"When she goes out, she feels better:" co-designing a Green Activity Program with Hispanic/Latino people living with memory challenges and care partners

Purpose

Utilizing a participatory approach, we sought to co-design a 12-week Green Activity Program (GAP) with Hispanic/Latino individuals living with memory challenges and their care partners, local outdoor professionals, and healthcare providers.

Methods

Participants were recruited via convenience and snowball sampling in the Bronx, New York with Hispanic/Latino persons living with memory challenges and care partners, outdoor activity professionals, and interdisciplinary healthcare providers/dementia experts. Co-design occurred iteratively with 5 focus groups and 4 individual interviews lasting 30-90 min and focused on program and research design. Sessions were recorded and transcribed. Utilizing directed content analysis data was coded using a priori codes program design and research design.

Results

21 participants completed co-design activities: (n = 8 outdoor activity professionals, n = 6 Hispanic/Latino persons living with memory challenges and care partners, and n = 7 interdisciplinary healthcare providers/dementia experts). Participant preferences for program design were captured by subcodes session duration (30-90 min), frequency (4-8 sessions), and delivery modes (in-person and phone). Participants' preferred nature activities included group exercise and outdoor crafts [crocheting], outcomes of social participation, connectedness to nature, decreased loneliness, and stewardship were identified. Preferred language for recruiting and describing the program were "memory challenges," "Hispanic/Latino," and "wellbeing." Referral pathways were identified including community-based organizations and primary care.

Conclusion

Co-design was a successful form of engagement for people living with memory challenges that enabled participants to help design key elements of the GAP and research design. Our processes, findings, and recommendations for tailoring co-design to engage Hispanic/Latino people living with memory challenges can inform the development of other programs for this population.

Animal-assisted and robotic animal-assisted interventions within dementia care: A systematic review

BACKGROUND

Animal-assisted interventions and robotic animal interventions are becoming increasingly popular to support the care of people with dementia and may have the potential to improve a range of psychosocial outcomes. This review aims to identify, describe, and compare animal-assisted and robotic animal interventions delivered to people with dementia, their characteristics, effectiveness, and the proposed mechanisms underlying any potential impact.

METHODS

A systematic literature search was conducted in MEDLINE, AMED, EMBASE, PsycINFO, OVID Nursing, PubMed, CINAHL and Web of Science. Random-effects meta-analyses of randomised controlled trials (RCTs) were conducted to summarise studies that evaluated common outcomes (agitation, depression, quality of life). A narrative approach was used to synthesise other findings.

RESULTS

Fifty-one studies were included: 18 RCTs; 12 non-randomised trials, 13 cohort studies, 7 qualitative studies and one mixed-methods study. Meta-analyses were conducted for a small number of RCTs, with effectiveness of animal-assisted interventions demonstrated for agitation. Narrative findings suggested animal-assisted and robotic animal interventions may be promising in improving depression, agitation, and quality of life. Three potential mechanisms of action were identified for both animal-assisted and robotic animal interventions, namely enhancing social connections, providing engaging and meaningful activities, and the affect-generating aspect of the human-animal bond. A fourth mechanism was identified for animal-assisted interventions only: promoting physical activity. Robotic animals appear to have a place in complex human-animal relationships, but a greater understanding of robotic animal interventions is required to harness the benefits that may be derived from their use.

CONCLUSION

Delivering these interventions appear promising in improving psychosocial outcomes for people with dementia. As most included studies had methodological limitations, these findings are preliminary, but contribute to the body of evidence providing an understanding in terms of intervention characteristics and mechanisms of action. When developing intervention guidance, attention should be given to potential mechanisms and fundamental characteristics such as session content, delivery format and facilitator role.

Feasibility of an adaptive riding pilot study and acceptability to dementia care partners: "Your spirits are lifted"

OBJECTIVES

We sought to assess the feasibility and acceptability of an adaptive riding program with dyads (persons living with dementia, family care partners) and a gardening comparison condition.

DESIGN

This is a two-arm (adaptive riding and adaptive gardening), mixed methods, convergent, feasibility study that occurred February 2019-June 2019.

INTERVENTIONS

Upon enrollment, dyads (n=9) self-selected into either community-based adaptive riding (n=5) or adaptive gardening (n=4), two complementary interventions in Northern Colorado. Interventions occurred for hour-long, weekly sessions for eight weeks.

OUTCOME MEASURES

Feasibility was measured with recruitment (actual/planned, response rate, participants enrolled/month) retention, adherence to study procedures (attendance, retention, fidelity), and data collection processes (planned versus collected); and analyzed with descriptive statistics. Acceptability of adaptive riding was measured with pre/post care partner interviews and analyzed using thematic analysis. Afterwards, findings were converged.

RESULTS

We recruited n=10/24 dyads (6 dyads per month), with the highest response rates for referrals and in-person events, n=9 dyads enrolled. We adhered to study procedures with attendance (6/8 gardening, 8/8 riding), retention (100%), fidelity (100%) and data collected (98%). Care partners (n=5) found the adaptive riding intervention acceptable with two themes Overall hopes: "Joy in the present moment" and "Experience as a Whole: "Your spirits are lifted," affirming quantitative attendance and retention data.

CONCLUSION

Findings underscore the feasibility and acceptability of including care partners of persons living with dementia in complementary interventions involving horsemanship activities. Feasibility data can guide study designs and implementation processes for other nature-based complementary interventions for this population.

Photo-elicited conversations about meetings with a therapy dog as a tool for communication in dementia care: An observational study

INTRODUCTION

It is well-known that people with dementia living in residential care facilities spend most of their time not engaged in meaningful activities. Being involved in activities can improve their quality of life. Animal-assisted therapy is an activity that can evoke engagement and joy. Another way to create engagement and promote communication between people with dementia and caregivers is to use photos.

