The impact of a resident dog on an institution for the elderly: effects on perceptions and social interactions

Home- and community-level predictors of social connection in nursing home residents: A scoping review

Background and Aims

Social connection is associated with better physical and mental health and is an important aspect of the quality of care for nursing home residents. The primary objective of this scoping review was to answer the question: what nursing home and community characteristics have been tested as predictors of social connection in nursing home residents? The secondary objective was to describe the measures of social connection used in these studies.

Methods

We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), APA PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified associations between nursing home and/or community characteristics and resident social connection. Searches were limited to English-language articles published from database inception to search date (July 2019) and update (January 2021).

Results

We found 45 studies that examined small-scale home-like settings (17 studies), facility characteristics (14 studies), staffing characteristics (11 studies), care philosophy (nine studies), and community characteristics (five studies). Eight studies assessed multiple home or community-level exposures. The most frequent measures of social connection were study-specific assessments of social engagement (11 studies), the Index of Social Engagement (eight studies) and Qualidem social relations (six studies), and/or social isolation (five studies) subscales. Ten studies assessed multiple social connection outcomes.

Conclusion

Research has assessed small-scale home-like settings, facility characteristics, staffing characteristics, care philosophy, and community characteristics as predictors of social connection in nursing home residents. In these studies, there was no broad consensus on best approach(es) to the measurement of social connection. Further research is needed to build an evidence-base on how modifiable built environment, staffing and care philosophy characteristics-and the interactions between these factors-impact residents' social connection.

Social Connection in Long-Term Care Homes: A Scoping Review of Published Research on the Mental Health Impacts and Potential Strategies During COVID-19

Objectives

Good social connection is associated with better health and wellbeing. However, social connection has distinct considerations for people living in long-term care (LTC) homes. The objective of this scoping review was to summarize research literature linking social connection to mental health outcomes, specifically among LTC residents, as well as research to identify strategies to help build and maintain social connection in this population during COVID-19.

Design

Scoping review.

Settings and Participants

Residents of LTC homes, care homes, and nursing homes.

Methods

We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified an aspect of social connection among LTC residents; we limited searches to English-language articles published from database inception to search date (July 2019). For the current analysis, we included studies that reported (1) the association between social connection and a mental health outcome, (2) the association between a modifiable risk factor and social connection, or (3) intervention studies with social connection as an outcome. From studies in (2) and (3), we identified strategies that could be implemented and adapted by LTC residents, families and staff during COVID-19 and included the articles that informed these strategies.

Results

We included 133 studies in our review. We found 61 studies that tested the association between social connection and a mental health outcome. We highlighted 12 strategies, informed by 72 observational and intervention studies, that might help LTC residents, families, and staff build and maintain social connection for LTC residents.

Conclusions and Implications

Published research conducted among LTC residents has linked good social connection to better mental health outcomes. Observational and intervention studies provide some evidence on approaches to address social connection in this population. Although further research is needed, it does not obviate the need to act given the sudden and severe impact of COVID-19 on social connection in LTC residents.

Animal-Facilitated Therapy Program: Outcomes from Caring Canines, a Program for Patients and Staff on an Inpatient Surgical Oncology Unit

BACKGROUND

Animal-facilitated therapy (AFT) is a complementary medicine intervention. To the authors' knowledge, no study has investigated the benefits of an AFT program in an adult surgical oncology setting.

OBJECTIVES

The purpose of this study is to assess the effects of an AFT program on patients and staff on a surgical oncology unit.

METHODS

A quasiexperimental design was used for the patient group, and a pre-/post-test design was used for the staff group. The intervention involved the AFT program being fully integrated on a surgical inpatient unit. Outcomes included patient-reported symptoms and quality-of-life (QOL) outcomes for patients, as well as professional QOL for staff.

FINDINGS

QOL indicators improved for all patients, and the level of energy at follow-up was significantly higher in the AFT group after adjusting for baseline. For staff, compassion satisfaction was high and burnout was low.

