ReviewAnimal-assisted interventions for elderly patients affected by dementia or psychiatric disorders: A review
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.
Section snippets
Search strategy and selection criteria
The US National Library of Medicine National Institute of Health (www.pubmed.org), Embase, PsycINFO, were resourced to identify original publications describing the effects of AAI in the elderly with Dementia or Psychiatric Diseases. Since there is no full agreement in literature on the more appropriate terminology to define the therapeutic use of animals, we included the following search terms: “Animal Assisted Interventions”/“Animal Assisted Activities”/“Animal Assisted Therapy”/”Pet-Therapy”
Results
The search retrieved 56 original articles and three reviews (selection procedure shown in Fig. 1). We excluded 47 articles, because they were not relevant to our purpose (reports on uncontrolled and/or informal observations, studies on inpatients without mental diseases or descriptive articles; see Fig. 1).
We found 9 articles examining AAI effects in elderly patients with mental diseases. Out of 9 articles, 6 studies were conducted with patients presenting Dementia, 3 on persons with
Discussion
Most of the studies examined found AAI to be effective on patients with Dementia, although evidence supporting the use of AAI in elderly affected by Psychiatric Disorders was less clear.
With regards to patients with Dementia seven of the ten studies investigating the effects of AAI on BPSD demonstrated favourable results. AAI effects on Mood Disorders were investigated by six studies, four of which showed positive results. Null AAI cognition effects were observed. Positive results on other
Contributors
V. Bernabei conceptualized this analysis and wrote the paper; A.R. Atti, F. Moretti and D. DeRonchi assisted with conceptualization of the work and writing the paper; and B. Ferrari, M. Forlani, T. La Ferla and L. Tonelli assisted with writing the paper.
Funding source
None.
Conflict of interest
None.
Acknowledgement
We are grateful to all colleagues of the Institute of psychiatry in Bologna “P. Ottonello”.
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