Ethel Legrand had put on her silky black beret for the occasion, and sat in her wheelchair cradling a blue-eyed baby doll in both her arms, pressing her chin into its head, rubbing one of its feet with her left hand. She had already named the doll "Betty Jean" and meant to keep it close to her, "right on my bed," she said.
She'd had a few dolls in her day - "Ooh, brother, I had a whole lot of dolls" - but now she is 88 years old and was tuning in and out of the morning's proceedings in the chapel at Summit Park Health & Rehabilitation Center in Catonsville. She would join in a song and take up a chat, then fold into her silence, her head down on the doll's head.
The little gathering last week revolved around this pairing of elderly women and dolls. Two women from Catonsville have taken up the cause of collecting used dolls and giving them a second life in the hands of elderly people with dementia, some of whom seem in anecdotal and research reports to benefit from having a child's toy.
For many patients with Alzheimer's disease and other forms of dementia, the doll becomes a companion, an object of affection, a connection to another time when a child needed them.
"They don't have anyone to hug or hold," said Wendy Geist, who has been working on the project with Amy Nelson. "No one's hugging them anymore."
Geist got the idea from her grandmother's experience about 10 years ago, but her interest in elderly people started when she was a girl and her mother would take her to visit nursing homes.
Geist and Nelson have been at this about a year, having put out the word through friends, and via e-mail asking for slightly used but presentable dolls - baby dolls, many dressed in frocks and all with lifelike facial features. They've been collecting the dolls in their homes and then handing them out, or giving them to elementary school children to offer at local long-term care, rehabilitation and assisted living centers. Sometimes they just drop off a box of dolls, sometimes they stay to make a presentation, as in Summit Park.
Eight women were wheeled into the chapel, with its carpeting and light floral wallpaper. Geist, Nelson and Geist's mother, Nancy Park, took the floor to begin the presentation. They had brought two baskets containing 14 baby dolls.
Park opened by leading the group in two songs, "Baby Face" and "You Beautiful Doll," and was joined by some women and not others. In minutes, a group of second-graders from Hillcrest Elementary School took up the baskets and began stepping from one woman to the next, offering a doll.
Park said later that she made such an offer to her own mother in the years before she died, when she was in her mid-80s, suffering with dementia and recovering from hip surgery at Good Samaritan Hospital in Baltimore in the late 1990s.
"She loved baby dolls when she was little," Park said. At the end of her life, she seemed to find the doll comforting.
Extensive research on "doll therapy" has not been done, but small-scale studies conducted in the United States, Canada and Great Britain since the 1990s suggest the approach can help some elderly patients with dementia. Studies show that dolls can help diminish aggressive, agitated or disruptive behavior that might otherwise have to be managed with medication. In some cases, the dolls can draw more expression and conversation from patients who seem extremely withdrawn.
An elderly care home in England this year reported in Nursing Times that after giving dolls to its patients, much less medication was needed to manage behavior.
No formal guide to using "doll therapy" yet exists, and researchers point out a number of ethical and practical problems with it. A 2006 article in the International Journal of Geriatric Psychiatry reported that relatives of some patients "saw the use of the dolls as demeaning." The same article noted that the practice can cause fights among patients over whose doll is whose, and raise the complicated question of whether the therapist is "colluding with the patient's misunderstanding that the doll is a baby."
Geist and Nelson so far receive good reviews for their efforts.
Medina Lundy, the activities director at Manor Care in Chevy Chase, where Nelson dropped dolls off in the spring, said some patients are treating their dolls as if they were infants. One patient who often seemed upset to the point of crying has improved.
"I can't tell if she thinks it's a real baby or not," Lundy said. "I think it's just a piece of security."
Lori Manalansan, activity director at Frederick Villa in Catonsville, said that since dolls were donated there in September, some patients seem happier.
"It calms a lot of them down," Manalansan said. Some patients "believe it's actually their child."
At Summit Park, the women were showing the range of responses that Geist and Nelson have come to expect.
Lucille Ellis held her doll in her lap, but looked off in the distance in silence. Her daughter, Mildred Ellis, said her mother had suffered a stroke and could not speak. She thought the doll could give her mother "something to do with her hands."
Helen Paysour said she would introduce the doll to her grandchildren, then "I'll put it on my bed."
Ethel Legrand seemed the most enthusiastic - about the doll, the songs, the day in general. She said she would "treasure this baby doll." Then she put the doll to her face and kissed its forehead.