Animal-assisted interventions research: issues and answers

Human-Animal Bond Generated in a Brief Animal-Assisted Therapy Intervention in Adolescents with Mental Health Disorders

BACKGROUND

The human-animal bond is crucial for the proper development of animal-assisted therapy (AAT) sessions. However, in specific cases such as in AAT focused on psychiatric patients who are admitted to acute units, there is only a short period of time available to establish this bond.

OBJECTIVES

To assess the degree of HAB generated after two AAT sessions in adolescents admitted to acute psychiatry units.

METHODS

A prospective multicenter cohort study aimed at adolescents aged 13 to 17 years admitted to the acute child and adolescent psychiatry unit of three hospitals.

INTERVENTION

Two weekly 1 h group sessions of AAT with therapy dogs.

MAIN OUTCOME

The Center for the Study of Animal Wellness Pet Bonding Scale Survey (CSAWPB).

RESULTS

One hundred and fourteen adolescents participated. A positive perception of the dog was generated, achieving a good level of bonding and attachment.

CONCLUSIONS

The results obtained make it possible to affirm that a short period of time is enough to establish a good HAB between patients and therapy dogs. This study aims to contribute to the study of non-pharmacological interventions as a complement to pharmacological treatments in adolescents with mental health disorders.

Brief Report: Above and Beyond Safety: Psychosocial and Biobehavioral Impact of Autism-Assistance Dogs on Autistic Children and their Families

Autism-Assistance Dogs (AADs) are highly-skilled service animals trained primarily to ensure the safety of an autistic child by preventing elopement and mitigating 'meltdowns'. Although anecdotal accounts and case-studies have indicated that AADs confer benefits above and beyond safety, empirical support anchored in validated clinical, behavioral, and physiological measures is lacking. To address this gap, we studied children and their families before and after receiving a well-trained AAD using a within-subject, repeated-measures design. Notably, this study is the first to assess change in a biomarker for chronic stress in both autistic children and their parents. Final analyses included pre-/post-AAD data from 11 triads (parent/handler-dog-child) demonstrating significantly positive psychosocial and biobehavioral effects of AADs.

Pet ownership issues encountered by geriatic professionals: Preliminary findings from an interdisciplinary sample

Pets often factor in older adults’ health behaviors and decisions. However, the degree to which issues related to pet ownership are encountered or addressed by professionals working with this population remains unknown. The aim of this study was to identify specific issues stemming from pet ownership professionals had encountered in their work with older adults, people living with dementia, and care partners. An interdisciplinary (e.g., social services and healthcare) sample (N = 462, 89.13% female, M_age = 53.02, SD_age = 12.18) completed an online survey addressing pet ownership issues encountered in their work. Descriptive statistics, t-tests, and repeated measures ANOVAs were used to analyze quantitative data. A conventional content analysis was used to analyze open-ended responses to an item asking about “other” issues encountered in their work with these populations. The professionals estimated 46.29% of clients had been pet owners, 41.23% regularly asked about pets, and 79.22% had encountered issues related to pet ownership. Specific issues raised to the professionals varied by type of client. The professionals reported older adults most often raised getting pet items into the home and concerns about their pets’ health. The issues most often raised by people living with dementia to the professionals were planning for the pet due to a housing transition and basic pet care. Care partners focused on basic pet care and planning for the pet due to a housing transition. The professionals themselves most often raised the issues of basic pet care, concerns about falling, and the pets’ behavior. Professionals who entered clients’ homes were more likely to raise issues stemming from pet ownership compared to those who reported they did not enter clients’ homes in their current job, t(429.40) = 5.59, p < 0.00001. The eleven new issues identified by the content analysis (e.g., pets impeding care, people refusing care due to the pet) underscored how the health and wellbeing of people and their pets are linked. The results of this study provide strong evidence that professionals do encounter issues related to pet ownership. Including issues stemming from pet ownership into procedures, policies, and programs is likely to have positive impacts on those served by and working in the geriatric workforce.

