Animal-Assisted Therapy as an Intervention for Older Adults: A Systematic Review and Meta-Analysis to Guide Evidence-Based Practice.

BACKGROUND: Animal-assisted therapy (AAT) can ameliorate diverse health problems in older adults. However, applications of AAT have been limited because of the lack of intervention guidelines for older adults. AIMS: This study aimed to explore applications of AAT to older adults, analyze its health effects, and provide evidence for future interventions. METHODS: A systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data were analyzed based on both a narrative synthesis and a meta-analysis specifically for depression. RESULTS: A total of 47 studies were selected for analysis. About 45% focused on older adults with diseases such as dementia, and 57.4% selected dog(s) as an intervention animal. About 34.0% delivered interventions once a week, and the behavioral outcome domain was the most frequently investigated. The meta-analysis showed that the effect sizes of the AAT group were -1.310 (95% CI [-1.900, -.721]). LINKING EVIDENCE TO ACTION: This review provides evidence for AAT as an intervention in the physiological, psychosocial, cognitive, and behavioral domains of older adults. When planning interventions for older adults, nurses should consider intended health outcomes, appropriate therapeutic animals, and the consequent intervention contents.

Influences of Animal-Assisted Therapy on Episodic Memory in Patients with Acquired Brain Injuries.

Animal-assisted therapy (AAT) is shown to be an effective method to foster neurorehabilitation. However, no studies investigate long-term effects of AAT in patients with acquired brain injuries. Therefore, the aim of this pilot study was to investigate if and how AAT affects long-term episodic memory using a mixed-method approach. Eight patients rated pictures of therapy sessions with and without animals that they attended two years ago. Wilcoxon tests calculated differences in patients' memory and experienced emotions between therapy sessions with or without animals. We also analyzed interviews of six of these patients with qualitative content analysis according to Mayring. Patients remembered therapy sessions in the presence of an animal significantly better and rated them as more positive compared to standard therapy sessions without animals (Z = -3.21, p = 0.002, g = 0.70; Z = -2.75, p = 0.006, g = 0.96). Qualitative data analysis resulted in a total of 23 categories. The most frequently addressed categories were "Positive emotions regarding animals" and "Good memory of animals". This pilot study provides first evidence that AAT might enhance episodic memory via positive emotions in patients with acquired brain injury.

Implementation of Assisted Therapy With Dogs in the Therapeutic Approach to People With Autistic Spectrum Disorder.

A holistic intervention is needed for individuals who suffer from autism spectrum disorders. Our objective was to work with these individuals in a multidisciplinary manner through the use of animal-assisted therapy, finding improvements in the experimental group as compared with the control group in the different evaluated areas.

Dog-assisted therapy in the dental clinic. Part B. Hazards and assessment of potential risks to the health and safety of the dental therapy dog.

Background: A dental therapy dog may help anxious patients in the dental clinic overcome their fear and facilitate the completion of necessary dental care. Dental clinic activities are associated with hazards that may pose potential risks to the health and safety of the dental therapy dog. Objectives: To describe potential hazards associated with risks to health and safety to therapy dogs in dental clinics and to present suggestions for risk minimisation by adopting best practices in dental clinic settings. Materials and method: Literature searches in Medline, http://Clinicaltrials.gov, and Google Scholar for qualitative and quantitative assessments of occupational hazards and risks in dental clinics, in combination with a review of the reference list of the included studies. Identified hazards and risks were analysed relative to their relevance for the health and welfare of a therapy dog present in a dental clinic setting. Results: Workplace hazards in the dental clinic that apply to both humans and therapy dogs are allergies, sharps injury, eye injury, stress, rhinitis, hearing impairment, and other hazards. Additional concerns associated with risks for the dental therapy dog are situations involving erratic patient behaviour and threats if the patient is an undisclosed disease carrier. Risks to the health and safety of the dental therapy dog in the clinics are present but are low if the dental clinical staff and dog handlers comply with best practices. Conclusions: Best practice includes awareness amongst the clinic staff and the dog handler of all potential hazards in the dental clinic and on how to reduce these hazards as well as adverse events that may scare the dental therapy dog. The dental therapy dog team must be specially trained to work in a dental clinic. Each treatment session has to be exclusively tailored to that specific appointment and the individual patient.

