Regular Research Article
Animal-Assisted Therapy and Agitation and Depression in Nursing Home Residents with Dementia: A Matched Case–Control Trial

https://doi.org/10.1016/j.jagp.2013.03.004Get rights and content

Objectives

To investigate the efficacy of animal-assisted therapy (AAT) on symptoms of agitation/aggression and depression in nursing home residents with dementia in a randomized controlled trial. Previous studies have indicated that AAT has beneficial effects on neuropsychiatric symptoms in various psychiatric disorders but few studies have investigated the efficacy of AAT in patients suffering from dementia.

Methods

Of 65 nursing home residents with dementia (mean [standard deviation] age: 81.8 [9.2] years; mean Mini–Mental State Examination score: 7.1 [0.7]), 27 matched pairs (N = 54) were randomly assigned to either treatment as usual or treatment as usual combined with AAT, administered over 10 weekly sessions. Blinded raters assessed cognitive impairment with the Mini–Mental State Examination, presence of agitation/aggression with the Cohen-Mansfield Agitation Inventory, and depression with the Dementia Mood Assessment Scale at baseline and during a period of 4 weeks after AAT intervention.

Results

In the control group, symptoms of agitation/aggression and depression significantly increased over 10 weeks; in the intervention group, patients receiving combined treatment displayed constant frequency and severity of symptoms of agitation/aggression (F1,48 = 6.43; p <0.05) and depression (F1,48 = 26.54; p <0.001). Symptom amelioration did not occur in either group.

Conclusions

AAT is a promising option for the treatment of agitation/aggression and depression in patients with dementia. Our results suggest that AAT may delay progression of neuropsychiatric symptoms in demented nursing home residents. Further research is needed to determine its long-time effects.

Section snippets

Study Design and Subjects

This study is a substudy of a prospective cluster-cohort guideline implementation study in Berlin, Germany (Leuchtturm Projekt VIDEANT, funded by the German Ministry of Health, BMG, LT 44-076). Recruited from 18 nursing homes, all 75 patients met the following criteria: 1) had a sum score on the Mini–Mental State Examination (MMSE)33 <25; 2) fulfilled criteria for dementia of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV);34 3) duration of cognitive

Sample Characteristics

Baseline characteristics are presented in Table 1, Table 2. At baseline, the two groups were not significantly different in terms of age; gender; prescription of antipsychotics, antidepressants, mood stabilizers, and benzodiazepines; and CMAI total scores. The mean DMAS total scores were significantly higher in the intervention group than in the control group at baseline, and significantly more patients received antidementia agents in the control group. At baseline, 27 pairs (n = 54) were

Discussion

In our sample of elderly nursing home residents with mostly severe and very severe stages of dementia, we found that symptoms of agitation/aggression and depression remained on a constant level when combining AAT with TAU, compared with TAU only, in which agitation/aggression and depression increased over time. AAT seems to have helped some of the patients receiving combined therapy avoid developing more severe stages of these symptoms. The treatment groups did not differ significantly in their

Conclusions

To our knowledge, this clinical trial is the largest sample to date examining the effects of AAT on BPSD. Our results indicate that AAT is a promising option for treating symptoms of agitation/aggression and depression in elderly demented nursing home residents. Additional research is needed to determine middle- and long-term effects, although long-term effects might not be expected due to the natural course of cognitive decline, especially in more severely demented subjects. However, in these

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    Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.