Tuesday, 24 June 2008


Increasingly there's pressure to manage Behavioural and Psychological Symptoms of Dementia (BPSD) in ways other than just through antipsychotics. This is a good thing. I still maintain that antipsychotics can be part of the answer for some patients some of the time, but they're not a cure when used alone.

I'm blessed to be working with nursing staff who are exceptionally good at what they do. Which isn't diagnosis or medical stuff, it's nursing care. I've a lady in permanent care, through progression of her dementia. She has become increasingly vocal (shouting out) and wandersome. We have no antishouting pill. We have no antimoving pill.

I looked at her medication and stopped some of it, which made things better. Two months on, things have progressed and again the home's struggling to cope with her. My nursing colleague visited and tried to understand why this lady was shouting and moving. Hip pain from arthritis after nonunion of a fracture could be one factor. Constipation could be another. Disorientation, through diminished insight and a lack of appreciation of what's going on, could be a factor. Thirst sometimes seems to be.

As well as spending time divining why the behaviour unfolds and what it means, the nurse also undertook some interventions at frequent intervals within the care home. Aromatherapy. Hand massage. Doll therapy.

It's all worked.



Dragonfly said...

And love the Blackadder reference.

Oliver Smith said...

Doll Therapy?

Can anyone explain, please?

ditzydoctor said...

doll therapy???

but ooh much goodness it's worked :)

Oliver Smith said...

I've done a bit of reserach into this Doll Therapy and this is what I've drawn from what I have read (please someone correct me if I am wrong)

It would appear that this form of therapy is used with patients who suffer from Dementia.

The patient is given a doll to look after and care for. It apparently fulfils some of the significant universal emotional needs (mainly To feel needed and useful, To have opportunity to care and To love and be loved).

When these needs [the five significant universal emotional needs] are not fulfilled in this reality they tend to go back into their memories and recreate significant people, places, objects or situations where those needs were fulfilled.

Doll Therapy is the wise and mindful use of dolls for their symbolic significance to help improve the well-being of people with dementia.

Hmmm interesting...

The Shrink said...

Cooo, I didn't think it's be something folk would easily be able to sleuth out but you're spot on. When starting to become distraught, one option is to present her with a very life like looking doll. As a type of distraction that lets her become engrossed in talking to, stroking and cuddling the doll and babbling to staff with stories 'bout the doll it can work well in helping her change tack from escalating behavioural symptoms.

Of course, on other occasions she hurls it across the room.

But, there's no one technique or tool that works all the time in every situation, eh? As one option that can help it's obviously fairly side effect free and can have fair utility.

Oliver Smith said...

It's all good if it works.

I just explained the therapy to my mum who is working with more and more patients in earlier stages of dementia (works in palliative care). She’s up for anything that might result in being gummed to death less.

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