Dog-assisted therapy in the dental clinic: Part A-Hazards and assessment of potential risks to the health and safety of humans.

Background: Dog-assisted therapy in the dental clinic may be an attractive alternative to sedation for anxious patients. Including a dental therapy dog in a clinical setting introduces new hazards and potential risks to health and safety for both humans and animal. Objectives: The study aims to describe potential hazards associated with risks to humans by having a therapy dog present in the dental clinic and to provide guidance on best practices to minimise and control risks for the patients, the dentist, and the dental clinic staff. Materials and Methods: Literature searches in Medline, http://Clinicaltrials.gov, and Google Scholar for qualitative and quantitative assessments of hazards and risks associated with the use of therapy dogs in health care settings, in combination with a review of the reference list of the included studies. Identified hazards and risks were analysed with respect for the health and welfare of humans in a dental clinic setting that involves the presence of a therapy dog. Results: Potential risks to health and safety for humans in dental clinics that offer dog-assisted therapy can be categorised within four general categories of hazards: the dog as a source of zoonotic pathogens and human diseases, exposure to canine allergens, adverse animal behaviour, and dangers associated with high activity in a congested dental clinic operatory. Risks to humans are reduced by maintaining awareness amongst the dental clinic staff and the dog handler of all potential hazards in the dental clinic, and on how to reduce these hazards as well as adverse events that may scare the dental therapy dog. Conclusions: Risks to the health and safety of humans in the presence of therapy dog in the clinics are present but are low if the dental clinical staff and dog handlers comply with best practices.

Health Benefits and Risks of Pets in Nursing Homes: A Survey of Facilities in Ohio.

Pets are encountered in nursing homes and although they provide health benefits to individuals, they are also a source of health risks. The current study aimed to determine the frequency and types of animals in nursing homes, perceived benefits, and content of policies addressing health risks. Ninety-five administrators from unique nursing homes in Ohio completed an online survey addressing perceived benefits and risks of animals and policies in place. Animals were permitted in 99% of nursing homes, with dogs (95%), cats (85%), birds (71%), fish (55%), and farm animals (40%) most frequently reported. Respondents perceived animal interactions resulted in high health benefits for residents. Most facilities (70/75; 93%) reported having an animal policy, yet important gaps were frequently identified in the content of policies. Most respondents (75%) did not report health and safety concerns with animals in facilities. Best practice guidelines and policies should be developed and implemented in nursing homes to address requirements for different animal ownership models, range of animal species, and staff knowledge. [Journal of Gerontological Nursing, 44(5), 39-45.].

Who let the dogs out? Therapy dogs in clinical practice.

OBJECTIVES: Animal-assisted therapy (AAT) is a growing field in Australia, and therapy dogs are becoming increasingly common in clinical settings. This paper aims to highlight the current issues facing AAT in Australia and to make recommendations on how to progress the field. We acknowledge that there are several ways that therapy dogs may enhance treatment outcomes for clients, such as reductions in stress and acute anxious arousal, and improvements in engagement and rapport. These psychological and physiological advantages, however, may not be sustained once interaction with the dog ceases. Clinicians require adequate training and support to develop and implement interventions that are based on sound theoretical foundations, and take advantage of the adjunctive benefits of animal presence. CONCLUSIONS: A series of recommendations are made for the professionalisation of AAT, including the development of consensus definitions, clinical governance, accreditation, research and evaluation.

Animal-Assisted Therapy for Post-traumatic Stress Disorder: Lessons from "Case Reports" in Media Stories.

Post-traumatic stress disorder (PTSD) can follow war trauma, sexual abuse, other traumas, and even be experienced by commanders for the PTSD of their subordinates. Medications and counseling are sometimes not effective, so new treatments are needed. Some years ago, I suggested that animal-assisted therapy (AAT) (pet therapy) might be beneficial for PTSD. A large randomized controlled trial is underway of canine-assisted therapy for PTSD. Randomized controlled trials are most useful in assessing the efficacy of a medical intervention as these trials control for known and unknown biases. However, due to their very nature and rigorous requirements, knowledge gained from randomized controlled trials may need to be supplemented from other kinds of studies. Here, I note that media reports of AAT for PTSD may effectively function as case reports and suggest further studies: For PTSD, these demonstrate that (1) AAT can be dramatically effective in improving PTSD symptoms; (2) there is the potential for benefit from AAT by multiple different animals besides canines for PTSD; and (3) AAT may have a role in preventing suicide in patients with PTSD.

