What is ‘doll therapy’ for people with dementia? And is it backed by science?
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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.
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I’m Moving Forward and Facing the Uncertainty of Aging
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It takes a lot of courage to grow old.
I’ve come to appreciate this after conversations with hundreds of older adults over the past eight years for nearly 200 “Navigating Aging” columns.
Time and again, people have described what it’s like to let go of certainties they once lived with and adjust to new circumstances.
These older adults’ lives are filled with change. They don’t know what the future holds except that the end is nearer than it’s ever been.
And yet, they find ways to adapt. To move forward. To find meaning in their lives. And I find myself resolving to follow this path as I ready myself for retirement.
Patricia Estess, 85, of the Brooklyn borough of New York City spoke eloquently about the unpredictability of later life when I reached out to her as I reported a series of columns on older adults who live alone, sometimes known as “solo agers.”
Estess had taken a course on solo aging. “You realize that other people are in the same boat as you are,” she said when I asked what she had learned. “We’re all dealing with uncertainty.”
Consider the questions that older adults — whether living with others or by themselves — deal with year in and out: Will my bones break? Will my thinking skills and memory endure? Will I be able to make it up the stairs of my home, where I’m trying to age in place?
Will beloved friends and family members remain an ongoing source of support? If not, who will be around to provide help when it’s needed?
Will I have enough money to support a long and healthy life, if that’s in the cards? Will community and government resources be available, if needed?
It takes courage to face these uncertainties and advance into the unknown with a measure of equanimity.
“It’s a question of attitude,” Estess told me. “I have honed an attitude of: ‘I am getting older. Things will happen. I will do what I can to plan in advance. I will be more careful. But I will deal with things as they come up.’”
For many people, becoming old alters their sense of identity. They feel like strangers to themselves. Their bodies and minds aren’t working as they used to. They don’t feel the sense of control they once felt.
That requires a different type of courage — the courage to embrace and accept their older selves.
Marna Clarke, a photographer, spent more than a dozen years documenting her changing body and her life with her partner as they grew older. Along the way, she learned to view aging with new eyes.
“Now, I think there’s a beauty that comes out of people when they accept who they are,” she told me in 2022, when she was 70, just before her 93-year-old husband died.
Arthur Kleinman, a Harvard professor who’s now 83, gained a deeper sense of soulfulness after caring for his beloved wife, who had dementia and eventually died, leaving him grief-stricken.
“We endure, we learn how to endure, how to keep going. We’re marked, we’re injured, we’re wounded. We’re changed, in my case for the better,” he told me when I interviewed him in 2019. He was referring to a newfound sense of vulnerability and empathy he gained as a caregiver.
Herbert Brown, 68, who lives in one of Chicago’s poorest neighborhoods, was philosophical when I met him at his apartment building’s annual barbecue in June.
“I was a very wild person in my youth. I’m surprised I’ve lived this long,” he said. “I never planned on being a senior. I thought I’d die before that happened.”
Truthfully, no one is ever prepared to grow old, including me. (I’m turning 70 in February.)
Chalk it up to denial or the limits of imagination. As May Sarton, a writer who thought deeply about aging, put it so well: Old age is “a foreign country with an unknown language.” I, along with all my similarly aged friends, are surprised we’ve arrived at this destination.
For me, 2025 is a turning point. I’m retiring after four decades as a journalist. Most of that time, I’ve written about our nation’s enormously complex health care system. For the past eight years, I’ve focused on the unprecedented growth of the older population — the most significant demographic trend of our time — and its many implications.
In some ways, I’m ready for the challenges that lie ahead. In many ways, I’m not.
The biggest unknown is what will happen to my vision. I have moderate macular degeneration in both eyes. Last year, I lost central vision in my right eye. How long will my left eye pick up the slack? What will happen when that eye deteriorates?
Like many people, I’m hoping scientific advances outpace the progression of my condition. But I’m not counting on it. Realistically, I have to plan for a future in which I might become partially blind.
It’ll take courage to deal with that.
Then, there’s the matter of my four-story Denver house, where I’ve lived for 33 years. Climbing the stairs has helped keep me in shape. But that won’t be possible if my vision becomes worse.
So my husband and I are taking a leap into the unknown. We’re renovating the house, installing an elevator, and inviting our son, daughter-in-law, and grandson to move in with us. Going intergenerational. Giving up privacy. In exchange, we hope our home will be full of mutual assistance and love.
There are no guarantees this will work. But we’re giving it a shot.
Without all the conversations I’ve had over all these years, I might not have been up for it. But I’ve come to see that “no guarantees” isn’t a reason to dig in my heels and resist change.
