Alzheimer's in a Healthy Community 'Literature Review' chapter

  • Length: 7 pages
  • Subject: Healthcare
  • Type: 'Literature Review' chapter
  • Paper: #43997315

Excerpt from 'Literature Review' chapter :

Alzheimer Healthy Community


Alzheimer's Healthy Community

Dog-Assisted Therapy for Older People with Dementia

A review of nine studies on the subject produced loose conclusions on the value of this type of therapy (Perkins et al., 2008). They, however, established a trend, indicating increased social behavior and decreased agitation when dogs were in the company of the respondents. This improvement in social behavior was unrelated with the severity of the respondents' dementia. Six of the 9 studies were conducted in the U.S.A., 2 in Japan and 1 in Australia on 28 respondents, all with a diagnosis of Alzheimer's disease or dementia (Perkins et al.).

The behavioral and psychological symptoms of this ailment not only cause the afflicted individuals much pain but also put them at risk of physical harm (Perkins et al., 2008). Animal-assisted therapy, on the other hand, has shown positive effects over pro-social behavior and the reduction of the behavioral and psychological symptoms of AD and dementia.. The connection, however, has not been adequately investigated. Hence, the rationale of this review.

The authors (2008) recommended the conduct of randomized control trials on this therapy to clearly determine its efficacy for this population and, if effective, the extent and why. Future research should cover the effects of human contact from the dog handlers themselves, the halo effects of the dogs, and prior relationships with animals (Perkins et al.).

Resident Dog in the Alzheimer's Special Care Unit

The effect of dog contact was further investigated at this 22-bed special care unit in an urban health care facility in a mid-Western state (McCabe et al., 2002). The presence of the dog was shown to reduce the occurrence of behavioral disturbance at daytime during the period of study. The occurrence slightly increased in the third week of the period of study and this was attributed to Halloween celebrations. In the fourth week, the occurrence of problem behaviors was even lower than in the first two weeks. There were no significant increases in the occurrence in the evening hours. Staffing patterns, conditions in the special unit and unit routines in evening hours could have influenced the responses of the patient-residents towards the dog (McCabe et al.).

The reduced occurrence of behavioral disturbances was lower in the evening than at day time (McCabe et al., 2002). This finding reinforces that of Churchill et al. (1999 as qtd in McCabe et al.) that soothing background music and tranquilizing drugs could explain the lower level of occurrence in the respondents. The presence of more visitors and less staff in the evening may also explain the improvement. Residents usually receive and interact with family and friends in the evening. There are also fewer transients, like laundry and repairs, in the late hours (McCabe et al.).

A Study on the Establishment and Evaluation of Adult Day Care Service Centers

This evaluated the operating assessment system of a long-term care within the Nantou County in the Republic of China in providing adult welfare and care services for the elderly population in the area (Hung, 2012). This was to help the centers cope with the demands of the ageing society. The performance assessment system accurately indicates those perspectives. Findings reveal that these, in their order, are internal business process, perspectives, customer perspectives, customer perspectives; learning and growth perspectives; and financial perspectives. They serve as a useful guide to organizations in continuously upgrading the services extended to the older adult population (Hung).

The phenomenal growth of the ageing population continues to be felt worldwide. In its Proclamation on Ageing in early 1991, the United Nations proposed the 5 universal principles for the elderly (Hung, 2013). These are independence, participation, care, self-fulfillment and dignity. At the end of 2010, the Taiwanese Ministry of the Interior announced that there were more than 24.8 million citizens older than 65 or 10.74% of the entire population. In response, the government actively promotes health care strategies, such a pilot program for long-term care systems, for the welfare of its elderly and to fill their welfare needs, now and in the future (Hung).

