When pretend play is real for Alzheimer's patients

Sitting beside a neatly made crib, 88-year-old Vivian Guzofsky held up a baby doll dressed in puppy dog pajamas.

"Hello, gorgeous," she said, laughing. "You're so cute."

Guzofsky, who has Alzheimer's disease, lives on a secure memory floor of a home for seniors. Nearly every day, she visits the dolls in the home's pretend nursery. Sometimes she changes their clothes or lays them down for a nap.

No one knows whether she believes she is holding a doll or a real baby. What the staff at Sunrise Senior Living in Beverly Hills, Calif., does know is that Guzofsky - who can get agitated and aggressive - is always calm when caring for the dolls.

Senior facilities nationwide are using a controversial technique called doll therapy to ease anxiety among their residents with dementia. Senior care providers and experts say the dolls are an alternative to medication and help draw in elderly people who are no longer able to participate in many activities.

"A lot of people with Alzheimer's are bored and may become depressed or agitated or unhappy because they aren't engaged," said Ruth Drew, director of family and information services at the Alzheimer's Association.

Caregivers aren't trying to make their charges believe the dolls are real infants, and they don't want to infantilize the seniors, Drew said. They are just "trying to meet them where they are and communicate with them in a way that makes sense to them."

But some facilities argue that it can be demeaning for seniors to play with dolls.

"They are adults, and we want to treat them like adults," said Stephanie Zeverino, who works in community relations at Belmont Village Senior Living Westwood, also in California. "These are very well-educated residents."

The facility prefers other types of therapy, including art and music, she said. And staff members there work with residents to play brain games that promote critical thinking.

"We want to provide a sense of dignity," Zeverino said.

Studies on doll therapy are limited, but some research has shown that it can reduce the need for medications, diminish anxiety and improve communication, according to Gary Mitchell, a nurse specialist at Four Seasons Health Care in the United Kingdom who has written a new book about doll therapy.

However, Mitchell acknowledged it is possible that doll therapy, because it can infantilize adults, "perpetuates a lot of stigma with dementia care that we are trying to get away from."

But Mitchell said it can be very beneficial for some people - especially those who may get easily distressed or pace obsessively. "Having the doll . . . offers them an anchor or a sense of attachment in a time of uncertainty," he said. "A lot of people associate the doll with their younger days and having people to care for."

At Sunrise Beverly Hills, the nursery is set up like a baby's room. A stuffed bear rests inside the wooden crib. On a shelf above are framed photos of Guzofsky and a few other women who regularly interact with the dolls. A few bottles, a swaddling blanket, a Dr. Seuss book, and diapers sit on a nearby changing table.

The nursery is just one of several areas in the Sunrise centers designed to engage residents, said Rita Altman, senior vice president of memory care for Sunrise, which has facilities in the U.S., Canada, and the U.K. There are also art centers, offices, gardens and kitchens where residents may find familiar objects from their past.

Sunrise caregivers also use the dolls to spark conversations by asking questions: How many children do you have? Was your first baby a boy or a girl? What are the best things about being a mom?

The executive director of the Beverly Hills facility, Jason Malone, said he was skeptical about the use of dolls when he first heard about them.

"I almost felt like we were being deceitful," he said. "It didn't feel like it was real."

But he quickly changed his mind when he realized that staff could use the dolls respectfully.

"We don't want to confuse treating our seniors as children," Malone said. "That's not what this activity is truly about."

Guzofsky began caring for the dolls soon after moving into the facility. When asked what she likes about the dolls, she said, "I love babies. I have some very nice ones back where I live now."

Guzofsky's daughter, Carol Mizel, said her mother raised three children and volunteered extensively in Colorado and Mexico before being found to have Alzheimer's about five years ago. Mizel said she doesn't see any downside to her mother caring for the dolls. It is a "creative way of dealing with her where she is now," she said.

For some residents, including 87-year-old Marilou Roos, holding the dolls is one of the only times they interact with the staff. Roos is confined to a wheelchair and rarely speaks. She sleeps much of the day.

"There is not much [Roos] can participate in," said Vladimir Kaplun, former coordinator of the secure memory floor. "When she spends some time with the babies, she wakes up and she brightens up."

On a recent day, caregiver Jessica Butler sat next to Roos, who held a doll against her chest and patted her on the back. She kissed the doll twice.

"The baby's beautiful like you," Butler said.

"It's a boy," Roos said. "Five months."

Roos, the mother of five, was involved with the PTA, Girl Scouts, and other activities, according to her daughter, Ellen Swarts.

Swarts said it's been difficult to watch the decline of her mother, who hasn't called her by name in more than a year. Watching her with the dolls helps, she said.

"To see the light in her eyes when she has a baby in her arms, I don't care if it's real or if it's pretending," she said. "If that gives her comfort, I am A-OK with it."