1.1. Introduction
Whitfield (1993) defines dementia as a disorder happening because of the ailment of the encephalon, which is typically interminable or dynamic in nature. It comprises of the weakness of a few higher cortical capacities, which incorporate memory, considering, perception, learning, dialect, judgment and estimation. These debilitations frequently happen close by changes in passionate control, social conduct or inspiration. Cerebrovascular disease and Alzheimer’s disease are among the reasons of dementia (Whitfield, 1993). Dening & Sandilyan (2015) stated that the reasons behind dementia are not completely clear, but the result is always manufactured in changes in the brain, provoking neuronal incident and shrinkage of cerebrum the volume. Small (2014) stated that age is the greatest threat issue for developing dementia. At the point when individuals achieve age 65, their risk of dementia is 10% and by age 85, roughly 33% will develop Alzheimer disease (AD) which is the commonest type of dementia. Around 60% to 80% of the population have Alzheimer’s dementia (WebMD, 2017). This disease carries devastating effects upon the individual, as well as for those around himher, especially his/her family and friends; both financially, as well as emotionally. Individuals encumbered with dementia is presently around 47 million globally (WHO, 2017). It is further stated that the number of cases present globally are most likely to triple by 2050. A table representing the various types of dementia may be found on the next page (Table 1.1.).
Chapter 1 Introduction
Table 1.1. Types of Dementia
Type of Dementia History Signs and Symptoms Pathology/Imaging
Alzheimer’s Disease (50-80% of all dementia cases) Gradual progressive onset •
• • • •
• Memory loss, especially for names and recent events
Language deficits
Rapid forgetting
Impaired visuospatial skills
Normal gait and neuro exam early
Later affective disturbance; behavioural symptoms such as aggression • Generalized atrophy (esp.medial temporal)
• Beta amyloid plaques
• Neurofibrillary tangles
Vascular (20-30%) Abrupt or gradual onset •
• Focal neurological signs Signs of vascular disease • Stroke
• Lacunar infarcts
• White matter lesions
• Vulnerable to cerebrovascular events
Lewy Body (10-25%) Insidious onset, progres- • sive with fluctuations •
• • • •
• Fluctuating cognition
Visual hallucinations
Neuroleptic sensitivity
Shuffling gait
Increased tone
Tremors
Falls • Generalized atrophy
• Lewy bodies in cortex and midbrain
Frontotemporal (10-15%) Insidious onset •
Typically in 50s-60s; rapid • progression
• •
• Disinhibition
Socially inappropriate behaviour
Poor judgment
Apathy decreased motivation
Poor executive • Frontal and temporal atrophy
• Pick cells and pick bodies in cortex
Table 1.1. A table representing the various types of Dementia. Adopted from The Carlat Psychiatry Report. Retrieved August 2 2017, from https:// pro.psychcentral.com/6467/006467.html.
1.2. Management of Dementia
Currently, there are no practices which completely inhibits the progression of dementia, but there are medications that can reduce a one’s symptoms. Treatment includes the use of Cholinesterase inhibitors; such as Rivastigmine, Donepezil, and Galantamine and N-methyl-D-aspartate (NMDA) receptor antagonist such as Memantine (Alzheimer's Society, 2017). It is still unclear whether these drugs actually have any prominent effects in controlling this condition. However, Scerri, Abela and Innes, (2010) argued that these medications have been proven to soothe the mental deterioration for up to 3-6 months. Local practice dictates that Memantine is the only drug that is accepted for AD (Scerri, Abela & Innes, 2010), as it was proclaimed that symptoms of dementia will improve by lowering the amount of clinical deterioration amongst patients with moderate to severe AD. (Scerri, Abela & Innes, 2010), Adjuvant psychopharmacological medications such as antipsychotics, antidepressants, anticonvulsants, and sedative-hypnotics, are usually prescribed as well, to manage the signs of psychological and the behaviour related to Alzheimer’s disease and related dementias (ADRD) (Gruber-Baldini, Struart, Zuckerman, Simoni-Wastila, & Miller, 2007).
