Simulated presence therapy

Simulated presence therapy (sometimes ‘simulated family presence therapy’) uses a personalised video or audio recording of a familiar, trusted voice to quieten and reassure people living with dementia when they are anxious or agitated. [1] The recorded voice usually tells stories of the person’s earlier life. It might also recall shared, happy moments involving family and friends. The aim is to create a sense of familiarity and security for the person with dementia when family or friends cannot be with them in person. [2]

This evidence theme on simulated presence therapy is a summary of one of the key topics identified by a scoping review of dementia research. If you need more specific or comprehensive information on this topic, try using the PubMed search below.

One recently published review has investigated the effect of simulated presence therapy on responsive behaviours such as anxiety and agitation. [1] This review could not make a conclusive statement on the effectiveness of simulated presence therapy due to the low quality of the available evidence. Specifically, the review found studies into the therapy had problems with their methods. It was also not possible to compare these studies due to:

• The small number of studies available for analysis
• The low numbers of participants in each study
• Major differences in the way the therapy was applied and assessed across studies. This includes the types of personal messages recorded, how frequently they were played, for how long, the responsive behaviours measured, and the methods for doing so. [1]

The review also found that some people with dementia became more agitated by the recorded message, rather than less.

• Until researchers conduct better quality studies on this approach, we cannot be certain if simulated presence therapy improves responsive behaviours or worsens mood or agitation for people living with dementia.
• If considering using this approach, choose participants carefully and monitor their responses closely. [3]
• Family members might be encouraged to record short, simple, and reassuring messages on an iPad or mobile phone for playing to the person with dementia when needed.

• Simulated presence therapy could be a less expensive and safer alternative to drug treatments for responsive behaviours in residential aged care. It might also provide a positive experience for many.
• However, until there is more known about potential harms, this approach should be applied cautiously and perhaps under the guidance of a trained practitioner.

1. Abraha I, Rimland JM, Lozano-Montoya I, Dell'Aquila G, Velez-Diaz-Pallares M, Trotta FM, et al. Simulated presence therapy for dementia. Cochrane Database Syst Rev. 2020;4:CD011882.
2. Woods P, Ashley J. Simulated presence therapy: Using selected memories to manage problem behaviors in Alzheimer's disease patients. Geriatr Nurs. 1995;16(1):9-14.
3. Zetteler J. Effectiveness of simulated presence therapy for individuals with dementia: A systematic review and meta-analysis. Aging Ment Health. 2008;12(6):779-85.