Impact of canine-assisted interventions on the health and well-being of older people residing in long-term care: a mixed methods systematic review protocol

OBJECTIVE

The objective of this review is to synthesize and integrate the best available evidence on the impact of canine-assisted interventions on the health and well-being of older people residing in long-term care.

INTRODUCTION

Canine-assisted interventions are commonly used as an adjunct therapy to enhance health and well-being, and are often implemented in long-term care facilities. The number of studies undertaken in this area has increased substantially over the previous five years; therefore, an update of two previous systematic reviews is warranted.

INCLUSION CRITERIA

This review will consider older people who reside in long-term care facilities and who receive canine-assisted interventions. For the quantitative component, canine-assisted interventions will be compared to usual care, alternative therapeutic interventions, or no interventions, and outcomes will be grouped under the following headings: biological, psychological, and social. For the qualitative component, the experiences of older people receiving canine-assisted interventions, as well as the views of people directly or indirectly involved in delivering canine-assisted interventions, will be explored. Quantitative, qualitative, and mixed methods studies published from 2009 to the present will be considered.

METHODS

A search of 10 bibliographic databases and other resources for published and unpublished English language studies will be undertaken. Study selection, critical appraisal, data extraction, and data synthesis will be undertaken by two independent reviewers following the segregated JBI approach to mixed methods reviews.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020161235.

Dog-assisted interventions and outcomes for older adults in residential long-term care facilities: A systematic review and meta-analysis

OBJECTIVE

To comprehensively review studies on dog-assisted interventions (DAIs) among older people in residential long-term care facilities (RLTCFs) and to provide an overview of their interventions, outcomes and methodological quality.

METHOD

We searched 18 electronic databases to identify English articles (published January 2000-December 2019) reporting on well-defined DAIs targeting older adults (≥65 years) in RLTCF. Data were extracted by two independent reviewers. Descriptive statistics were produced for quantitative studies, with key themes identified among qualitative studies. Where possible, estimates were pooled from randomised controlled trials using random effects meta-analyses.

RESULTS

Forty-three relevant studies (39 quantitative; 4 qualitative) were identified. The majority of quantitative studies were assessed as low-quality according to the MMAT criteria (n = 26, 67%). Almost half of the quantitative studies (n = 18, 46%) found no significant changes over time or between groups across outcomes measured. The most salient intervention effects included improved social functioning (n = 10), reduced depressive symptoms (n = 6) and loneliness (n = 5). A random-effects meta-analysis revealed a medium effect in favour of DAT on reducing depressive or loneliness symptoms (pooled SMD: 0.66, 95%CI 0.21-1.11; I²  = 50.5; five trials), relative to treatment as usual. However, compared to treatment as usual, no overall effect of DAI on activities of daily living was detected (p = .737). Key themes from qualitative studies included (a) animals as effective transitional objects, (b) the therapeutic value of pets and (c) the significance of the care environment and stakeholders in facilitating DAI.

IMPLICATIONS FOR PRACTICE

The findings of this review indicate that while DAI has value for older people in RLTCF, challenges remain in accurately measuring its impact to provide a stronger evidence-base. Standardisation of DAI service design, delivery and evaluation is required for future research and practice in providing holistic care for older adults.

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 Economic Feasibility of Canine-Assisted Interventions (CAIs) on the Health and Social Care of Older People Residing in Long Term Care: A Systematic Review

BACKGROUND

Obtaining economic data on health care interventions and practices is extremely important, with the bulk of systematic reviews continuing to concentrate on the effectiveness of an intervention. Although popular, there is a scarcity of information available on the cost considerations associated with canine-assisted intervention programs for older population residing in long term care facilities.

OBJECTIVE

The aim of the review was to synthesise the best available evidence on the economic feasibility 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. An expert in the field, and various contacts from a reputable organisation involved in delivering programs, were also contacted to determine if any other papers or reports were available.

REVIEW METHODS

This review considered quantitative/economic research papers that addressed the feasibility of canine-assisted intervention programs used for older people residing in long term care. In the absence of research papers, text and opinion were considered. Critical appraisal and data extraction of papers was to be undertaken using the appropriate Joanna Briggs Institute instruments dependant on design.

RESULTS

There were no studies located that met the inclusion requirements of this review. There were also no text and opinion pieces that were specific to canine-assisted interventions, long term care settings and older people.

CONCLUSION

The economic feasibility of a canine-assisted intervention program in a long term care facility remains largely unknown. The evidence is additionally hampered by a lack of scientific data to support whether canine-assisted interventions provide physical, emotional and social benefits to older people, particularly in the longer term.

IMPLICATIONS FOR PRACTICE

Preliminary evidence from textual papers suggest long term care facilities that are contemplating introducing a program should consider the following aspects: the available resources the facility can offer (staff, time, resources, training), setup/changes to infrastructure, the mode of program delivery (independent, resident animal), insurance and liability and program evaluation. Regardless of cost, the preferences and safety of staff, residents' and their family should always be considered.

IMPLICATIONS FOR RESEARCH

Economic studies are urgently required to determine the feasibility of providing canine-assisted interventions in long term care settings.