Dogs in the Workplace: A Review of the Benefits and Potential Challenges

Pet dogs, therapy dogs, and service dogs can be seen in workplaces with increasing frequency. Although dogs may provide many benefits to employees and employers, their presence may introduce additional hazards and concerns to the work environment. Therefore, decisions to accept dogs in the workplace may include many considerations including the health, safety, and well-being of employees, legal and cultural sensitivities, and animal welfare. The present paper serves to introduce the issue of dogs in the workplace and outline the potential benefits and challenges to their presence. The legal accommodations afforded to certain types of dogs in workplace settings are discussed, and the research findings pertaining to the potential benefits of dogs on human health and well-being are summarized. The paper concludes with considerations for human resource management personnel in the areas of diversity, employee relations, ethics and corporate responsibility, organizational and employee development, safety and security, and legal considerations, as well as suggested topics for future research.

Methodological Considerations in Designing and Evaluating Animal-Assisted Interventions

Simple Summary

There is a growing literature on the benefits of companion animals to human mental and physical health. Despite the literature base, these benefits are not well understood, because of flawed methodologies. This paper draws upon four systematic reviews, focusing exclusively on the use of canine-assisted interventions for older people residing in long-term care. Two guides are offered for researchers, one for qualitative research, one for quantitative studies, in order to improve the empirical basis of knowledge. Research in the area of the human-animal bond and the potential benefits that derive from it can be better promoted with the use of uniform and rigorous methodological approaches.

Abstract

This paper presents a discussion of the literature on animal-assisted interventions and describes limitations surrounding current methodological quality. Benefits to human physical, psychological and social health cannot be empirically confirmed due to the methodological limitations of the existing body of research, and comparisons cannot validly be made across different studies. Without a solid research base animal-assisted interventions will not receive recognition and acceptance as a credible alternative health care treatment. The paper draws on the work of four systematic reviews conducted over April–May 2009, with no date restrictions, focusing exclusively on the use of canine-assisted interventions for older people residing in long-term care. The reviews revealed a lack of good quality studies. Although the literature base has grown in volume since its inception, it predominantly consists of anecdotal accounts and reports. Experimental studies undertaken are often flawed in aspects of design, conduct and reporting. There are few qualitative studies available leading to the inability to draw definitive conclusions. It is clear that due to the complexities associated with these interventions not all weaknesses can be eliminated. However, there are basic methodological weaknesses that can be addressed in future studies in the area. Checklists for quantitative and qualitative research designs to guide future research are offered to help address methodological rigour.

The effects of Canine-Assisted Interventions (CAIs) on the health and social care of older people residing in long term care: a systematic review

EXECUTIVE SUMMARY

Background: Animal-assisted interventions are classified as 'any therapeutic process that intentionally includes or involves animals as part of the process'. Providing these interventions within the long term care environment may potentially reduce or alleviate symptoms of disease and illness and increase quality of life. Many people suggest that the use of animal-assisted interventions produces beneficial effects, however an examination of the current evidence base reveals a lack of rigorous quantitative research in this area.Objective The aim of the review was to synthesise the best available evidence on the effects of canine-assisted interventions on the health and social care of the older population residing in long-term care.Data sources A comprehensive search was undertaken on 32 electronic databases from their inception to 2009. The search was restricted to English language and both published and unpublished studies were considered.Review methods Studies that examined canine-assisted interventions used for older people residing in long term care were considered. Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments. Data extraction was via the Joanna Briggs Institute standard data extraction form for evidence of effectiveness.Results Eight randomised controlled trials were included in the review of which half were doctoral theses. Due to the presence of heterogeneity, meta-analyses were not appropriate and a narrative summary was provided.Based on the results of single studies, the evidence suggests that providing canine-assisted interventions in long term care facilities can provide some short term benefits to residents, both physically and emotionally, however they appear to be no more effective than other interventions such as visits from humans and providing opportunities to interact with inanimate objects. Providing sessions once a week seems to be just as effective as providing session three times a week in the short term and more research is needed to determine if providing interventions on an individual basis is actually more effective than group interactionsConclusion The current evidence base for the effects of canine-assisted interventions in long term care facilities is methodologically weak and is unable to be pooled. No solid recommendations can be made, however some preliminary conclusions based on the results of single studies are provided. Caution is advised when interpreting these results.Implications for practice Due to the poor quality of evidence located on this topic the use of canine-assisted interventions cannot currently be recommended nor refuted. If, however, a long term care facility is considering implementing canine-assisted interventions for older residents they should be aware that canine-assisted activities may produce some short term beneficial effects but they are similar to those seen from organising visits from people or arranging interactions with animal-like inanimate objects.Implications for research Due to the lack of well-designed trials further higher quality experimental studies that examine the effects of canine-assisted interventions on older long term care residents should be conducted. Trials need to be conducted following a standardised rigorous process.