Dementia could also be managed by implementing non-pharmacological means. This is usually preferred as a first-line treatment unless the patient in question is in need of immediate care (Lyketsos et al., 2006). Pharmacological management encompasses a great number of adverse drug effects, such as extrapyramidal signs, sedation, syncope and recent studies indicate that neuroleptic medications induce mental deterioration (Douglas, James & Ballard, 2004). Hence, implementing and studying other means of managing this chronic condition has been the priority of caregivers globally.
A number of non-pharmacological interventions used internationally are listed below:
• Activity therapy
• Aromatherapy
• Art therapy
• Behavioural therapy
• Bright-light therapy
• Cognitive–behavioural therapy
• Interpersonal therapy
• Multisensory approaches
• Music therapy
• Reminiscence therapy
1.3. Doll therapy
Doll therapy is a non-pharmacological approach which has been used for over 20 years for patients with dementia (Fernandez, Arthur, Fleming, & Perrin, 2014). Albeit the theoretical work on annexation focused on children, the effect of connection encounters holds on from adolescence into grown-up life (Green & Scholes, 2004). For individuals with dementia, connection conduct can be observed at different phases of dementia and the nearness of parent obsession or seeking for dead relatives has been accounted for when connection needs were not being met (Nelis, Clare, & Whitaker, 2013). The utilization of dolls for remedial purposes includes providing a doll to an individual with dementia to look after is implied to help with conquering a portion of the connection necessities (Mitchell & O’Donnell, 2013). For instance nestling and minding behavior towards the doll is said to be a declaration of being required, feeling subsidiary and the capacity to look after others
(Bisiani & Angus, 2012). Furthermore, embracing a transitional enquiry such as a doll is a portrayal of security amid a time of vulnerability. Doll treatment has been accounted to decrease tumult, animosity and has also been used in a number of clinical trials in pursuit of better understanding the condition (James, Mackenzie, & Mukaetova-Ladinska, 2006).
1.4. Purpose of this review
The main purpose of this review will be to examine if doll therapy has any significant effects on people with dementia and whether it would avail in decrementing challenging behavior (Higgins, 2010). The essential purpose of this examination is to research if there is genuinely any favorable circumstances in using doll therapy as opposed to utilizing medications. The effectiveness of doll therapy as a treatment plan is still being debated by healthcare professionals on a global scale and this review will hopefully serve as a reference for future trials. Moreover, the point of this review will be to present the best accessible proof, identifying the impact of this therapy on individuals with dementia. As a management plan which does not incorporate medications of any sort, it may benefit such individuals and would bring about a change in their conduct and with the people around them.
The topic in question was of interest to me due to the fact that I currently work in a psychiatric ward which houses a number of individuals who are encumbered with dementia. Mental health care is a complex branch of nursing which has always been fascinating to me. With this literature review, I hope to shed new light on the subject under study which will hopefully be beneficial for the patients afflicted with this chronic ailment. Upon a quick search on the local government’s site, a local protocol was obtained. A more detailed guideline on the Mental Health Act (2012) may be found attached in the appendix (Refer to Appendix A).
1.5. Research Question using the PICO Framework
The essential goal of this dissertation will be to extricate appropriate evidence based literature on the efficacy of doll therapy in challenging behaviors amongst people with dementia. The PICO structure (Population, Intervention, Comparison, and Outcome) will be utilized for this pursuit since it is an exceptionally solid instrument while examining literature from electronic sources (Caldwell, 2014). The framework for this review will be exhibited in the following PICO question:
“Is doll therapy more effective in challenging behavior among people with dementia, than treatment as usual?”
Table 1.2 will exhibit precisely how the PICO components are represented in the above question.
Table 1.2. The PICO Framework
Framework Components of the PICO Question Index Key Term
Population/ Problem Elderly over 65 years with dementia Dementia
Intervention Doll therapy Doll therapy
Comparison Treatment as usual Treatment as usual
Expected Outcome Less challenging behavior Less challenging behavior
Table 1.2. A representation of the main PICO elements incorporated for this review.
1.6. Conclusion
The motivation behind this chapter was to give a short summary of the examination which will be handled in the later chapters and will likewise fill in as a starting point to the dissertation. The following chapter will cover the pursuit system actualized and the later chapters will assess and dissect the literature discovered individually, as well as systematically. This will enable the reviewer as well as future researchers in their pursuit of clear evidence regarding the topic.
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