Animal-assisted therapy at a University Centre for Palliative Medicine - a qualitative content analysis of patient records.

BACKGROUND: Animal-assisted therapy (AAT) is a therapeutic concept, which has only recently been explored in more detail within the palliative care setting. A programme of AAT was begun in June 2014 at the Interdisciplinary Centre for Palliative Medicine of the University Hospital Dusseldorf, Germany. The AAT sessions were performed by two trained and certified dog assistant therapy teams (DATT). To date only very limited scientific data are available with regard to feasibility, therapeutic indications and efficacy of AAT in palliative care. The present qualitative study aims to describe the first year's practice and experience of AAT after implementation as an integral part of adjunctive therapy options offered within an academic palliative care centre. METHODS: This study is a qualitative content analysis of all post-encounter protocols of AAT interventions recorded by the dog handlers from June 2014 through May 2015. Qualitative content analysis was conducted according to Mayring's approach; the report followed the recommendations of the Standards for Reporting Qualitative Research (SRQR). RESULTS: Fifty-two patients received 84 AAT interventions, with only 18 patients receiving more than one intervention due to discharge or death. In 19 cases relatives also participated in the AAT session. The inductive coding process yielded four main categories. One hundred and fifty-three codes related to the content and structure of the AAT sessions, with physical contact with the dog taking considerable precedence. The AAT sessions included conversations with the dog handler, 10.5% of which related to the current health state as well as to discussions around death and dying. Eighty-nine codes related to perceived emotional responses, with pleasure being the most often observed response. Two hundred and seventeen codes related to the effects of the AAT sessions, identifying the dog as a catalyst of communication and observing patients' physical activation or relaxation. CONCLUSIONS: AAT may constitute a valuable and practicable adjunct to the interdisciplinary therapeutic repertoire of palliative care in the hospital setting. The results of this study suggest that patients may potentially benefit from AAT in terms of facilitated communication, positive emotional responses, enhanced physical relaxation or motivation for physical activation. These early stage results will need to be followed-up by more robust study designs.

Terapia asistida con perros en niños y adolescentes / Dog assisted therapy in children and adolescents

El presente trabajo revisa los múltiples beneficios de la terapia asistida con animales, desde sus orígenes a la actualidad. Se exponen los requisitos y características de la terapia asistida con perros en pacientes pediátricos crónicos. Finalmente, se defiende la utilidad de la creación e implementación de la terapia asistida con perros en hospitales (AU)

This paper reviews the multiple benefits of animal assisted therapy since its inception to the present. The requirements and characteristics of dog assisted therapy with chronic pediatric patient are described. Finally, this work defends the utility of the creation and implementation of dog assisted therapy in hospitals (AU)

Terapia asistida con perros en pacientes con demencia y SPCd institucional en el centro residenciales de Toledo, España / No disponible

Los síntomas psicológicos y conductuales de la demencia (SPCD) generan un sufrimiento sobreañadido en el anciano y en el cuidador, agravan el deterioro cognitivo y funcional y precipitan la institucionalización del anciano (1,2). En los últimos años se ha investigado acerca de La Terapia Asistida con Animales de Compañía (TAAC) como terapia no farmacológica para el control dichos síntomas, demostrando ser una buena alternativa coste- efectiva para el tratamiento. El presente estudio valora la efectividad de la terapia para el control de síntomas conductuales en pacientes con Demencia institucionalizados. Se realizó un estudio prospectivo, multicéntrico, de manera simultánea en 2 residencias de la Provincia de Toledo, con un total de 36 pacientes, 24 con deterioro cognitivo moderado-severo y SPCD, y 12 pacientes sin demencia con trastornos afectivos. De forma aleatorizada se distribuyeron los pacientes con demencia en un grupo de intervención con TAAC (12) y un grupo control sin TAAC (12), además del grupo de sanos (12). La intervención consistía en 16 sesiones, 2 sesiones cada semana de 35 minutos de duración. La medición se realizó con las escalas de MMSE, Barthel Modificado, Cornell, Quality Scale, NPI y MOPI, antes de iniciar las terapias y al finalizar las sesiones. La terapia asistida con animales resultó eficaz tras reducir agitación y agresividad según la puntuación de NPI (P0.004) y mejoró la calidad de vida según la escala Quality of Life (P 0,004), de los pacientes con TAAC