METHODS

In this observational study, the researchers combined animal-assisted therapy and photobooks in order to explore whether photos of people with dementia who were engaged in animal-assisted therapy could be used as a tool for communication in dementia care. Ten persons (4 men and 6 women; aged 72-92) with dementia were video recorded during photo-elicited conversations with a dog handler/assistant nurse. The recordings were conducted in two residential care facilities in Sweden during 2017-2018. Each participant was video recorded 2-4 times. The recordings were analysed using The Observed Emotion Rating Scale and The Observational Measurement of Engagement-OME Modified. In addition, the video recordings were interpreted from a hermeneutic perspective.

FINDINGS

The findings showed that the most frequently observed effects were pleasure and general alertness, and the participants were observed to be attentive most of the time. The most common attitude during the conversations was 'somewhat positive'. The hermeneutic interpretations were grouped into four themes: Conveys a structure for the conversation with an inherent beginning and ending; An opportunity to recognise oneself and recall a sense of belonging; Awakens emotions and creates fellowship and Entails confirmation and revitalises their identity.

CONCLUSION

Photobooks can be used by caregivers as a tool for meaningful and joyful communication with people with dementia, even those with severe dementia.

In-home online music-based intervention for stress, coping, and depression among family caregivers of persons with dementia: A pilot study

Little is known about how music affects family caregivers who provide care to persons with dementia at home. We examined the effects of an 8-week online music-based intervention on self-reported stress, coping, and depression among dementia family caregivers. Mann-Whitney U test and Wilcoxon signed-ranked tests were performed to examine between- and within-group differences between intervention (n = 24) and comparison (n = 11) groups from baseline to post-test. The coping subscale yielded a significant difference between the groups at post-test (U=76.50, Z=-1.978, p=0.048), indicating the intervention group had better coping than the comparison group at post-test. Significant within-group differences in overall stress (Z=-2.200, p=0.028) and coping subscale (Z=-1.997, p=0.046) in the comparison group at post-test suggest that overall stress and coping were maintained throughout the study in the intervention group, whereas the comparison group had higher overall stress and lower coping at post-test. Our in-home music-based intervention showed potential benefits for dementia family caregivers.

Pet ownership supports quality of life in home-dwelling people with Alzheimer's disease

OBJECTIVES

Human-animal interactions have beneficial psychosocial and psychophysiological effects on individuals in both the presence and absence of medical health conditions. No previous prospective studies with long follow-up have investigated the effects of domestic pets on individuals with Alzheimer's disease (AD) who live at home. We examined the effects of pets on quality of life (QoL) and general well-being during a 5-year follow-up of home-dwelling persons with AD.

METHODS

In a prospective study including 223 patients with very mild (Clinical Dementia Rating Scale [CDR] 0.5) or mild (CDR 1) AD at baseline who participated in the ALSOVA study, 40 (18%) had a pet. Self- and proxy-rated QoL in AD quality of life-AD (QoL-AD), 15D, and self-rated visual analogic scale (VAS) were assessed annually for 3 years and after 5 years. The Mini-Mental State Examination, Neuropsychiatric Inventory, and CDR sum of boxes (CDR sum of boxes) were measured at the same visits.

RESULTS

A significant positive effect of pet ownership (p = 0.003, proxy-rated QoL-AD) on QoL was found over the entire follow-up. However, self-rated QoL-AD, 15D, and VAS did not significantly differ between pet owners and non-pet owners.

CONCLUSIONS

The findings suggest that having a pet may support QoL in home-dwelling persons with AD. Self-rated or general QoL or well-being measurements are not an accurate method for studying QoL in individuals with dementia over time due to a lack of insight. Adding proxy-rated evaluations to this kind of study is recommended.

Effect of animal assistant therapy on quality of life in older adults: A meta-analysis

This meta-analysis was conducted to determine the effect of animal-assistant therapy on the quality of life of older adults. This research systematically searched electronic databases (CINAHL, Cochrane Central, Medline/PubMed, Web of Science, Science Direct, and the National Thesis Centre and ULAKBİM of the Council of Higher Education) for studies published between April - June 2021. Seven studies with experimental design were used, three were quasi-experimental and four were randomly controlled studies. The total sample size in the meta-analysis was 375 (experimental group: 177 and control group: 198). The mean duration of animal-assistant therapy was 38.5 ± 12.4 min. Animal-assistant therapy had a significant effect on the quality of life of older adults (mean difference: -4.59 p: 0.03, Z:2.23). Therefore, animal assistant therapy is an effective method to improve older adults' quality of life.

Animal-Assisted Interventions for Dementia: A Systematic Review

Behavioral and psychological symptoms of dementia (BPSD) can be devastating for people who have dementia and their families. More than 5 million Americans are living with dementia, and approximately 97% of these individuals have BPSD, including agitation, aggression, anxiety, depression, apathy, sleep disturbances, wandering, and disinhibition. Animal-assisted interventions (AAI) have increasingly been used to treat these symptoms in individuals with dementia and constitute an optimal nonpharmacological treatment strategy. The current review aims to explore the literature regarding AAI in treating BPSD. Of 3,573 publications reviewed, 15 articles met inclusion criteria. All studies included a type of AAI exploring BPSD within individuals with dementia. The systematic review unveils AAI may be beneficial for those with dementia; however, further research is necessary to address limitations in the existing literature. [Research in Gerontological Nursing, 14(6), 317-324.].