Canine-Assisted Interventions and the Relevance of Welfare Assessments for Human Health, and Transmission of Zoonosis: A Literature Review

CAIs (canine-assisted interventions) include "canine-assisted therapy" in which a therapist sets client-oriented goals, 'canine-assisted activities' with recreational goals for clients, and 'canine-assisted education/learning' in which teachers or coaches create learning goals for students or clients. CAIs vary in nearly every way; their only common trait is the involvement of dogs to respond to human need. However, the benefits of involving dogs are highly dependent on the animal's health and behavior. A dog exhibiting negative behavior or an unwell dog might pose a risk, especially for CAI target groups, specifically individuals with immunosuppression, chronic illness, children, elderly, etc. Therefore, positive animal welfare as preventative medicine to avoid incidents or transmission of zoonosis is an attractive hypothesis, with implications for human and animal, health and well-being. This review aims to summarize the current published knowledge regarding different aspects of welfare in CAIs and to discuss their relevance in the light of health and safety in CAI participants. As method for this study, a literature search was conducted (2001-2022) using the Prisma method, describing issues of dog welfare as defined in the Welfare Quality® approach. This welfare assessment tool includes 4 categories related to behavior, health, management, and environment; it was, therefore, applicable to CAIs. Results indicate that dogs working in CAIs are required to cope with diverse variables that can jeopardize their welfare. In conclusion, we propose regular welfare assessments for dogs in CAIs, which would also protect the quality of the CAI sessions and the clients' safety and well-being.

Pawsitive Connections: The role of Pet Support Programs and pets on the elderly

OBJECTIVES

This study describes the experiences of Pet Support Program clients in Melbourne, Australia and how the programs reduce the social isolation of the elderly. The study also describes the role of pets and associated health benefits of pet ownership.

METHOD

The qualitative description study comprised of two phases: a secondary data analysis of interviews with 14 PSP clients, and key informant interviews with four PSP providers.

RESULTS

The interviews were thematically analysed which resulted in three interconnected themes: Attachment, Support and Social Isolation. Social isolation was reduced by the PSP through access to social support groups, as well as the provision of a regular visitor who provides meaningful conversation and companionship.

CONCLUSION

These results align with literature on pet ownership and Attachment Theory. The results also offer an insight into how PSPs allow the elderly to maintain pet ownership and age in place, thus enhancing their health and well-being.

Social Development of Adults with Autism Spectrum Disorder During Dog-Assisted Therapy: A Detailed Observational Analysis

Social communication and self-esteem are often affected in adults with autism spectrum disorder. Implementation and evaluation of interventions targeting social skills are challenged due to specific characteristics of autism. Intensive, valid evaluation of social skills programs is needed. In this explorative multiple case study, we examined effects and working mechanisms of dog-assisted therapy on social communication and self-esteem, by analyzing detailed observations with Monte Carlo permutation tests (testing against 10,000 random samples) and using self- and other-reports in N=6 high-functioning adults with ASD. Results showed significant positive effects on secure body posture. There was an indication of improved self-esteem and more spontaneous touching of the dog, while no convincing increase was found for verbal initiatives. Cross-correlation analyses revealed that touching the therapy dog may be an important determinant to elicit social development in Animal Assisted Therapy (AAT). Considering preliminary results, we recommend exploring underlying mechanisms more thoroughly with real-time observations, accounting for possible gender-effects.

Evaluating Animal-Assisted Interventions: An Empirical Illustration of Differences between Outcome Measures

Simple Summary

This study compares and contrasts several outcome measures to assess the effect of an equine-assisted intervention for a child with Autism Spectrum Disorder. Before and after the equine-assisted sessions, we conducted a semi-structured interview with the participant’s parents, asked parents to fill out a general screening instrument separately, and observed the participant’s social and communication skills during five equine-assisted sessions. We found differences between the interview and questionnaire with regard to parents’ perceptions of aggression regulation and interacting with peers. Differences with regard to parental reports and observations were found for play development and anxiety. The observations provided a detailed view of the child’s development during the intervention, which yielded an interesting hypothesis in terms of the current dose–response discussion in AAI for children with Autism Spectrum Disorder.

