Potential health benefits of pets for older adults findings from the pet assisted living study.ppt

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Potential Health Benefits of Pets for Older Adults: Findings from the Pet Assisted Living (PAL) Study

Human-Animal Interaction and Healthy Aging SymposiumGSA Annual Scientific Meeting, Nov 16-20th, 2016

Nancy R. Gee1, Erika Friedmann2 & Elizabeth Galik2

1WALTHAM; 2University of Maryland


DISCLOSURE(S)

• Research Support: [Friedmann - ISAZ/WALTHAM Collaborative Research Award]

• Consultant: [Gee - WALTHAM]

• Discussion of Off-Label, Investigational, or Experimental Drug Use: [None]


Potential Health Benefits for Older Adults: Findings from the Pet Assisted Living Study

• Nancy R. Gee, PhDState University of New York, Fredonia & WALTHAM

• Erika Friedmann, PhDBeth Galik, PhDUniversity of MarylandSchool of Nursing


What is the Human-Animal Bond?

…a mutually beneficial and dynamic relationship between people and other animals that is influenced by behaviours that are essential to the health and well-being of both

Definition of the Human-CompanionAnimal Bond (HCAB) taken from theAmerican Veterinary Medical Association (AVMA) 2006


An enduring and important relationship…

• 7.5 M cats• 8.5 M dogsUK• 60+ M cats• 66+ M dogsEU• 2/3 of all homes

include a petUS• 7 M cats• 6.4 M dogsCA

U.S. children are more

likely to grow up with a

pet than a father

Pompeii Mosaic 79 AD

Ancient Cave Painting


Plan for Part I…• Theoretical basis of the bond• Evidence related to the impact on older

adults of interacting with companion animals

– Psychological• Depression

• Anxiety

• Loneliness

• Social functioning

– Physical: Heart Health & Exercise

• Brief evaluation of the evidence• Intervention Study Example

– Pet Assisted Living Study Methodology– Results & Conclusions

• Part II – Dr. Mueller’s presentation will focus on the impact of pet ownership


Theoretical Basis of the Bond

• Neoteny (Beck & Katcher, 1999)

– Retention by adults of juvenile traits– Selective breeding of domestic dog for

specific traits:• Large eyes, rounded forehead, large

ears, shortened muzzle

• Biophilia hypothesis (Wilson, 1984)

– Instinctive bond between human beings and other living systems.


Theoretical Basis of the Bond

• Attachment Theory (Bowlby 1969, 1980)

– Human need to protect and be protected – maintain close proximity to others in order to better cope with the world.

• Social Support (Cohen & Wills, 1985)

– Perception and reality that one is cared for, is part of a supportive social network and has access to supportive resources (e.g., companionship, nurturance.

– Serves a protective function from the adverse effects of stressors.


Theoretical Basis of Health Outcomes from the Bond

• BioPsychoSocial - individual level (Engel, 1997, 1980)

– Disease outcomes result from a complex interaction of biological factors (e.g., biochemical, genetic), psychological factors (e.g., personality, behavior) and social factors (e.g., culture, family).

• Social-Ecological Model – community/policy level (Brofenbrenner, 1979)

– Understanding of human development must be considered within the context of the entire ecological system in which growth occurs.

– Network of interactions among:• Microsystem: interactions with immediate surroundings (e.g., family)• Mesosystem: interactions among the systems (e.g., interactions

between church and neighborhood)• Exosystem: social, political and economic conditions• Macrosystem: cultural values, customs and laws


The Evidence – intervention studies

• Emerging evidence indicates that for older adults interacting with companion animals:

• Reduces:– Depression – Anxiety– Loneliness

• Increases:– Social Functioning– Physical Health & Exercise


Reducing Depression

• Cognitively unimpaired institutionalized older adults (Colombo, et al 2006)

– N = 144 - randomly assigned to receive:• Canary, plant, or nothing (control) for 3 months

– Depression and anxiety (measured by the Brief Symptom Inventory)

• Canary group significant reduction relative to plant and control groups

• Residents of aged care facilities – with dementia (Travers, et al 2013)

– N = 55 RCT– 11 week intervention (dog-assisted therapy vs

human therapist)– Dog assisted intervention resulted in significant

improvements in:• Depression scores • Quality of life scores


Reducing Depression

• AL residents (65 years and older) using wheelchairs or walkers (LeRoux & Kemp, 2009)

– N = 16 randomly assigned:• AAA (involving a dog) or Control (not defined)

– Dog group - significant decrease Pre to Post intervention on depression as measured by the Beck Depression Inventory.