Effects of Day Care on the Behavior of Older Dementia Patients

A sampling of 30 dementia older patients living at a day care was compared with 30 receiving usual home care to determine the effects of day care on them (Mosello et al., 2008). The assessment was made for 2 months on their cognitive and functional status, behavioral and psychological symptoms, using the neuropsychiatric inventory and psychotropic drugs. Their caregivers were likewise evaluated through the use of the Caregiver Burden Inventory and depressive symptoms. Investigation revealed the effectiveness of day care in reducing behavioral and psychological symptoms and caregivers' burden as well. The study concluded that providing day care assistance to the respondents for the two-month period reduced their behavioral and psychological symptoms and alleviated caregivers' burden in providing care (Mosello et al.).

The respondents were among the older patients with dementia at the outpatient Geriatric Evaluation and Management Unit of the Healthcare District of Pistoia in Central Italy between 1999 and 2002 (Mosello et al., 2008). They were referred y their primary care physicians for the assessment for possible long-time care. The geriatric unit included a geriatrician, a nurse and a social worker who performed the evaluation. The evaluation was considered independent and balanced as it was a shared judgment drawn from clinical and social factors, individual preferences, and available resources (Mosello et al.).

Conclusions could not be drawn on the long-term effects of day care, specifically on the benefits of institutionalization (Mosello et al., 2008). Benefits, however, were observed after a few weeks as to its possible short-term effect on a temporary and flexible basis. It may effectively help a large number of such patients for limited periods of time. On the whole, the findings of the study reinforce other findings on the effectiveness of day care as a non-pharmacological treatment for dementia patients with severe behavioral and psychological symptoms. This result may appeal to patients who are unresponsive to, or intolerant of, psychotropic drugs. It may also provide promise of relief to families who are burdened with severe psychological burden in caring for members afflicted with this devastating condition (Mosello et al.).

Animal-Assisted Therapy or AAT and Activities in Alzheimer's Disease

This therapy is an intervention, which focuses on human and animal interaction (Cevizci et al., 2013. It is supplemented by the work of a physical therapist, a psychologist, and an occupational therapist with an AAT certification and the patients' doctor who will work on the recommendations of these health professionals. AAT is specifically used for aged persons in ameliorating their agitations and other psychological, occupational, social and physical disorders, especially AD and dementia. The elderly who have AD find no trouble understanding or decoding a dog's simple, repetitive and non-verbal actions. A dog can be the transitional tool. It can allow the patient to establish a bond with the animal and then extend that bond to persons (Cevizci et al.).

Most research concluded that AAT, especially dog therapy, produces a pacifying effect on dementia and AD patients (Cevizci et al., 2013). This effect is seen as a communication aid during therapy and in reducing agitations. Agitation, aggression, social withdrawal, depression and psychotic disorders are serious concerns to special care units, staff and families of such patients. Environmental factors in health care units have also become forcible burdens for AD therapy. AAT and other similar animal activities and interventions have posed as helpful alternatives in difficult situations such as these. AAT is specifically effective to elderly with cognitive disorders like AD who undergo agitation, especially in the evening hours, called "sundowning." This evening occurrence is particularly stressful not only to the patients themselves but to the health care personnel themselves. Touching an animal alone has shown to reduce anxiety and increase calmness and a sense of well-being, especially in the late hours. A pet can "listen" and interact with an AD patient better than another human being, that is, without judging the patient. AAT is aimed at producing the complete well-being of this special population physically, socially and mentally. There are, however, relevant questions and concerns that must be clearly addressed about this intervention by further research (Cevizci et al.).

Dog Visitation Therapy in Dementia Care

This is one major research that bolsters the benefits derived by AD and dementia patients and other residents in care settings. These benefits include relaxation, reduced apathy, apathy and aggression, and lower blood pressure (Williams & Jennings, 2008). But much of the evidence available is merely verbal accounts and thus needs to be subjected to careful multidisciplinary planning and strict rules and procedures meant to protect the health and safety of the patients. As it is, there is a shortage of empirical research on pet therapy (Williams & Jennings).

Pet therapy has been known and practiced for a long time but has not been embedded into routine and complete care programs (Williams & Jennings, 2008). Possible barriers may include contraindications to the therapy,…

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