Thank you to everyone who has taken time to share your experiences and insights about aging. Thank you for your openness, honesty, and courage. These conversations will become even more important in the years ahead, as baby boomers like me make their way through their 70s, 80s, and beyond. May the conversations continue.
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The Oh She Glows Cookbook – by Angela Liddon
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Let’s get the criticism out of the way first: notwithstanding the subtitle promising over 100 recipes, there are about 80-odd here, if we discount recipes that are no-brainer things like smoothies, sides such as for example “roasted garlic”, or meta-ingredients such as oat flour (instructions: blend the oats and you get oat flour).
The other criticism is more subjective: if you are like this reviewer, you will want to add more seasonings than recommended to most of the recipes. But that’s easy enough to do.
As for the rest: this is a very healthy cookbook, and quite wide-ranging and versatile, with recipes that are homely, with a lot of emphasis on comfort foods (but still, healthy), though certainly some are perfectly worthy of entertaining too.
A nice bonus of this book is that it offers a lot of available substitutions (much like we do at 10almonds), and also ways of turning the recipe into something else entirely with just a small change. This trait more than makes up for the slight swindle in terms of number of recipes, since some of the recipes have bonus recipes snuck in.
Bottom line: if you’d like to broaden your plant-based cooking range, this book is a fine option for expanding your repertoire.
Click here to check out The Oh She Glows Cookbook, and indeed glow!
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Beetroot vs Pumpkin – Which is Healthier?
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Our Verdict
When comparing beetroot to pumpkin, we picked the beetroot.
Why?
It was close! And an argument could be made for either.
In terms of macros, beetroot has about 3x more protein and about 3x more fiber, as well as about 2x more carbs, making it the “more food per food” option. While both have a low glycemic index, we picked the beetroot here for its better numbers overall.
In the category of vitamins, beetroot has more of vitamins B6 and B9, while pumpkin has more of vitamins A, B2, B3, B5, E, and K. So, a fair win for pumpkin this time.
When it comes to minerals, though, beetroot has more calcium, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while pumpkin has a tiny bit more copper. An easy win for beetroot here.
In short, both are great, and although pumpkin shines in the vitamin category, beetroot wins on overall nutritional density.
Want to learn more?
You might like to read:
No, beetroot isn’t vegetable Viagra. But here’s what it can do
Take care!
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How to Stay Sane – by Philippa Perry
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First, what this book is not: a guide of “how to stay sane” in the popular use of the word “sane”, meaning free from serious mental illness of all and any kinds in general, and especially free from psychotic delusions. Alas, this book will not help with those.
What, then, is it? A guide of “how to stay sane” in the more casual sense of resiliently and adaptively managing stress, anxiety, and suchlike. The “light end” of mental health struggles, that nonetheless may not always feel light when dealing with them.
The author, a psychotherapist, draws from her professional experience and training to lay out psychological tools for our use, as well as giving the reader a broader understanding of the most common ills that may ail us.
The writing style is relaxed and personable; it’s not at all like reading a textbook.
The psychotherapeutic style is not tied to one model, and rather hops from one to another, per what is most likely to help for a given thing. This is, in this reviewer’s opinion at least, far better than the (all-too common) attempt made by a lot of writers to try to present their personal favorite model as the cure for all ills, instead of embracing the whole toolbox as this one does.
Bottom line: if your mental health is anywhere between “mostly good” and “a little frayed around the edges but hanging on by at least a few threads”, then this book likely can help you gain/maintain the surer foundation you’re surely seeking.
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Why Zebras Don’t Get Ulcers – by Dr. Robert M. Sapolsky
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The book does kick off with a section that didn’t age well—he talks of the stress induced globally by the Spanish Flu pandemic of 1918, and how that kind of thing just doesn’t happen any more. Today, we have much less existentially dangerous stressors!
However, the fact we went and had another pandemic really only adds weight to the general arguments of the book, rather than detracting.
We are consistently beset by “the slings and arrows of outrageous fortune” as Shakespeare would put it, and there’s a reason (or twenty) why many people go grocery-shopping with the cortisol levels of someone being hunted for sport.
So, why don’t zebras get ulcers, as they actually are hunted for food?
They don’t have rent to pay or a mortgage, they don’t have taxes, or traffic, or a broken washing machine, or a project due in the morning. Their problems come one at a time. They have a useful stress response to a stressful situation (say, being chased by lions), and when the danger is over, they go back to grazing. They have time to recover.
For us, we are (usually) not being chased by lions. But we have everything else, constantly, around the clock. So, how to fix that?