Cortisol Levels of Shelter Dogs in Animal Assisted Interventions in a Prison: An Exploratory Study

Simple Summary

Animal Assisted Interventions (AAI) are growing in popularity among professionals of psychological therapies due to their clear benefit for human health. However, to date, little attention has been paid to the welfare of the animals involved in the interventions. In this study we evaluated the potential impact of such activities on the welfare of dogs living in a kennel, which had weekly interactions with inmates held at a prison. To assess their stress levels, we analyzed their physiological response to a stressful situation by measuring the cortisol levels in saliva samples. We found a significant decrease in cortisol concentration at the end of the AAI program measured in the dogs’ living environment (i.e., kennel), which suggests a positive effect of the AAI activities on the welfare of kennel dogs. The results also suggest that transportation from the kennel to the prison could be perceived as a stressful event since it significantly increased dogs’ cortisol levels. Therefore, particular care should be taken in the management of this phase.

Abstract

Previous studies regarding the Animal Assisted Interventions (AAI) have mainly focused on the beneficial effects of human–animal interactions on human health; whereas the impact of such activities on the welfare of the animals involved has received limited attention. So far, few studies have addressed this issue by evaluating the physiological and behavioral reactions of therapy dogs during the interventions. The aim of this study was to evaluate the potential effect of AAI on the cortisol levels of shelter dogs. Five dogs participated in weekly AAI working activities with adult inmates held at a prison of the South of Italy for two months. Saliva samples were collected every two weeks in three conditions: at the kennel (baseline), after transportation and at the end of the working sessions. The results revealed a significant decrease in the cortisol baseline at the end of the AAI program, suggesting that the activities carried out with humans and in a different environment could improve the welfare of dogs housed in kennels. Moreover, we found that transportation significantly increased subjects’ cortisol levels, suggesting that it is a critical phase that deserves particular care.

Animal-assisted therapy on happiness and life quality of chronic psychiatric patients living in psychiatric residential care homes: a randomized controlled study

BACKGROUND

Psychiatric patients who live in psychiatric residential care homes may often feel a loss of autonomy, decision making, and participation in social activities. They usually have few or no visitors and also do not have any purpose for living. Animals may increase the happiness and quality of life of psychiatric patients. This study aimed to evaluate the effects of Animal-Assisted Therapy (AAT) on happiness and quality of life of chronic psychiatric patients living in psychiatric residential care homes in Tehran, Iran.

METHODS

This randomized controlled trial was conducted with 70 males with a chronic psychiatric disorder who were living in psychiatric residential care homes in Tehran, Iran, in 2016. The patients were randomly selected and divided into animal therapy intervention group and control group. Patients in the intervention group received animal-therapy with a bird for eight weeks. Patients in the control group received no intervention. The Oxford Happiness Inventory evaluated all patients pre and post-intervention. To evaluate life quality, the Wisconsin Quality of Life Index was used. Data were statically analyzed using SPSS Ver.19.0. ANCOVA with pretest statistical control. The significance level was set as p < 0.05.

RESULTS

The mean age in both control and intervention groups were 47.12 and 45.82 years, and the mean age of illness onset for both control and intervention groups was 18.94 and 16.83 years, respectively. The result of this study showed that happiness in the intervention group had significantly increased (p < 0.001). The results also showed that the quality of life in four sub-domains increased significantly.

CONCLUSION

To bring happiness to chronic psychiatric patients living in psychiatric residential care homes is essential and may result in returning them to society and healthy life. The results of this study showed that AAT was helpful for chronic psychiatric patients living in psychiatric residential care homes and not only made them happy but also increased their quality of life.

TRIAL REGISTRATION

This was registered in Iranian Registry of Clinical Trials (IRCT) (clinical trial code: IRCT20101013004922N4. Registered 2018-08-19. Retrospectively registered, https://www.irct.ir/trial/32390.

Validation of the Human-Animal Interaction Scale (HAIS) in Czech Language

Human–Animal interaction (HAI) refers to any contact between humans and animals. Despite the lack of standardized measures of evaluation, one possible tool is the Human Animal Interaction Scale (HAIS). This study aimed to evaluate it in Czech language and to verify its use in clinical settings. One group of participants included 85 non-clinical volunteers; the second included 22 clinical participants, who were hospitalized in a long-term inpatient department All participants filled out the HAIS, the Companion Animal Bonding Scale (CABS) and the Companion Animal Semantic Differential (CASD). The Czech HAIS achieved similarly good psychometric properties as the original scale. The Cronbach’s alpha showed strong internal consistency (α = 0.920) in the sample of volunteers, but low internal consistency (α = 0.656) in the group of clinical participants. In non-clinical volunteers, all scales and subscales correlated mutually at the p < 0.01 level. In the group of clinical participants, the CABS did not show significant correlations with other scales and subscales, nor was there a correlation of total HAIS score with the perceived rapport with animals. The findings of this study suggest that the Czech HAIS may be an effective tool for evaluating HAI with non-clinical contingents, however careful modification is suggested before clinical use. One reason for this is the difficulty in conducting some activities assessed by the scale in a clinical practice or hospital setting.

What Are the Benefits of Pet Ownership and Care Among People With Mild-to-Moderate Dementia? Findings From the IDEAL programme

Pet ownership has been associated with positive outcomes in many populations, yet the associations with physical and psychological wellbeing in people with dementia remain unclear. The current study used baseline data from 1,542 people living at home with mild-to-moderate dementia from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) programme. Regression analyses investigated associations of pet ownership and pet care with self-reports of walking, loneliness, depression, and quality of life (QoL). After adjusting for covariates, having any pet was associated with higher likelihood of walking over 3 hr in the last week. Those with a dog and who were involved in its care were less likely to be lonely than those with no dog. Having any pet but no involvement in its care was associated with increased depression and decreased QoL compared with those without a pet. The key factor in the associations was involvement in the care of the pet by the person with dementia.

The psychological and behavioural effects of an animal-assisted therapy programme in Korean older adults with dementia

AIM

The purpose of this study was to investigate the psychological and behavioural effects of animal-assisted therapy on cognitive function, emotional state, problematic behaviours, and activities of daily living among older adults with dementia.

