Overview
Dementia is a major health challenge associated with population aging. As dementia progresses, patients often experience a decline in their ability to perform basic activities of daily living (BADL), such as dressing and personal hygiene, leading to increased dependence on caregivers. Apathy, characterized by reduced motivation, interest, and initiative, is a common symptom of dementia and may contribute to difficulties in initiating daily activities.
Doll therapy is a non-pharmacological intervention that involves guided interaction with dolls to promote emotional engagement, motivation, and participation in activities. Previous studies suggest that doll therapy may help alleviate apathy and improve behavioral symptoms in patients with dementia. However, its effects on the initiation of basic daily activities remain unclear.
This study aims to evaluate the effectiveness of doll therapy in improving apathy and basic activities of daily living among older adults with dementia. Participants will be randomly assigned to either a doll therapy group or a usual care group. The intervention will last for 2 weeks, and outcomes will be assessed at baseline, Week 2 (end of intervention), and Week 4 (follow-up).
The primary outcome is the severity of apathy. Secondary outcomes include basic activities of daily living, quality of life, and neuropsychiatric symptoms.
The study hypothesizes that doll therapy will reduce apathy and improve the ability to initiate and perform basic daily activities in older adults with dementia compared with usual care.
Description
Background
Dementia is a progressive condition characterized by cognitive impairment, neuropsychiatric symptoms, and declining functional independence. Impairment in basic activities of daily living (BADL), particularly dressing and personal hygiene, represents a major challenge in dementia care. Such impairment may result not only from cognitive and physical limitations but also from apathy-related difficulties in initiating goal-directed activities.
Apathy is characterized by diminished motivation, reduced initiative, and decreased engagement in purposeful activities. It is commonly observed in patients with dementia and may contribute to increasing dependence on caregivers. Interventions targeting apathy may therefore have potential benefits for maintaining daily functioning and reducing care dependency.
Doll therapy is an emerging non-pharmacological intervention that provides sensory stimulation, emotional engagement, and opportunities for social interaction. Existing evidence suggests potential benefits for behavioral and psychological symptoms of dementia. Nevertheless, evidence regarding its effects on apathy and BADL initiation deficits remains limited.
Study Objectives
The primary objective of this study is to evaluate the effectiveness of doll therapy in reducing apathy among older adults with dementia. The secondary objective is to investigate whether doll therapy improves basic activities of daily living, particularly difficulties in initiating daily activities, as well as quality of life and neuropsychiatric symptoms.
Study Design and Procedures
This study is a randomized controlled trial with an assessor-blinded, parallel-group design. Eligible participants will be randomly allocated to either the intervention group or the control group using stratified permuted block randomization.
Participants in the intervention group will receive doll therapy in addition to usual care. The intervention will be delivered three times per week, with each session lasting approximately 30 minutes, over a 2-week period. The control group will receive usual care without doll therapy.
Outcome assessments will be conducted at three time points: baseline, Week 2 (immediately after the intervention), and Week 4 (2 weeks after completion of the intervention). Outcome assessors will remain unaware of participants' group assignments.
Expected Contribution
This study aims to provide evidence regarding the potential effectiveness of doll therapy in reducing apathy and improving daily functioning among older adults with dementia. The findings may inform the development of practical, low-cost, non-pharmacological interventions for dementia care.
Eligibility
Inclusion Criteria:
- Aged 60 years or older.
- Diagnosed with Alzheimer's disease or other types of dementia according to the International Classification of Diseases, 10th Revision (ICD-10), or with major neurocognitive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
- Hospitalization duration exceeding 4 weeks.
- Apathy Evaluation Scale-Informant Version (AES-I) score ≥33.
- Not participating in any other clinical research trials.
- Voluntary participation with written informed consent provided by the participant or their legally authorized representative.
Exclusion Criteria:
- Explicit refusal to interact with dolls.
- Severe uncorrected hearing or visual impairment.
- Uncontrolled severe behavioral and psychological symptoms (e.g., delusions or aggressive behavior) or a primary psychiatric disorder (e.g., schizophrenia or bipolar disorder).
- Comorbid conditions that may impair the ability to independently perform personal hygiene activities, such as hemiplegia, paralysis, joint or skeletal disorders, or Parkinson's disease.
- Presence of a terminal illness.