• AAA not significantly different from Control

• Pet therapy (6 weeks) was effective in reducing depression among older patients with mental illness (Moretti, et a., 2011)

– Pet therapy group N=10 vs Control group N=11– Both groups improved from pre to post test– 50% reduction in Geriatric Depression Scale (GDS) for pet

group


Reducing Depression – Meta-Analyses

• AAA/AAT associated with fewer depressive symptoms (Souter & Miller, 2007)

– Inclusion criteria: random assignment, appropriate control/comparison

– 5 studies identified– Aggregate effect size = medium and

significant

• Similar results (Virues-Ortega et al, 2012)

– AAT - moderately effective in reducing depression (d = -.34)


Reducing Anxiety

• AAA with Alzheimer’s patients in Daycare setting (Mossello, et al., 2011)

– Repeated measures design (2 week pre-intervention, 3 weeks plush toy, and 3 weeks with dog)

– Dog intervention:• Decrease in anxiety and sadness and an increase in physical activity• Effects apparent immediately and 3 hours later

• Similar results with – AAA in patients hospitalized with heart failure (Cole, et al., 2007)

– AAA in older adult residents of a long-term care facility (LeRoux & Kemp, 2009)


Decreasing Loneliness

• AAT in long-term care facilities (Banks & Banks, 2002)

– N = 45 (15 – no AAT, 15 – AAT once/week, 15 – AAT three times/week

– UCLA loneliness scale– AAT significantly reduced loneliness scores in comparison to

the no AAT group.

• AAT: A 6 month dog companionship program - interaction with a dog three times/week (Vrbanac, et al, 2013)

– N = 21 (pre-test/posttest)– Used the short form of the UCLA loneliness scale– Significant reduction in loneliness from pre to post-test.– Most participants reported improved quality of life and mood,

and demonstrated increased physical activity and social interaction.


Improving Social Functioning

• AAA with dogs produced significantly higher interactions than photographic interaction (both were higher than the control) among older psychiatric patients (Haughie et al, 1992)

• AAT with Dementia patients (ABAB design) resulted in a significantly increase in social behaviors and a corresponding decrease agitated behaviors (Sellers, 2005)

• Dogs and dog related stimuli appear to get dementia patients to engage/interact (Marx, et al, 2010)

– Puppy video, real dog, dog color activity were all equally good at eliciting engagement behaviors.

• Meta-analysis (Virues-Ortega et al, 2012)

– AAT improved social functioning (pooled effect size = 1.06)– Effects were larger in individuals with psychiatric conditions.


Increasing Physical Health & Exercise

• AL residents who walked with a dog walked farther than when they walked alone (Herbert & Greene, 2001)

• Parasympathetic neural activity as measured by HF Power values of Heart Rate Variability (HRV) increased significantly for healthy older adults when (Motooka et al, 2006):

– They were walking a dog compared to walking without the dog.– They were home with the dog compared to when they were at their

home without the dog.

• Gait retraining following a stroke was improved by working with a rehabilitation dog (Rondeau, et al, 2010).

– Walking speed significantly increased after training with the dog.– Patients gait pattern improved and walking speed was faster with the

rehabilitation dog than when using a cane.


Evaluation of existing evidence

Preponderance of evidence (not all)• Lacks standardized measures• Short term impact (lack of longitudinal

designs)• Small sample sizes• Animals/animal interaction not well

described• Pet ownership history/involvement not

included


Example Intervention Study

Pet Assisted Living Study – addresses concerns• The functional status of older adults with dementia who

reside in assisted living facilities deteriorates quickly – Often leads to movement to nursing homes

Purpose:• Evaluate the use of structured activities with a dog to

prevent deterioration in function in AL residents with dementia


PAL Design

Participants: Assisted Living Residents with mild to moderate dementia

Inclusion Criteria• Mild to moderate cognitive impairment (MMSE score > 11)