The benefits of human-companion animal interaction: a review

This article provides a review of research published since 1980 on the benefits of human-companion animal interaction. Studies focusing on the benefits of pet ownership are presented first, followed by research on the benefits of interacting with companion animals that are not owned by the subject (animal-assisted activities). While most of the published studies are descriptive and have been conducted with convenience samples, a promising number of controlled studies support the health benefits of interacting with companion animals. Future research employing more rigorous designs and systematically building upon a clearly defined line of inquiry is needed to advance our knowledge of the benefits of human-companion animal interaction.

Animal-assisted interventions research: issues and answers

Animal visitation programs have been used in a wide variety of clinical settings with predominantly positive outcomes reported anecdotally. However, there is also a growing body of research investigating the effects of these interventions. Developing and conducting rigorous studies of animal interventions can be a complex and challenging process, The purpose of this article is to identify and discuss several issues arising with this type of research and to posit suggestions for avoiding pitfalls.

A day care program and evaluation of animal-assisted therapy (AAT) for the elderly with senile dementia

We conducted a survey to clarify the evaluation methods of animal-assisted therapy (AAT) for the elderly with senile dementia in an adult day care center. AAT was implemented for a total of six biweekly sessions. The AAT group consisted of seven subjects and the control group numbered 20 subjects. In a comparison between Mini-Mental State Exam (MMSE) scores at baseline and those measured three months later, the average MMSE score before AAT (baseline) was 11.43 (+/- 9.00), and three months later it was 12.29(+/- 9.69). In the AAT group, the average score on Nishimura's Activities of Daily Living (N-ADL) at baseline was 28.43(+/- 14.00), and after ATT it was 29.57(+/- 14.47). In the AAT group, the average baseline score on behavioral pathology of Alzheimer's disease (Behave-AD) was 11.14(+/- 4.85), and three months after AAT it was 7.29(+/- 7.11) (p < 0.05). In the control group, the average baseline score was 5.45(+/- 3.27) and three months later it was 5.63(+/- 3.59). The evaluation of salivary CgA, as a mental stress index, showed a decreasing tendency in the AAT group. Our findings demonstrate the usefulness of using several methods for evaluation of the changes in patients given AAT.

Pets and health

Beneficial and adverse effects of pets for individuals in a wide range of circumstances have been reported. Nevertheless, well-designed unbiased experiments and long-term follow-up studies are needed. Pets appear to be therapeutic for some individuals and deleterious for others. The controversies concerning the effects of pets on health merit objective assessment by unbiased researchers.

Implications of pet-facilitated therapy in palliative nursing

Pet therapy is reviewed in terms of its history, physical and psychological benefits and potential problems. There are many reasons why pet therapy is ideally suited to palliative care and these are discussed. The introduction of an appropriate pet to a hospice or palliative care unit/service is described and possible pitfalls are identified.

The roles staff play in the social networks of elderly institutionalized people

This paper concerns different ways in which nursing home residents interpret their relationships with institution staff. The research on which it is based involved an anthropological social network analysis. Analysis revealed different patterns of resident-staff interaction that are described in relation to four types of personal networks. Their meaning is interpreted in terms of the tensions between residents' common needs for attachment and autonomy and their limited means to achieve satisfaction.

The impact of companion animals in later life and considerations for practice

Interaction with companion animals, or pets, is increasingly recognized as a contributor to well-being in later life. This article focuses on the actual impact of animal companionship on older adults' (institutionalized and community dwelling) physical, social, and psychological health. Considerations for practice are discussed, with particular emphasis on professionals' recognizing the effect of multiple life-course factors that may moderate the therapeutic value of companion animals. Such factors include older persons' health, financial status, housing situation, and current and previous attitudes and attachments to pets.