Abstract

Multiple authors have called for strong empirical evaluations to strengthen the foundation of Animal-Assisted Interventions. Carefully choosing the outcome measures of these studies is important, as choosing the wrong outcomes may lead to a failure to detect effects. The current study therefore compares and contrasts the use of several outcome measures, to assess the effect of an equine-assisted intervention for a child with Autism Spectrum Disorder: (1) a semi-structured interview with both parents, specifically designed for children with cognitive disabilities, (2) a general screening instrument filled out by both parents separately, which can be used to assess children’s psycho-social problems, and (3) systematic observations of social and communication skills during the equine-assisted sessions. All instruments indicated an improvement in the participant’s social and communication skills. We found differences between the interview and questionnaires with regard to parents’ perception of aggression regulation and interacting with peers. Differences with regard to parental reports and observations were found for play development and anxiety. The observations provided a detailed view of the child’s development during the intervention, which yielded an interesting hypothesis in terms of the current dose–response discussion in AAI for children with Autism Spectrum Disorder.

Animal-assisted therapy in a Canadian psychiatric prison

PURPOSE

Prison-based animal programs are becoming increasingly common in North America. The majority focus on community and animal well-being, with less explicit therapeutic goals for human participants. The purpose of this paper is to measure the objectives of a canine animal-assisted therapy (AAT) program in a Canadian psychiatric prison and examine whether the program supports inmates' correctional plans.

DESIGN/METHODOLOGY/APPROACH

A modified instrumental case study design was applied with three inmates over a 24-AAT-session program. Quantitative and qualitative AAT session data were collected and mid- and end-of-program interviews were held with the inmates, their mental health clinicians and the therapy dog handlers.

FINDINGS

Inmates connected with the therapy dogs through the animals' perceived offering of love and support. This development of a human-animal bond supported inmates' correctional plans, which are largely situated within a cognitive-behavioral skill development framework. Specifically, inmates' connections with the therapy dogs increased recognition of their personal feelings and emotions and positively impacted their conduct.

RESEARCH LIMITATIONS/IMPLICATIONS

The findings suggest that prison-based AAT programs emphasizing inmate mental well-being, alongside that of animal and community well-being generally, merit further exploration. It would be worthwhile to assess this AAT program with a larger and more diverse sample of inmates and in a different institutional context and also to conduct a post-intervention follow-up.

ORIGINALITY/VALUE

This is the first study of a prison-based AAT program in a Canadian psychiatric correctional facility.

Pets enhance antidepressant pharmacotherapy effects in patients with treatment resistant major depressive disorder

Treatment resistant major depressive disorder (TR-MDD) is a severe disease, with very low remission rates. The resistance to pharmacotherapy leads to the search of non-pharmacological alternative approaches. Animal therapy has been used in patients with psychiatric conditions and the results have been promising. However, there have been no studies in TR-MDD patients with pet adoption. This study assessed the impact of TR-MDD patients adopting a pet. Eighty patients were suggested to adopt a pet, and 33 accepted the challenge. Other 33 patients constituted the control group (did not accept the suggestion of pet adoption and did not already have a pet). All patients maintained their usual pharmacotherapy. All participants were evaluated at baseline, 4, 8 and 12 weeks for depressive symptoms using HAMD17 and GAF. Results show that the pet group had an improvement in HAMD17 and GAF scores as well as higher response and remission rates compared to the control group, where no patient responded or remitted. Therefore, pets can be used as an effective adjuvant to pharmacotherapy with regular medical appointments.

Animal-Assisted Therapies and Dementia: A Systematic Mapping Review Using the Lived Environment Life Quality (LELQ) Model

OBJECTIVE

The authors mapped the literature on animal-assisted therapies (AATs) and institutionalized adults with dementia onto the Lived Environment Life Quality (LELQ) Model as a guide for future services and research.

METHOD

Refereed literature addressing AATs and institutionalized people with dementia was comprehensively gathered, described, categorized, and synthesized in this systematic mapping review.