METHODS

A nonequivalent control group pretest and post-test study design was used in this study. Twenty-eight participants-14 in the intervention group and 14 in the control group-were recruited from two hospitals in Gyeonggi Province, South Korea, between February and April 2015. The intervention group received two 60-min sessions of animal-assisted therapy weekly for 8 weeks, while the control group received conventional care. The cognitive function, emotional state (mood, depression), activities of daily living, and problematic behaviours of the two groups were compared at three points (before the study, at week 4, and at week 8).

RESULTS

The results showed significant group-by-time interactions of cognitive function (P < 0.001), mood status (P < 0.001), depressive symptoms (P < 0.01), degrees of activities of daily living (P < 0.001), and problematic behaviours (P < 0.001). There were no significant group differences, but significant time differences were observed in cognitive function (P < 0.001), mood status (P < 0.05), degrees of activities of daily living (P < 0.01), and problematic behaviours (P < 0.05).

CONCLUSION

The findings of the study suggest the adoption of animal-assisted therapy in the daily care of older adults with dementia for improving their psychological and behavioural problems.

Interacting With a Visiting Dog Increases Fingertip Temperature in Elderly Residents of Nursing Homes

The aim of this study was to investigate whether interacting with a visiting dog influences fingertip temperature and cortisol levels in residents living in nursing homes for the elderly. The study included two groups, the dog group (n = 13) and the control group (n = 11–15) and lasted for 8 weeks for the dog group and 6 weeks for the control group. All participants were residents living at nursing homes for the elderly. The researchers visited small groups of the participants twice weekly during the entire study in both the dog and the control group. The visiting dog and the dog handler accompanied the researchers during weeks 3–6. Fingertip temperature was measured and saliva samples for cortisol determination were collected at 0, 20 and 60 min for the dog group and at 0 and 20 min for the control group. For analysis the study was divided into periods; Period 1 (week 1–2), Period 2 (week 3–4), Period 3 (week 5–6) and Period 4 (week 7–8, only the dog group). Mean values based on all data obtained at 0 and 20 min during period 1–3 were compared between groups. A second, separate analysis for the dog group also included data from 60 min and for period 4. For the dog group fingertip temperature increased significantly between period 1 and 2, 1 and 3 and 1 and 4 (p < 0.05). In addition, fingertip temperature rose significantly between 0 and 20 min and between 0 and 60 min within all periods. For the control group a significant decrease in fingertip temperature was observed between period 1 and 3 (p < 0.05). Fingertip temperature did not differ between the two groups during period 1, but was significantly higher for the dog group than for the control group during periods 2 and 3 (p < 0.05 and p < 0.001, respectively). Cortisol results are only presented descriptively due to that many samples had too low volume of saliva to be analyzed. In the present study interaction between elderly residents and a visiting dog resulted in increased fingertip temperature, probably reflecting a decrease in the activity of the sympathetic nervous system and therefore a decrease in stress levels.

Animal-Assisted Therapy Improves Communication and Mobility among Institutionalized People with Cognitive Impairment

Disorders of communication, social relationships, and psychomotricity are often characterized by cognitive impairment, which hinders daily activities and increases the risk of falls. This study aimed to evaluate the efficacy of an animal-assisted therapy (AAT) program in an institutionalized geriatric population with cognitive impairment. The variables evaluated included level of communication and changes in gait and/or balance. We performed a two-arm, parallel controlled, open-label, nonrandomized cluster clinical trial in two nursing home centers from an urban area. Patients in the two centers received 12 weekly sessions of physiotherapy, but the experimental group included AAT with a therapy dog. The study included a total of 46 patients (23 Control Group [CG], 23 Experimental Group [EG]) with a median age of 85.0 years. Of these, 32.6% had mild–moderate cognitive decline (Global Deterioration Scale of Reisberg [GDS] 2–4) and 67.4% severe cognitive decline (GDS 5–6). After the intervention, patients in the CG and EG showed a statistically significant improvement in all the response variables. When comparing both groups, no statistically significant differences were found in any of the Tinetti scale results (measuring gait and balance). However, the communication of patients in the EG, measured on the Holden scale, showed a statistically significant greater improvement postintervention than that of patients in the CG. AAT can be useful as a complementary, effective treatment for patients with different degrees of cognitive decline.

Trained assistance dogs for people with dementia: a systematic review

This systematic review investigated evidence for the effectiveness of trained assistance dogs as an intervention and support for people with dementia. Peer-reviewed articles were retrieved from multiple databases (SCOPUS, Web of Science, and Google Scholar). Reference lists of the articles retrieved were also screened to identify key authors for inclusion. Articles were subject to a quality review, and the results synthesised to address the research questions. Both qualitative and quantitative data were reported. There was evidence of the potential positive effects of dog-assisted interventions in relation to mood, prosocial behaviours, activities of daily living and/or quality of life, cognitive impairment and symptoms specific to dementia, and existential functions. However, the form and quality of the studies varied considerably. It was concluded that further research is needed, particularly for those with younger onset dementia (YOD), for whom there were no specific studies available. Attention needs to be given to establishing adequate-sized samples and designs incorporating control groups. Research would benefit from employing mixed-methods, allowing for the triangulation of qualitative and quantitative data. For deteriorating conditions such as the dementias, studies need to be conducted over time. Furthermore, given the important place family members play in the lives of those with dementia, the effects of dog-assisted interventions on the wider family should also be considered.

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.

Children report positive experiences of animal-assisted therapy in paediatric hospital care

AIM

To evaluate children's experiences of and responses to animal-assisted therapy using a therapy dog as complementary treatment in paediatric hospital care.

