Animal-assisted interventions for elderly patients affected by dementia or psychiatric disorders: A review

Abstract

Objective

The aim of this literature review was to assess the effects of Animal-Assisted Interventions (AAI) on elderly patients with dementia or various psychiatric disorders.

Methods

We conducted a comprehensive literature search using the online PubMed network of the US National Library of Medicine & National Institutes of Health, Embase, PsycINFO, with the purpose of investigating AAI effects on cognitive functions, mood, and behaviour.

Results

A total of 18 articles on dementia and 5 on psychiatric disorders were included in the present review. AAI were found to have positive influences on demented patients by reducing degree of agitation and by improving degree and quality of social interaction. Few studies have assessed the effects of AAI on mood, and even fewer have assessed its consequences on cognitive functions. The results that are available indicate a positive effect on communication and coping ability, but none on cognitive performance. A substitute pet robot yielded encouraging results, but its use requires further investigation.

The few studies conducted for elderly patients presenting a variety of psychiatric diagnoses produced controversial findings.

Conclusions

In spite of the encouraging results of AAI, much more research examining the issue of optimal AAI duration, frequency of sessions, and suitable target group is needed.

Introduction

Domestic animals were found to increase patient self-control, play an “emotional mediator” role, and serve as “social facilitator” and “catalyst” for social interaction (Wilson and Netting, 1983). These observational data were further confirmed by experimental studies showing higher neurochemical levels associated with attention-seeking behaviours during positive human–animal interaction (Odendaal, 2000).

The purposeful use of animals as an aid in treating mental and physical health disorders dates back to 1792. Animal-assisted interventions (AAI) include animal-assisted activities (AAA), animal-assisted therapy (AAT), and service animal programs (SAP) (Muñoz Lasa et al., 2011). Given the lack of agreement on the terminology (Kruger and Serpell, 2006), in the present article we adopt the broadest concept of AAI as the result of teamwork involving various types of expertise (Khan and Farrag, 2000; Banks et al., 2008; Williams and Jenkins, 2008). AAI have several important applications (Ballarini, 2003) in activities conducted with single individuals or groups and with either real animals or robotic pets. The most frequently employed animals in this approach are dogs, given their training potential and typically social nature (Jofre, 2005).

Not only do animals keep people company (Ryder, 1985), but they also enhance their health status (McNicholas et al., 2005; Edwards and Beck, 2002; Halm, 2008), provide sensory stimulation and emotional support, and a sense of physical and psychological well-being thereby (Jofre, 2005).

More recent research in the field has investigated the healthy effects of animals on people suffering from psychological distress or somatic diseases, including both sub-acute and chronic disorders (Stasi et al., 2004). For example, a case–control study examining 30 adult out patients with mild to moderate depression showed a greater reduction in depressive symptoms in the group exposed to AAI, as compared to the control group (Antonioli and Reveley, 2005). AAI positively impact patients' degree and quality of socialization and can produce a variety of psychological benefits (Rossetti and King, 2010). It has also been found to be useful in the rehabilitation of schizophrenic patients living in institutional settings (Kovacs et al., 2004). Moreover, AAI may have a useful role in psychiatric and medical procedures that are anxiety-inducing or have negative socially perceived connotations, such as Electro-Convulsive Therapy (Barker et al., 2003).

Older persons are frequently burdened by high co-morbidity and poly-pharmacological treatment, and are more likely to experience severe disability and/or institutionalization, which may lead to a poorer quality of life. In elderly individuals receiving assistance in long-term care settings, AAI increase verbal interactions and socialization (Fick, 1993) and alleviate participants' feeling of loneliness (Calvert, 1989; Banks et al., 2008). Indeed, treatments based on affective-emotional motivation and psychological stimulation are particularly suitable for individuals suffering the co-occurrence of cognitive disturbances, mood disorders, anxiety, and psychotic symptoms in later life.

AAI present no specific age limits but the most of the available data refer to children/adolescents or adults. Conversely, the amount of data on elderly, especially with mental disorders, is scant. Furthermore, the available literature review on AAI are not systematic (Rossetti and King, 2010; Cozza et al., 1994), refer to children/young persons (Barker and Wolen, 2008; Friedmann and Son, 2009; Cirulli et al., 2011; Endenburg and van Lith, 2011; Muñoz Lasa et al., 2011), are not up-dated (Natoli, 1997; Dossey, 1997) or have narrow inclusion/exclusion criteria (Shibata and Wada, 2011; Filan and Llewellyn-Jones, 2006).

The purpose of the present work was to review the current literature concerning the beneficial and (if any) harmful effects of AAI in elderly patients affected by Dementia or Psychiatric Disorders.