Dr. Sapolsky comprehensively describes our physiological responses to stress in quite different terms than many. By reframing stress responses as part of the homeostatic system—trying to get the body back into balance—we find a solution, or rather: ways to help our bodies recover.
The style is “pop-science” and is very accessible for the lay reader while still clearly coming from a top-level academic who is neck-deep in neuroendocrinological research. Best of both worlds!
Bottom line: if you try to take very day at a time, but sometimes several days gang up on you at once, and you’d like to learn more about what happens inside you as a result and how to fix that, this book is for you!
Click here to check out “Why Zebras Don’t Get Ulcers” and give yourself a break!
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Citicoline: Better Than Dietary Choline?
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Citicoline: Better Than Dietary Choline?
Citicoline, also known as cytidine diphosphate-choline (or CDP-Choline, to its friends, or cytidine 5′-diphosphocholine if it wants to get fancy) is a dietary supplement that the stomach can metabolize easily for all the brain’s choline needs. What are those needs?
Choline is an essential nutrient. We technically can synthesize it, but only in minute amounts, far less than we need. Choline is a key part of the neurotransmitter acetylcholine, as well as having other functions in other parts of the body.
As for citicoline specifically… it appears to do the job better than dietary sources of choline:
❝Intriguing data, showing that on a molar mass basis citicoline is significantly less toxic than choline, are also analyzed.
It is hypothesized that, compared to choline moiety in other dietary sources such as phosphatidylcholine, choline in citicoline is less prone to conversion to trimethylamine (TMA) and its putative atherogenic N-oxide (TMAO).
Epidemiological studies have suggested that choline supplementation may improve cognitive performance, and for this application citicoline may be safer and more efficacious.❞
Source: Citicoline: A Superior Form of Choline?
Great! What does it do?
What doesn’t it do? When it comes to cognitive function, anyway, citicoline covers a lot of bases.
Short version: it improves just about every way a brain’s healthy functions can be clinically measured. From cognitive improvements in all manner of tests (far beyond just “improves memory” etc; also focus, alertness, verbal fluency, logic, computation, and more), to purely neurological things like curing tinnitus (!), alleviating mobility disorders, and undoing alcohol-related damage.
One of the reasons it’s so wide in its applications, is that it has a knock-on effect to other systems in the brain, including the dopaminergic system.
Long version: Citicoline: pharmacological and clinical review, 2022 update
(if you don’t want to sit down for a long read, we recommend skimming to the charts and figures, which are very elucidating even alone)
Spotlight study in memory
For a quick-reading example of how it helps memory specifically:
Keeping dementia at bay
For many older people looking to improve memory, it’s less a matter of wanting to perform impressive feats of memory, and more a matter of wanting to keep a sharp memory throughout our later years.
Dr. Maria Bonvicini et al. looked into this:
❝We selected seven studies including patients with mild cognitive impairment, Alzheimer’s disease or post-stroke dementia
All the studies showed a positive effect of citicoline on cognitive functions. Six studies could be included in the meta-analysis.
Overall, citicoline improved cognitive status, with pooled standardized mean differences ranging from 0.56 (95% CI: 0.37-0.75) to 1.57 (95% CI: 0.77-2.37) in different sensitivity analyses❞
The researchers concluded “yes”, and yet, called for more studies, and of higher quality. In many such studies, the heterogeneity of the subjects (often, residents of nursing homes) can be as much a problem (unclear whether the results will be applicable to other people in different situations) as it is a strength (fewer confounding variables).
Another team looked at 47 pre-existing reviews, and concluded:
❝The review found that citicoline has been proven to be a useful compound in preventing dementia progression.
Citicoline has a wide range of effects and could be an essential substance in the treatment of many neurological diseases.
Its positive impact on learning and cognitive functions among the healthy population is also worth noting.❞
Source: Application of Citicoline in Neurological Disorders: A Systematic Review
The dopamine bonus
Remember how we said that citicoline has a knock-on effect on other systems, including the dopaminergic system? This means that it’s been studied (and found meritorious) for alleviating symptoms of Parkinson’s disease:
❝Patients with Parkinson’s disease who were taking citicoline had significant improvement in rigidity, akinesia, tremor, handwriting, and speech.
Citicoline allowed effective reduction of levodopa by up to 50%.
Significant improvement in cognitive status evaluation was also noted with citicoline adjunctive therapy.❞
Source: Citicoline as Adjuvant Therapy in Parkinson’s Disease: A Systematic Review
Where to get it?
We don’t sell it, but here’s an example product on Amazon, for your convenience
Enjoy!
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