METHODS

The study was performed using mixed methods, by means of qualitative and quantitative data. Fifty children in a paediatric surgery ward, at a tertiary hospital in Sweden, were included between February 2016 to May 2017. Children answered questions about feelings of well-being and experiences of the hospital stay before and after animal-assisted therapy, and experiences of their interaction with a therapy dog.

RESULTS

The children's well-being increased from moderately good before to very good after animal-assisted therapy, and the children assessed the hospital stay as better after than before. The vast majority of the children (93%) assessed the interaction with the dog as very good. The children described mixed experiences before and mainly positive aspects of joy, satisfaction and pain relief after animal-assisted therapy.

CONCLUSION

The children's responses before interaction, of both a positive and negative nature, show a focus shift after the interaction with a therapy dog to mainly positive nature regarding self-reported feeling of well-being and experiences of the hospital stay. Using a therapy dog in paediatric hospital care is suitable complementary treatment.

Effects of Dog-Assisted Therapy on Social Behaviors and Emotional Expressions: A Single-Case Experimental Design in 3 People With Dementia

This study examined the effects of dog-assisted therapy (DAT) on social behaviors, emotional manifestations, and experience during the activity of 3 people with dementia residing in a specialized dementia unit. The study used an A-B-A-B withdrawal single-case experimental design with two 5-session phases, baseline and DAT, replicating the same activities in each phase. The sessions were recorded and 2 independent coders quantified the frequency of social behaviors along with an assessment of the emotional manifestations and experience during the activity. Comparing with baseline sessions, DAT sessions showed an increase in prosocial behaviors (leans, looks, and verbalizations) and a significant impact on emotional manifestations with heightened pleasure. Dog-assisted therapy sessions also led to a better experience, with higher participation, pleasure, and relationship with others, together with lower rejection and displeasure than in the baseline sessions. Dog-assisted therapy seems to be a nonpharmacological therapy with potential to improve quality of life of people with dementia through promoting social behaviors and positive emotional manifestations.

Social Robots as a Complementary Therapy in Chronic, Progressive Diseases

Globally, the world population is ageing, which increases the prevalence of non-communicable diseases that affect patients both physically and psychologically, such as is the case of dementia. Consequently, there is a greater demand for the healthcare system as it needs to develop solutions to answer to these needs.The literature review shows that complementary therapies may be applied in dementia in order to aid the symptom management as well as to slow down the progression of the disease. The Socially Assistive Robots (SAR) are tools that may be used as a complementary therapy in dementia and have shown to promote a potentially beneficial relationship. The zoomorphic models of SAR have shown to have similar results to complementary therapies with animals, as they generate positive emotions and promote multisensorial interaction through the sight, hearing and touch.The use of SAR is a new tool that has shown to have benefits in terms of slowing down the progression of the disease, aiding to improving the quality of life in the elderly.

Animal-Assisted Intervention Improves Pain Perception in Polymedicated Geriatric Patients with Chronic Joint Pain: A Clinical Trial

Chronic joint pain is associated to an increase in the consumption of medication and decrease in life quality in elderly people, which requires developing non-pharmacological treatments. The aim of this study was to evaluate the effectivity of a group intervention, based on animal-assisted therapy and applied to elderly people with chronic joint pain and polymedication, regarding the decrease of chronic pain, use of analgesics and improvement of life quality. A randomized controlled trial, two arms and open-label was conducted in a Primary Health Center. Twelve weekly sessions of kinesitherapy; in the EG, these exercises were performed with the additional assistance of the therapy dog. A total of 52 participants (22 Control Group (CG), 30 EG), average age 77.50 (±7.3), women 90.4%. A significant reduction on post-intervention values of pain β = −0.67(−1.27, −0.08), p = 0.03 and pain induced insomnia β = −0.53(−1.01, −0.05), p = 0.03 was found in EG for increasing baseline values. Animal-assisted therapy leads to an additional reduction in the perception of pain and pain induced insomnia in individuals with higher baseline severity. The presence of the dog improves the attachment to intervention and the satisfaction of the participants.

Effectiveness of a Dog-Assisted Therapy Program to Enhance Quality of Life in Institutionalized Dementia Patients

The aim of this study was to assess the effectiveness of a dog-assisted therapy intervention to enhance quality of life in persons with dementia institutionalized in a public care home and to study its effect on the use of psychotropic medications. A dog-assisted therapy intervention was designed, in which 34 residents of a public care home in Cuenca (Spain) participated. The participants were assigned to two groups, an experimental and a control group. The program consisted of one 50-min session per week during 9 months. Analysis of covariance (ANCOVA) was used to compare post-training values between groups, using baseline values as covariates. Our findings do seem to support the hypothesis that Animal-Assisted Therapy may contribute to enhancing quality of life for residents in an aged care home. However, aspects such as the format, time, and content of the sessions as well as their possibilities of reducing psychotropic medication require more research.

Exposing the mechanisms underlying successful animal-assisted interventions for people with dementia: A realistic evaluation of the Dementia Dog Project

There is increasing recognition of animal-assisted interventions as a promising area of practice within health and social care for people living with dementia. However, much of the research focuses on benefits for those living in care homes and not in their own homes. The Dementia Dog Project is an innovative project that aims to support people with dementia to engage with dogs and to promote the use of dogs in dementia care in the community. The pilot project introduced a dementia assistance dog to four couples where one person had a diagnosis of dementia. The aim of this paper is to explore the mechanisms that can successfully expose the benefits of integrating dogs into dementia care by drawing on the findings of a realistic evaluation of the pilot phase of the Dementia Dog Project (2013-2015). A realistic evaluation, with its focus on context, mechanisms and outcomes illuminates why an approach may work in some situations but not in others. This makes it especially appropriate to the unique, complex experience of living with dementia and the early development stage of the programme. The analysis triangulated data from a range of primary and secondary sources including interviews with the project team, case reports, team meeting notes and transcripts of interviews with participants. The findings identified three mechanisms that help to unlock the most positive outcomes for both the participants and the dogs. These were (1) the human-animal bond, (2) relationship dynamics and (3) responsibility of caring. The findings presented within this paper provide essential information to inform and advance the planning for the use of assistance dogs for people with dementia.