• Age > 55 years

• Anticipated LOS >= 6 months

• English speaking

• Prior experience with or interest in interacting with a dog

Exclusion Criteria• Known allergies to dogs

• Known fear of dogs

• Physical illness exacerbated in the presence of furry animals

• Expected survival < 6 months (hospice care)


PAL Design

• Recruited from 7 Facilities

Recruitment• Informed Consent from LAR• Assent from Residents

Random Assignment of Facilities to Interventions• Dog Activities (4 facilities) • Reminiscing (3 facilities)

Intervention• 60-90 min sessions 2 X per week for 12 weeks


PAL DesignPAL (dog) Intervention

Skills taught/reinforced:• ADLs – feeding the dog, brushing the dog’s teeth, walking the dog,

dressing the dog in a bandana, brushing the dog’s hair; • range of motion – throwing a ball, grooming the dog, • small motor skills – attaching a leash, adjusting a collar,• hand feeding a treat, petting the dog; • sequencing events –opening a container of treats and then giving

the dog a treat; • social skills – talking to the dog, talking about the dog to another

person, giving the dog commands, petting the dog; • large motor skills – taking the dog for a walk, teaching the dog to

walk on the leash, teaching/practicing commands.


PAL Design

Reminiscing Intervention• Attentional control intervention – equal amount of attention from the

interventionist and on the same schedule as the PAL intervention

Skills taught/reinforced:• Social skills – talking to the researcher and other residents; • Small motor skills – picking up pictures and showing them to others

Both PAL and Reminiscing interventions:• Conducted in group living room environment• Each participant was encouraged to interact

http://www.crystalgraphics.com/powerpictures/Image.Search.Details.asp?product=cg5p644492c


PAL Design

Functional Assessments • 0, 4, 8, 12 weeks

Behavioral Function• Agitation (Cohen-Mansfield Agitation Inventory)

Emotional Function• Apathy (Apathy Evaluation Scale)• Depression (Cornell Scale for Depression in Dementia)

Physical Function• Activities of Daily Living (Barthel)• Physical movement (actigraph)


Participants

• Ages 56 to 95 years (M=81, SD=9.1)• Education 7- 20 years (M=13, SD=7.2)• Male 28%• Minority 5%• Married 20%• Diagnosed dementia 65%

• PAL N=22; Reminiscing N= 18

• No significant differences in demographics between the two groups


Results• Emotional Function: Depression

(lower is better)

Months after Start of Study0 1 2 3

Dep

ress

ion

4

5

6

7

8

9

10

11

Dog Group (n = 22)Reminiscing Group (n=18)

Initial 3 Months Initial 3 Months

Perc

ent D

epre

ssed

0

20

40

60

80

Reminiscing n = 18Dog n=22

Depression Major Depression

p = .065

p = .030

(Interaction p < .05)



Activ

ity k

Cal

s

10

20

30

40

50

60

70

80

90


Results

• Physical Function: Physical Activity

K Cals per 24 hours (Ms & SEMs)

(Interaction NS)



Bar

thel

Sco

re

50

55

60

65

70

75

80

85


Results

• Physical Function: Activities of Daily Living

(higher is better)

(Interaction p < .10)


Behavioral Results


Correlations

• Looking at the dog - not correlated with other behaviors• Touching - correlated with talking to the dog• Treating - correlated with talking to and touching the dog• Brushing - correlated with talking to, touching, and treating the dog• Walking with the dog - correlated with treating the dog


Correlations

Between average activities, baseline MMSE score, change in physical activity and change in depression


General Conclusions

• Evidence that the PAL program may be effective for preserving/enhancing function in residents of Assisted Living with mild to moderate dementia

• Considerable variability in function and in responses of residents

• Require further study to evaluate the duration of the effect

• Require further study to evaluate predictors of effectiveness for each type of function


Conclusions – Behavioral Analysis

• Participation in behaviors with the dog differed between participants, and between sessions

• Engagement in behaviors with the dog was linked to a to 12 week improvement in depression and physical activity

• Cognitive status did not predict behavior or improvement in depression or physical activity

• Touching the dog was not related to improvement• Assessment of behaviors during interventions may

enable evaluation of behaviors that predict target outcomes and personalization of activities for outcomes and individuals


Funded by ISAZ/WALTHAM®

Collaborative Research Award

Potential health benefits of pets for older adults findings from the pet assisted living study.ppt

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