulation, where the person with dementia may gain comfort from touching and holding the doll. Sensory stimulation may support emotional well-being and aid commnication.

However, not all people living with dementia will respond to an empathy doll.

The introduction of a therapeutic doll needs to be done in conjunction with careful observation and consideration of the person’s background.

Empathy dolls may be inappropriate or less effective for those who have not previously cared for children or who may have experienced past birth trauma or the loss of a child.

Be guided by the person with dementia and how they respond to the doll.

Are there downsides?

The approach has attracted some controversy. It has been suggested that child representation therapy “infantilises” people living with dementia and may increase negative stigma.

Further, the attachment may become so strong that the person with dementia will become upset if someone else picks the doll up. This may create some difficulties in the presence of grandchildren or when cleaning the doll.

The introduction of child representation therapy may also require additional staff training and time. Non-pharmacological interventions such as child representation, however, have been shown to be cost-effective.

Could robots be the future?

The use of more interactive empathy dolls and pet-like robots is also gaining popularity.

While robots have been shown to be feasible and acceptable in dementia care, there remains some contention about their benefits.

While some studies have shown positive outcomes, including reduced agitation, others show no improvement in cognition, behaviour or quality of life among people with dementia.

Advances in artificial intelligence are also being used to help support people living with dementia and inform the community.

Viv and Friends, for example, are AI companions who appear on a screen and can interact with the person with dementia in real time. The AI character Viv has dementia and was co-created with women living with dementia using verbatim scripts of their words, insights and experiences. While Viv can share her experience of living with dementia, she can also be programmed to talk about common interests, such as gardening.

These companions are currently being trialled in some residential aged care facilities and to help educate people on the lived experience of dementia.

How should you respond to your loved one’s empathy doll?

While child representation can be a useful adjunct in dementia care, it requires sensitivity and appropriate consideration of the person’s needs.

People living with dementia may not perceive the social world the same way as a person without dementia. But a person living with dementia is not a child and should never be treated as one.

Ensure all family, friends and care workers are informed about the attachment to the empathy doll to help avoid unintentionally causing distress from inappropriate handling of the doll.

If using an interactive doll, ensure spare batteries are on hand.

Finally, it is important to reassess the attachment over time as the person’s response to the empathy doll may change.

Nikki-Anne Wilson, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

There are renewed calls this week for the Australian government to implement a range of measures aimed at improving our diets. These include restrictions on junk food advertising, improvements to food labelling, and a levy on sugary drinks.

This time the recommendations come from a parliamentary inquiry into diabetes in Australia. Its final report, tabled in parliament on Wednesday, was prepared by a parliamentary committee comprising members from across the political spectrum.

The release of this report could be an indication that Australia is finally going to implement the evidence-based healthy eating policies public health experts have been recommending for years.

But we know Australian governments have historically been unwilling to introduce policies the powerful food industry opposes. The question is whether the current government will put the health of Australians above the profits of companies selling unhealthy food.

Diabetes in Australia

Diabetes is one of the fastest growing chronic health conditions in the nation, with more than 1.3 million people affected. Projections show the number of Australians diagnosed with the condition is set to rise rapidly in coming decades.

Type 2 diabetes accounts for the vast majority of cases of diabetes. It’s largely preventable, with obesity among the strongest risk factors.

This latest report makes it clear we need an urgent focus on obesity prevention to reduce the burden of diabetes. Type 2 diabetes and obesity cost the Australian economy billions of dollars each year and preventive solutions are highly cost-effective.

This means the money spent on preventing obesity and diabetes would save the government huge amounts in health care costs. Prevention is also essential to avoid our health systems being overwhelmed in the future.

What does the report recommend?

The report puts forward 23 recommendations for addressing diabetes and obesity. These include:

• restrictions on the marketing of unhealthy foods to children, including on TV and online
• improvements to food labelling that would make it easier for people to understand products’ added sugar content
• a levy on sugary drinks, where products with higher sugar content would be taxed at a higher rate (commonly called a sugar tax).

These key recommendations echo those prioritised in a range of reports on obesity prevention over the past decade. There’s compelling evidence they’re likely to work.

Restrictions on unhealthy food marketing

There was universal support from the committee for the government to consider regulating marketing of unhealthy food to children.

Public health groups have consistently called for comprehensive mandatory legislation to protect children from exposure to marketing of unhealthy foods and related brands.

An increasing number of countries, including Chile and the United Kingdom, have legislated unhealthy food marketing restrictions across a range of settings including on TV, online and in supermarkets. There’s evidence comprehensive policies like these are having positive results.

In Australia, the food industry has made voluntary commitments to reduce some unhealthy food ads directly targeting children. But these promises are widely viewed as ineffective.

The government is currently conducting a feasibility study on additional options to limit unhealthy food marketing to children.

But the effectiveness of any new policies will depend on how comprehensive they are. Food companies are likely to rapidly shift their marketing techniques to maximise their impact. If any new government restrictions do not include all marketing channels (such as TV, online and on packaging) and techniques (including both product and brand marketing), they’re likely to fail to adequately protect children.

Food labelling

Food regulatory authorities are currently considering a range of improvements to food labelling in Australia.

For example, food ministers in Australia and New Zealand are soon set to consider mandating the health star rating front-of-pack labelling scheme.

Public health groups have consistently recommended mandatory implementation of health star ratings as a priority for improving Australian diets. Such changes are likely to result in meaningful improvements to the healthiness of what we eat.

Regulators are also reviewing potential changes to how added sugar is labelled on product packages. The recommendation from the committee to include added sugar labelling on the front of product packaging is likely to support this ongoing work.

But changes to food labelling laws are notoriously slow in Australia. And food companies are known to oppose and delay any policy changes that might hurt their profits.

A sugary drinks tax

Of the report’s 23 recommendations, the sugary drinks levy was the only one that wasn’t universally supported by the committee. The four Liberal and National party members of the committee opposed implementation of this policy.

As part of their rationale, the dissenting members cited submissions from food industry groups that argued against the measure. This follows a long history of the Liberal party siding with the sugary drinks industry to oppose a levy on their products.

The dissenting members didn’t acknowledge the strong evidence that a sugary drinks levy has worked as intended in a wide range of countries.

In the UK, for example, a levy on sugary drinks implemented in 2018 has successfully lowered the sugar content in UK soft drinks and reduced sugar consumption.

The dissenting committee members argued a sugary drinks levy would hurt families on lower incomes. But previous Australian modelling has shown the two most disadvantaged quintiles would reap the greatest health benefits from such a levy, and accrue the highest savings in health-care costs.

What happens now?

Improvements to population diets and prevention of obesity will require a comprehensive and coordinated package of policy reforms.

Globally, a range of countries facing rising epidemics of obesity and diabetes are starting to take such strong preventive action.

In Australia, after years of inaction, this week’s report is the latest sign that long-awaited policy change may be near.

But meaningful and effective policy change will require politicians to listen to the public health evidence rather than the protestations of food companies concerned about their bottom line.

Gary Sacks, Professor of Public Health Policy, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.