RESULTS

From 1,342 screened records, the authors included 10 research articles that incorporated dogs in therapy for institutionalized adults with dementia. These canine-assisted therapies offered occupational opportunities and environmental supports conducive to experiences of relative well-being, occupational engagement, and optimal functioning.

CONCLUSION

The findings offer proof of the concept that canine-assisted therapies are feasible and can elicit positive quality-of-life experiences in institutionalized people with dementia. Researchers and practitioners need to elucidate the theoretical foundations of AATs. The LELQ Model may serve as a guide for client-centered, occupation-focused, and ecologically valid approaches to animal-assisted occupational therapy.

Assessing Preferences for Animals in Children with Autism: A New Use for Video-Based Preference Assessment

The inclusion of animals into interventions for children with autism spectrum disorder (ASD) is a growing practice known as animal-assisted intervention (AAI). The choice of the animal to include in an intervention is often solely up to the interventionist and depends on their experience, subjective judgment, and ease of access to different animals. For individuals with ASD who are non-verbal and unable to indicate preferred stimuli or activities, incorporating preference into interventions has been linked to increases in positive behaviors and enhanced quality of life. We propose that animal choice based on a participant's preference may enhance the experience of AAI and maximize its outcomes. A common technique used to reliably determine preferred interactions and activities in interventions for children with ASD is a stimulus preference assessment. The video-based multiple-stimulus without replacement (MSWO) procedure, in particular, allows for discrimination of complex stimuli that could not feasibly be presented all at once, which is the case when choosing an animal. Based on the well-documented reliability of this technique in the field of applied behavior analysis, we propose that a future direction in AAI is utilizing video-based MSWO to guide animal selection.

Effects of Interactions With Animals On Human Psychological Distress

CONTEXT

Human-animal interaction (HAI) is widely used as a method of reducing psychological distress. However, research findings in support of HAI have not kept pace with the widespread prevalence in practice.

OBJECTIVE

I review and synthesize the quantitative evidence for the influence of HAI on psychological distress and outline future directions for research.

RESULTS

The evidence suggests that HAI has a small-to-medium effect on distress but does not clarify whether animals account for the treatment effects. Research also has not determined whether positive effects observed in circumscribed HAI programs extend to companion animal ownership.

CONCLUSION

HAI research needs to address methodological limitations and expand the focus beyond treatment outcome studies. By increasing our understanding of the processes through which HAI reduces distress, the circumstances under which it is most effective at doing so, and the influence HAI has on the animals, we can enhance the impact of HAI.

Animal-Assisted Interventions for Children with Attention Deficit/Hyperactivity Disorder: A Theoretical Review and Consideration of Future Research Directions

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders and is characterized by core symptoms of inattention, impulsivity, and hyperactivity. Given the limitations of the existing treatment strategies, it seems necessary to consider the further exploration of alternative treatment approaches. In this review, the application and complementary use of animal-assisted interventions to the treatment of ADHD were discussed. Several mechanisms including calming, socializing, motivating, and cognitive effects of animal-assisted interventions were explored. Since studies directly investigating these effects on ADHD are scarce, so each of them were examined in terms of how it could benefit the treatment of ADHD. These effects can have a positive effect on several core symptoms of ADHD.

Animal-Assisted Activities: Results From a Survey of Top-Ranked Pediatric Oncology Hospitals

Animal-assisted activities (AAA) are increasingly common, yet little is known about practices in pediatric oncology. To address this gap, we surveyed the top 20 pediatric oncology hospitals in the United States in May and June of 2014. Questionnaires were sent via e-mail and generally returned by e-mail or postal mail. Among the 19 responding hospitals, the 18 that offered AAA to pediatric patients formed the basis of our analysis. All sites had written AAA policies. Most programs were restricted to dogs. At 11 hospitals, children with cancer could participate in AAA activities. Outpatient waiting rooms and individual inpatient rooms were the most common locations for AAA with pediatric oncology patients. Safety precautions varied by hospital, but all required hand sanitation after visits and that animals receive an annual health examination, be on a leash or in a carrier, be ≥1 year old, and not be directly from a shelter. Our findings reveal consistencies and variations in practice that may help other hospitals develop their own programs and researchers identify areas of future study.

