Dog-assisted therapy for older people with dementia

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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.).

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, such as patients' lack of interest, fear or allergy to the animal or a medical condition averse to the animal's presence. Nonetheless, available evidence underscores its significant influence over the psychological well-being of older people in the community or institutions as a companion (Williams & Jennings).

Attendance in Adult Day Care Centers of Cognitively Intact Older Persons

This research conducted interviews and a structured questionnaire in exploring the reasons for the non-use of adult day care centers or ADCCs and the reason for their use by those at those centers (Iecovich & Biderman, 2013). Sample populations were 819, 417 of whom are users of ADCCs and 402 are non-users in the southern region of Israel.

Results showed that the most common reasons for not using ADCCs were accessibility barriers, characteristics of the participants and of the ADCCs, lack of need for the service, and personal difficulties. Users said it improved their well-being, met their needs, allowed them to build social relationships, and reduced the burden of family caregivers. ACDDCs were found to be more responsive to the needs of weak older adults and more accessible to those who were non-users (Jecovich & Biderman).

The study recommended the promotion of ADCC programs and eliminating barriers to allow frail older adults to access available services from the programs (Jecovich & Biderman, 2013). Special focus should be made to those isolated in their homes, those who spend many hours outside outdoor and those living alone. Those who really need home help but cannot afford the costs should be provided the service and visits, not as alternative. For non-users, ADCC should shift from a social model to a more balanced model with health care components attuned to socialization and health problems of the more disabled and chronically ill. And those who prefer to stay at home will be better served by health promotion activities (Iecovich & Biderman).

A Day Care Program and Evaluation of AAT for the Elderly with Senile Dementia

A survey was conducted to clarify the AAT evaluation methods for elderly patients with senile dementia in a particular ADDC (Kamanori et al., 2001). An AAT group of seven subjects and a control group of 20 underwent therapy for six bi-weekly sessions. Findings disclosed the usefulness of many AAT methods for evaluating the changes of patients who received the therapy (Kamanori et al.).

AAT and similar therapeutic activities are assumed to be efficacious psychosocial approaches in managing dementia (Kamanori et al., 2001). But these assumptions are mainly subjective attestations of personal experience and staff responses. Some quantitative researches found a decrease in the patients' problem behavior related to dementia. These researches, however, were conducted on single AAT sessions only. The two kinds of effects produced by AAT are the short-term and the long-term effects. Short-term effects include an expression of an emotion, voluntary activities and concern for others while in contact with an animal. Long-term effects include changes in their daily life after the AAT session. There is need to objectively assess the specific changes of both types and the patients' attitude towards the animal. The assessment methods should be investigated for the widespread use of AAT (Kamanatori et al.).