Potential health benefits of pets for older adults findings from the pet assisted living study.ppt
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Transcript of Potential health benefits of pets for older adults findings from the pet assisted living study.ppt
Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016
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
Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016
DISCLOSURE(S)
• Research Support: [Friedmann - ISAZ/WALTHAM Collaborative Research Award]
• Consultant: [Gee - WALTHAM]
• Discussion of Off-Label, Investigational, or Experimental Drug Use: [None]
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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
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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
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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
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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
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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.
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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.
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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
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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
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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
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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
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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)
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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)
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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.
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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.
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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.
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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
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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
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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)
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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
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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.
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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
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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)
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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
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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)
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Months after Start of Study0 1 2 3
Activ
ity k
Cal
s
10
20
30
40
50
60
70
80
90
Dog Group (n = 22)Reminiscing Group (n=18)
Results
• Physical Function: Physical Activity
K Cals per 24 hours (Ms & SEMs)
(Interaction NS)
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Months after Start of Study0 1 2 3
Bar
thel
Sco
re
50
55
60
65
70
75
80
85
Dog Group (n = 22)Reminiscing Group (n=18)
Results
• Physical Function: Activities of Daily Living
(higher is better)
(Interaction p < .10)
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Behavioral Results
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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
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Correlations
Between average activities, baseline MMSE score, change in physical activity and change in depression
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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
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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
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Funded by ISAZ/WALTHAM®
Collaborative Research Award