The benefit of pets and animal-assisted therapy to the health of older individuals

Many studies utilizing dogs, cats, birds, fish, and robotic simulations of animals have tried to ascertain the health benefits of pet ownership or animal-assisted therapy in the elderly. Several small unblinded investigations outlined improvements in behavior in demented persons given treatment in the presence of animals. Studies piloting the use of animals in the treatment of depression and schizophrenia have yielded mixed results. Animals may provide intangible benefits to the mental health of older persons, such as relief social isolation and boredom, but these have not been formally studied. Several investigations of the effect of pets on physical health suggest animals can lower blood pressure, and dog walkers partake in more physical activity. Dog walking, in epidemiological studies and few preliminary trials, is associated with lower complication risk among patients with cardiovascular disease. Pets may also have harms: they may be expensive to care for, and their owners are more likely to fall. Theoretically, zoonotic infections and bites can occur, but how often this occurs in the context of pet ownership or animal-assisted therapy is unknown. Despite the poor methodological quality of pet research after decades of study, pet ownership and animal-assisted therapy are likely to continue due to positive subjective feelings many people have toward animals.

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.

Natural activity: an explorative study of the interplay between cage-birds and older people in a Swedish hospital setting

Aim.  The aim of this study was to describe the interaction between cage-birds and older people as it arises in spontaneous situations in a Swedish hospital ward setting. Background.  Older people are at risk of being affected by mental fatigue because of various age-related reductions and disease. Mental fatigue manifests itself through a reduced ability to concentrate. The method of alleviating mental fatigue with the use of stimulating natural settings or animal-assisted activities is so far unexplored in Sweden and subsequently it is important to study the method in a Swedish context to implement it as a recognized nursing intervention in the care of older people. Design.  The study had an explorative observational design, and was conducted at a geriatric ward with a consecutive selection of participants. Method.  The observations were analysed using a constant comparative method influenced by Grounded Theory. 'Attention restorative theory' was used as the theoretical framework to guide the study. Result.  Our findings indicate that animal-assisted therapy has a positive effect on involuntary attention and mental restoration, as well as on enhanced social behaviour among older people. Relevance to clinical practice.  The result strengthens the assumption that animal companionship should be considered a beneficial nursing intervention for older people to prevent mental fatigue.

Human-animal interaction: a concept analysis

PURPOSE

A concept analysis was performed on human-animal interaction (HAI).

DATA SOURCE

Nursing, psychology, and behavioral sciences literature.

DATA SYNTHESIS

Uses and definitions associated with HAI were used to articulate the attributes, antecedents, consequences, and empirical referents. Model, borderline, and contrary cases were developed.

CONCLUSIONS

HAI is operationally defined.

IMPLICATIONS FOR NURSING PRACTICE

Including HAI as a health promotion behavior, within a theoretical framework, appears to be a promising intervention and may be linked to physical activity.

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 Appropriateness 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: Canine-assisted interventions are used frequently in long term care settings, even though their effectiveness has not been definitively proven. One concern commonly described in the literature is the risk of zoonotic infection or animal-related injury/allergy associated with this type of interaction. To date, no systematic review has been undertaken to determine the appropriateness of canine-assisted interventions in relation to these issues.

OBJECTIVE

The aim of the review was to synthesise the best available evidence on the appropriateness of canine-assisted interventions on the health and social care of the older population residing in long term care with regards to zoonotic infection or animal-related injury/allergy.

DATA SOURCES

A comprehensive search was undertaken on 32 electronic databases and two reputable websites from their inception to 2009. The search was restricted to English language and both published and unpublished studies and papers were considered.