Animal assisted therapy: systematic review of literature

PURPOSE

to verify the applications of AAT in health by performing a systematic review of the literature.

RESEARCH STRATEGY

a survey was carried out in four databases with the descriptors: animal assisted therapy, horse assisted therapy, speech therapy.

SELECTION CRITERIA

article published between 2010 and 2018, in Portuguese or English, free electronic access and that mentioned the characteristics of the intervention program.

DATA ANALYSIS

criteria: casuistry, area of knowledge, program characteristic, type of research, year and language of publication, nationality, periodical and impact factor.

RESULTS

43 articles published in 30 journals, 16 with impact factor, were reviewed. Clinical studies prevailed (93.02%), 37.20% were from Medicine, the population studied had different diagnoses and ages, 55.81% with adults / elderly. AAT was used preferentially for physical rehabilitation (67.44%) and the main mediator was the dog, mentioned in 72.09% of the articles. Eight (n = 8) programs with a focus on communication intervention were described.

CONCLUSION

There is scientific evidence on the use of AAT published in the period studied, in Brazil and in the world. The programs were used by different health and education professionals. The AAT goals were specific to the profile of the participants, and consistent with the characteristics of the mediator animal and the site.

Canine-Assisted Therapy and Quality of Life in People With Alzheimer-Type Dementia: Pilot Study

BACKGROUND

With the aim of improving the quality of life of people with Alzheimer's disease, primarily as regards behavioral and psychological symptoms, we implemented canine-assisted therapy in a group of people with this disease.

METHODS

We conducted a quasi-experimental study, with a simple pre-post case series design. Participants comprised 10 Alzheimer's day care center users presenting severe or very severe cognitive decline. The measurement instrument employed was the Quality of Life in Late-Stage Dementia (QUALID) scale.

RESULTS

By the end of the therapy, 100% of participants showed an improvement in physical, behavioral, and psychological aspects. The total scores of the QUALID scale for the three different evaluation times (before the therapy and 6 and 12 months after starting) after the canine-assisted therapy intervention were smaller and less dispersed. The total score for the QUALID scale decreased significantly (p < 0.05) at 6 and 12 months after starting therapy. An analysis by item revealed that the scores of all of them fell during the course of the therapy.

DISCUSSION

Our study provides evidence of the significant benefits of canine-assisted therapy for quality of life in people with Alzheimer's disease.

Effects of an animal-assisted intervention on social behaviour, emotions, and behavioural and psychological symptoms in nursing home residents with dementia

AIM

The positive effects of animal-assisted interventions (AAIs) in people with dementia have been frequently reported in the literature. However, it remains unclear if the positive effects are directly due to the presence of the animal. The aim of this study was to investigate if the inclusion of an animal adds value to psychosocial interventions for people with dementia.

METHODS

The study followed a within-subject design with two studied conditions (AAI and control intervention) and several measurement points (baseline (i.e. at beginning of the intervention), after 3 months, and after 6 months). Nineteen nursing home residents with dementia participated in the AAI (with a dog) and the control intervention. Both interventions were delivered as weekly group sessions over a period of 6 months. Outcomes examined were social interaction, emotional expression, and behavioural and psychological symptoms. These outcomes were evaluated by using video recordings at baseline and after 3 and 6 months.

RESULTS

Nineteen patients with moderate to moderately severe dementia who lived in two nursing homes in Germany were included. During the AAI, we detected significantly longer and more frequent periods of positive emotions (pleasure) and social interaction (e.g. touch, body movements) than during the control intervention.

CONCLUSION

The presence of a dog appears to have beneficial effects on psychosocial intervention for people with dementia.

Effects of dog-assisted intervention on quality of life in nursing home residents with dementia

BACKGROUND

People with dementia often have a poor quality of life. Therefore, methods that can improve their life situation must be identified. One promising method is dog-assisted intervention.

AIM

This study aimed to investigate the effects of dog-assisted intervention on quality of life in nursing home residents with dementia.

MATERIALS AND METHODS

A one-group, pretest post-test study design was used. Quality of life was measured using the QUALID in 59 nursing home residents prior to and after a dog-assisted intervention. Non-parametric tests were used to analyze the data, and effect sizes were calculated.

RESULTS

The participants' total scores improved significantly between baseline and post-test 1 (p = < 0.001) and worsened significantly at post-test 2 (p = 0.025). The largest effect size was found for the item 'Verbalization suggests discomfort' (p = 0.001).

CONCLUSION

The results indicate that dog-assisted interventions can have positive effects on quality of life in nursing home residents with moderate to severe dementia.

SIGNIFICANCE

The results contribute to a growing knowledge base about non-pharmacological methods that can be used in dementia care. Occupational therapists should consider dog-assisted interventions when planning activities that can reduce the illness burden and improve the quality of life for people with dementia.

Animal-Assisted Intervention and Dementia: A Systematic Review

This review discusses the relationship between animal-assisted interventions (AAI) and behavioral and psychological symptoms of dementia (BPSD). A systematic search was conducted within CINAHL, Web of Science CAB Abstracts, PubMed, Abstracts in Social Gerontology, Google Scholar, and PsycINFO for primary research articles. A total of 32 studies were included in the final review. Variation was noted in study designs and in study setting. Twenty-seven of 32 studies used dogs as the intervention. Agitation/aggression showed a significant decrease in nine of 15 studies. Eleven of 12 studies demonstrated increased social interaction with AAI. Mood had mixed results in nine studies. Quality of life was increased in three of four studies. Resident activity and nutritional intake were each increased in two studies. Animal assisted activities/interventions showed a strong positive effect on social behaviors, physical activity, and dietary intake in dementia patients and a positive effect on agitation/aggression and quality of life.