The psychological and behavioral symptoms of dementia (SPCD) generate additional suffering in the elderly and caregiver, exacerbate cognitive and functional impairment and precipitate the institutionalization of the elderly (1,2). In recent years, research has been conducted in Animal-Assisted Therapy (AAT) as a non-drug therapy to control the symptoms, proving to be a good cost-effective alternative for treatment. Our study aims to assess the effectiveness of therapy to control behavioral symptoms [RR1] in institutionalized patients with dementia. A prospective multicenter study is performed simultaneously at two residences in the province of Toledo, with a total of 36 patients, 24 with moderate-severe cognitive impairment and SPCD, and 12 patients without dementia and affective disorders. Dementia patients were randomly divided into an intervention group with TAAC (12) and a control group without AAT (12), besides the healthy group (12). The intervention consisted of 16 sessions, 2 sessions per week for 35 minutes in duration. The measurement was performed with MMSE scales, Modified Barthel, Cornell, Quality Scale, NPI and MOPI before starting the therapies and at the end of the sessions. The animal-assisted therapy was effective after reducing agitation and aggressiveness according to an NPI score (P0.004) and improved quality of life according to the Quality of Life Scale (P 0.004), for the patients with AAT

Efectos de la terapia asistida con animales en personas con daño cerebral o lesión medular / Effects of animal assisted therapy in people with brain damage or spinal cord injury

Objetivo: Valorar los efectos terapéuticos obtenidos al aplicar un programa de terapia asistida con animales (TAA) en personas con daño cerebral o lesión medular. Material y método: Se realizó un estudio longitudinal prospectivo cuasi experimental en una población de 30 pacientes con diagnostico de daño cerebral o lesión medular. La selección se realizó mediante muestreo no probabilístico de conveniencia. Se dividieron en cinco grupos según criterios de edad. La duración del estudio fue de 16 meses, realizándose 23 sesiones de grupo, de 90 minutos de duración, durante los primeros nueve meses del estudio. Tres pacientes se perdieron durante el seguimiento. Para la evaluación se utilizó la Batería cognitiva LOTCA, el Índice de Barthel y la escala COPM. Resultados: En la valoración final, todos los pacientes mejoraron o se mantuvieron estables respecto a la valoración inicial. La evaluación COPM fue de 8,42±2,59 para la importancia, de 8,17±2,41 para el desempeño y de 8,96±2,07 en satisfacción. La valoración cognitiva mejoró en el 33% de los pacientes y la independencia funcional en el 37%. Conclusiones: La TAA puede servir como Técnica No Farmacológica (TNF) en los procesos de rehabilitación de las personas afectadas por patologías neurológicas (AU)

Objective: To evaluate the effects of animal assisted therapy (AAT) in a brain damaged or spinal injury population. Material and method: A prospective longitudinal study was undertaken on 30 patients with diagnosis of brain damage or spinal injury selected under non probabilistic accidental sampling, five groups were made according to patients age. A total of 23 sessions of AAT, 90 minutes long, were performed. Study period was 16 months, with therapy taking place in the first nine months. Three patients were lost in the follow up. Evaluation was performed using LOTCA cognitive battery test, Barthel index and COPM scale. Results: All patients showed improvement or no change according to initial evaluation. COPM evaluation were 8,42±2,59 for importance, 8,17±2,41 for performance, and 8,96±2,07 for satisfaction. Evaluation ranges from 1 to 10. Improvement was found in 33% of the patients for cognitive evaluation, and in 37% for functional independence evaluation showed improvement in most of the patients. Conclusion: AAT can be useful as non-pharmacological therapy in the rehabilitation process of neurological affected (AU)

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

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.

Service dogs. Final rule.

The Department of Veterans Affairs (VA) amends its regulations concerning veterans in need of service dogs. Under this final rule, VA will provide to veterans with visual, hearing, or mobility impairments benefits to support the use of a service dog as part of the management of such impairments. The benefits include assistance with veterinary care, travel benefits associated with obtaining and training a dog, and the provision, maintenance, and replacement of hardware required for the dog to perform the tasks necessary to assist such veterans.