REVIEW METHODS

The review took an inclusive approach and considered quantitative and qualitative studies that focussed on zoonotic risk/exposure/infection or animal-related injury/allergy from canine-assisted interventions used in long term care settings. In the absence of research studies, text and opinion were also considered. Critical appraisal of papers was to be undertaken using the appropriate Joanna Briggs Institute critical appraisal instrument and data extraction was to be via the Joanna Briggs Institute data extraction forms, dependant on design.

RESULTS

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

CONCLUSION

There is currently no evidence available to determine the appropriateness of canine-assisted interventions used for older people in long term care in regards to zoonotic risk/exposure/infection or animal-related injuries/allergies. There is a small body of literature available that focuses on health care but it is generalised and does not delineate between different age groups, settings or the animals used.

IMPLICATIONS FOR PRACTICE

No conclusive recommendations can be made regarding the use of canine-assisted interventions in long term care in the context of zoonotic infection and animal-related injuries/allergies. Text and opinion suggests that if a health care facility of any kind is planning to implement or is currently running this type of intervention (using any animal for people of any age group) the following should be considered:Implications for Research: Quantitative and qualitative research studies are urgently required to determine whether there is an increased risk of zoonotic infections or animalrelated injuries/allergies for those people involved in canine-assisted interventions undertaken in long term care. Those at risk need to be identified in a systematic way.

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

BACKGROUND

Preliminary evidence suggests that canine-assisted interventions (any therapeutic process that intentionally involves dogs as part of the process ) may produce some short term beneficial effects on the health and social care of older people residing in long term care facilities; however there has been no formal qualitative synthesis on how these activities are experienced by those involved. Determining peoples' opinions and feelings towards this activity is crucial to its success.

OBJECTIVE

The aim of this systematic review was to synthesise the best available evidence on the meaningfulness of canine-assisted intervention on older people who reside in long term care.

DATA SOURCES

A comprehensive search was undertaken of 32 electronic databases and two reputable websites 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 the experience of older people residing in long term care that were involved in canine-assisted interventions 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 meaningfulness.

RESULTS

Two studies met inclusion criteria and methodological quality requirements. Studies had some differences: one explored residents' experiences while the other focused on staff experiences, one was conducted in a 'Westernised' country and one included residents who had been involved in this activity for two years prior to the study being conducted. There were 41 findings extracted from both studies that were organised into 12 categories. A meta-synthesis was undertaken and two synthesised findings were developed; the first suggesting that providing residents of long term care facilities the opportunity to participate in canine-assisted interventions (more specifically canine-assisted activities) can provide a range of mental, emotional, physiological and social benefits and the other suggesting that undertaking a program in such a facility has both practical and safety considerations for staff, residents and animals.

CONCLUSIONS

The current evidence base for the meaningfulness of canine-assisted activities in long term care facilities is limited and methodologically weak. A qualitative meta-synthesis using the Joanna Briggs Institute Qualitative Assessment and Review Instrument software suggests that the experience of a resident being involved in a canine-assisted activity can be positive on an emotional, mental, physiological and social level but there are some practical issues to consider such as the personal preference of the resident and staff training. Caution is advised when interpreting these results due to the small number of studies included and their methodological limitations.

IMPLICATIONS FOR PRACTICE

Canine-assisted activities may provide a positive experience for residents however the following should be considered: IMPLICATIONS FOR RESEARCH: Due to the limited number of qualitative studies attempting to determine the experiences of older people involved in canine-assisted interventions within a long term care environment, further high quality studies should be undertaken. Studies should focus on the experiences of the different people involved (staff, family, animal handlers), and compare residents with different medical or psychological conditions to determine if involvement is experienced differently across populations.

Dog-Walking: Motivation for Adherence to a Walking Program

Healthy People 2010 cited walking as a major health indicator; however, adherence is challenging, especially among those with multiple chronic illnesses. Studies suggest that walking one’s own dog may motivate adherence. However, no research has studied whether walking a “loaner” dog may facilitate adherence. Using a pretest—posttest design, the authors studied adherence to and outcomes of a graduated walking program when 26 public housing residents walked certified therapy dogs with a handler. Participants walked 20 minutes, 5 days/week, for 26 or 50 weeks. In all, 13 participants in the 50-week group had a mean adherence rate of 72% and weight loss of 14.4 pounds ( p = .013). Thirteen participants in the 26-week group had a mean adherence rate of 52% and weight loss of 5 pounds (nonsignificant). Participants’ most commonly stated reason for adherence was that the dogs “need us to walk them.” Commitment to a dog that is not one’s own may effectively facilitate physical activity.