Measurement tools of resource use and quality of life in clinical trials for dementia or cognitive impairment interventions: A systematically conducted narrative review

OBJECTIVE

Knowledge is limited about the standardised instruments used to collect resource use and quality of life data alongside trials of dementia interventions. This review aimed to identify the trials using such instruments in order to guide the design of future trial-based cost-effectiveness studies.

METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, this review examined all original, peer-reviewed research in major databases and general searches published until June 2017, including randomised clinical trials, pilot studies, or feasibility studies about interventions for older adults with dementia or cognitive impairment.

RESULTS

Forty-one studies were identified. Only 8 collected the resource use data using adapted Client Service Receipt Inventory (CSRI), Resource Use Inventory (RUI), cost diary, or study-specific questionnaire. Quality of life was assessed using a wide range of instruments. The most frequently used dementia-specific instrument was Quality of Life in Alzheimer's Disease (QOL-AD) and Dementia Quality of Life questionnaire (DEMQOL). Among the generic measures, EuroQol 5-dimentison (EQ-5D) was mostly used to collect health utility data, and Short Form surveys (SF-36 or SF-12) were widely to measure general health.

CONCLUSIONS

Several useful resource use and quality of life measurement instruments have been identified by this review. For resource use, CSRI was mostly used, but no studies have used Resource Utilisation in Dementia (RUD); for quality of life, we recommend the inclusion of dementia-specific DEMQOL, generic SF-12, and health utility EQ-5D-5L, based on both self-report and proxy-report.

Animal-assisted intervention for individuals with cognitive impairment: A meta-analysis of randomized controlled trials and quasi-randomized controlled trials

The aim of this meta-analysis was to systematically examine the efficacy of animal-assisted intervention (AAI) for cognitive impairment patients. PubMed, Embase, the Cochrane library, PsycINFO, and Web of Science databases were searched up to June 2017 to collect studies related to AAI conducted in patients with cognitive impairment. Five randomized controlled trials (RCTs) and five quasi-randomized controlled trials (quasi-RCTs) involving 413 participants were included. Compared with control groups, AAI groups exhibited significantly fewer behavioral and psychological symptoms of dementia (BPSD), especially depression and agitation. In both the short and long term, AAI had beneficial effects on BPSD in cognitive impairment patients. However, no significant improvements were found in daily living activities, quality of life or cognitive score. The present meta-analysis showed that AAI can be effective in reducing BPSD in patients with cognitive impairment.

Systematic review of evidence underpinning non-pharmacological therapies in dementia

Objective Dementia is one of the most common illnesses worldwide, and is one of the most important causes of disability in older people. Currently, dementia affects over 35 million people around the globe. It is expected that this number will increase to 65.7 million by 2030. Early detection, diagnosis and treatment to control the principal behaviour symptoms may help reduce these numbers and delay the progression to more advanced and dangerous stages of this disorder with resultant increase quality of life for those affected. The main goal of the present systematic literature review was to examine contemporary evidence relating to non-pharmacological therapy in the treatment of dementia. Methods To achieve the study goal, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used. Results This study identified the five most common behaviours in patients with dementia as aggression, wandering, agitation, apathy and sleep disturbances. Two non-pharmacological therapies were the most studied treatment: music therapy and aromatherapy. Ten other non-pharmacological therapies were also identified, but these lack a sufficient evidence-base. Conclusion Although all the therapies identified could be used as part of the treatment of behavioural symptoms, there is insufficient evidence relating to the indications, appropriate use and effectiveness of these therapies to apply in each behavioural treatment. Thus, the present study has demonstrated a significant research gap. What is known about the topic? Despite the widespread use of many different types of therapies, there is limited evidence regarding the efficacy of non-pharmaceutical therapies deployed in the management of behaviours of concern manifested by some people who suffer with dementia in all its forms. What does this paper add? This systematic review examines contemporary evidence from the literature to determine whether there is an evidence base available that would underpin the use of these therapies. This report on a PRISMA systematic review of the available literature demonstrates that only two therapies have some evidence to underpin the use of these non-pharmaceutical therapies and that a significant research gap is exists. What are the implications for practitioners? The implications for practitioners is that significant research effort is required to determine the efficacy of many of the therapies that are currently deployed, and thus many of the therapies used lack an evidence base at this time.

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.

Factors Associated with the Quality of Life of People with Dementia and with Quality of Life-Improving Interventions: Scoping Review

Objectives

To synthesise current research exploring the factors and interventions associated with the quality of life of people with dementia.

Background

Dementia is a progressive condition affecting an estimated 40 million people worldwide. The illness has a significant impact on the lives of the persons affected and their loved ones, and may thus impair the quality of life of both. As it progresses, dementia weakens the patients’ ability to express their own views about their quality of life and the factors associated with it.

Design

Scoping review.

Data sources

Electronic database search of MEDLINE, CINAHL, PsycINFO, Joanna Briggs Institute Library, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), EMBASE, Medic published up to March 2016; and incremental hand search. Review method: Systematic or other kinds of reviews and single studies were included for the review if they met the inclusion criteria. Results: A total of 20 reviews and 7 primary studies were retained for synthesis. Key findings were abstracted and a themes matrix was generated to identify patterns of meaning. The factors associated with the quality of life of people with dementia were sociodemographic factors, factors related to dementia and social and caring environment. Interventions supporting quality of life focused on the activation of people with dementia. Conclusions: This scoping review identified a large body of knowledge exploring the factors and interventions associated with the quality of life of people with dementia. The interventions were heterogeneous and the sample sizes small, which is why more research is needed.