Measuring clinical outcomes of animal-assisted therapy: impact on resident medication usage

OBJECTIVE

To measure changes in medication usage of as-needed, psychoactive medications and other select as-needed medication usage as a result of a therapy dog residing in the rehabilitation facility. Additional measures are participants' thoughts and feelings on quality-of-life factors.

DESIGN

One group, pretest, post-test.

SETTING

Residential rehabilitation facility.

PARTICIPANTS

Convenience sample, N = 58 residents living at the facility.

INTERVENTION

A certified, trained therapy dog.

MAIN OUTCOME MEASURE(S)

Changes in as-needed medication usage for the following categories: analgesics, psychoactive medications, and laxatives, as well as changes in vital sign measurements of blood pressure, pulse, respiration rate, and body weight. Additionally, changes in the residents' perception of quality-of-life factors.

RESULTS

One of the three monitored drug classes, analgesia, revealed a decrease in medication usage (mean = 2.6, standard deviation [SD] +/- 6.90, P = 0.017), and one of four monitored vital signs, pulse, showed a decrease (mean = 5.8, SD +/-7.39, P = 0.000) in study participants exposed to the therapy dog. Positive changes were reported in study participants' quality of life.

CONCLUSION

The benefits to human welfare as a result of the presence of a therapy dog have the potential to decrease medication usage for certain conditions in long-term care patients as well as decrease costs. Pharmacist involvement in animal-assisted therapy has the potential to make unique and measurable improvements to best patient care.

Pet therapy and institutionalized elderly: A study on 144 cognitively unimpaired subjects

The aim of this study was to assess whether a pet therapy program had a favorable effect on psychopathological status and perception of quality of life in cognitively unimpaired institutionalized elderly. Seven elderly rest homes in Veneto Region of Northern Italy participated in the project, which was conducted on 144 cognitively intact elderly residents (97 females and 47 males). The participants were randomly divided into three groups: 48 subjects were given a canary, 43 subjects were given a plant, and 53 subjects were given nothing. The observation period (t0-t1) lasted for 3 months. At time t0 and t1 participants were administered the mini mental state examination (MMSE) to assess their cognitive status, the LEIPAD II-Short Version (LEIPAD-SV), to gauge subjective perception of quality of life in the elderly, and the brief symptom inventory (BSI), for self-evaluation of the presence of psychopathological symptoms. At the end of the 3-month trial, tests were re-administered, without removing the experimental condition. Even if the group that received a plant seemed to benefit from the experience, they did not achieve the same positive results on BSI and quality of life subscales exhibited by the group that received a pet. This study reinforces the hypothesis that pet therapy may have a beneficial effect on the psychological well being of institutionalized elderly, in particular on aspects related to depressive symptoms and perception of quality of life.

Older Latinos, pets, and health

The majority of thefindings regarding pet ownership, interaction, and the human-animal bond have involved only Caucasians or have included other ethnic group members only incidentally. The extent to which older adultsfrom other ethnic groups may benefitfrom pet ownership and interaction is unclear. If the benefits of human-animal interaction are to be used effectively in promoting health and preventing illness, it is necessary to identify the "boundaries" of effectiveness for this interaction across various populations. The present study is an initial effort at describing one ethnic minority group, Latino pet owners, the extent of their relationships with their pet, and the extent to which these relationships may be beneficial in facilitating health. Twenty-four Latinos over age 50 were studied and are described in terms of their demographic characteristics, relationships with their pets, health, and exercise practices. The findings suggest that the participants were very devoted to their pets, had been involved with pets since childhood, and viewed themselves as healthy.