Effect of animal-assisted interventions on depression, agitation and quality of life in nursing home residents suffering from cognitive impairment or dementia: a cluster randomized controlled trial

OBJECTIVES

The prevalence of neuropsychiatric symptoms in cognitively impaired nursing home residents is known to be very high, with depression and agitation being the most common symptoms. The possible effects of a 12-week intervention with animal-assisted activities (AAA) in nursing homes were studied. The primary outcomes related to depression, agitation and quality of life (QoL).

METHOD

A prospective, cluster randomized multicentre trial with a follow-up measurement 3 months after end of intervention was used. Inclusion criteria were men and women aged 65 years or older, with a diagnosis of dementia or having a cognitive deficit. Ten nursing homes were randomized to either AAA with a dog or a control group with treatment as usual. In total, 58 participants were recruited: 28 in the intervention group and 30 in the control group. The intervention consisted of a 30-min session with AAA twice weekly for 12 weeks in groups of three to six participants, led by a qualified dog handler. Norwegian versions of the Cornell Scale for Depression, the Brief Agitation Rating Scale and the Quality of Life in Late-stage Dementia scale were used.

RESULTS

A significant effect on depression and QoL was found for participants with severe dementia at follow-up. For QoL, a significant effect of AAA was also found immediately after the intervention. No effects on agitation were found.

CONCLUSIONS

Animal-assisted activities may have a positive effect on symptoms of depression and QoL in older people with dementia, especially those in a late stage. Copyright © 2016 John Wiley & Sons, Ltd.

Engagement in elderly persons with dementia attending animal-assisted group activity

The need for meaningful activities that enhance engagement is very important among persons with dementia (PWDs), both for PWDs still living at home, as well as for PWDs admitted to a nursing home (NH). In this study, we systematically registered behaviours related to engagement in a group animal-assisted activity (AAA) intervention for 21 PWDs in NHs and among 28 home-dwelling PWDs attending a day care centre. The participants interacted with a dog and its handler for 30 minutes, twice a week for 12 weeks. Video-recordings were carried out early (week 2) and late (week 10) during the intervention period and behaviours were categorized by the use of an ethogram. AAA seems to create engagement in PWDs, and might be a suitable and health promoting intervention for both NH residents and participants of a day care centre. Degree of dementia should be considered when planning individual or group based AAA.

Change in quality of life in older people with dementia participating in Paro-activity: a cluster-randomized controlled trial

AIM

The aim of this study was to investigate effects of robot-assisted group activity with Paro on quality of life in older people with dementia.

BACKGROUND

Nursing home residents with severe dementia often experience social withdrawal and lower quality of life, which are suggested to be enhanced by non-pharmacological interventions.

DESIGN

A cluster-randomized controlled trial. Ten nursing home units were randomized to robot-assisted intervention or control group (treatment as usual).

METHODS

Data were collected between March 2013-September 2014. 27 participants participated in group activity for 30 minutes twice a week over 12 weeks, 26 participated in the control group. Change in quality of life was assessed by local nurses through the Quality of Life in Late-Stage Dementia scale at baseline, after end of intervention and at 3 months follow-up. The scale and regular psychotropic medication were analysed stratified by dementia severity. Analysis using mixed model, one-way anova and linear regression were performed.

RESULTS

An effect was found among participants with severe dementia from baseline to follow-up showing stable quality of life in the intervention group compared with a decrease in the control group. The intervention explained most of the variance in change in the total scale and in the subscales describing Tension and Well-being for the group with severe dementia. The intervention group used significantly less psychotropic medication compared with the control group after end of intervention.

CONCLUSION

Pleasant and engaging activities facilitated by nursing staff, such as group activity with Paro, could improve quality of life in people with severe dementia. The trial is in adherence with the CONSORT statement and is registered at www.clinicaltrials.gov (study ID number: NCT01998490) [corrected].

Quality of life ratings in dementia care--a cross-sectional study to identify factors associated with proxy-ratings

Objective

Quality of life (QoL) is one major outcome parameter in the care for people with dementia (PwD); however, their assessment is lacking a gold standard. The purpose of this study was to evaluate potential factors associated with nurse-rated quality of life of PwD in nursing homes in Berlin, Germany.

Method

An explorative cross-sectional study was performed in five nursing homes to evaluate QoL. Nurses rated the QoL for all residents with dementia by completing two different standardised assessments (ADRQL, QUALIDEM). Potential associated factors were evaluated concerning resident and nurse related factors. A fixed-effects models of analysis of co-variance (ANCOVA) was used to analyse effects of assumed associated factors of the major outcome parameters ADRQL and QUALIDEM. Associated factors were severity of dementia (GDS), challenging behaviour (CMAI), and other characteristics. Regarding the nurses, burnout (MBI), satisfaction with life (SWLS), attitude (ADQ) and empathy toward residents (JSPE), as well as circumstances of the ratings and days worked in advance of the ratings were assessed.

Results

In total, 133 PwD and 88 nurses were included. Overall, the ratings show moderate to high QoL in every subscale independent of the instrument used. Assumed confounders relevantly influenced 14 out of 17 ratings. Predominantly, residents’ challenging behaviour, nurses’ burnout and satisfaction with life as well as the circumstances of the ratings are significant and clinically relevant associated factors.

Conclusion

Assessing QoL of PwD is acknowledged as a central component of health care and health care research. In later stages of dementia, proxy-reported information obtained from quality of life questionnaires is and will continue to be essential in this research. However, methodological issues that underline this research - matters of measurement and instrument validity - must receive more attention. Associated factors in proxy-ratings have to be routinely assessed in order to get more valid and comparable estimates.