Study on the Effects of Dog-Assisted Therapies on Physical and Psychological Well-Being in the Institutionalized Elderly

Project location: ITALY, Rome
Project start date: December 2008 - Project end date: December 2009
Project number: 2008-23
Beneficiary: ANUCSS



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 Timeline of the present  report: From December 2008 to May 2009

Pet therapy is a goal-directed intervention designed to improve human physical, social, emotional and cognitive functioning using animals as co-therapists. The elderly population is highly sensitive to change and loss. Aging is a peculiar stage of life which makes the individual vulnerable to pathological relapses and deterioration in somatic, psychic and the overall quality of life. Separations from the family - as in the case of rest home residents - and marginalization and isolation that often stem from institutionalization can represent important risk-factors for depression and other diseases.
The aim of this study was to assess whether a Pet therapy program has a beneficial effect on the psychological well-being, particularly on aspects related to depressive symptoms and perception of quality of life, in the cognitively intact, institutionalized elderly.
More specifically, the main objectives of the study were:
i) Assess the impact of dog-assisted therapies in an institutionalized elderly population recruited in nursing homes in Rome by means of objective neuropsychological and physiological measurements of the subject's well-being with a special reference to psychological and physiological measures of stress (using non-invasive methodologies).
ii) Promote and implement new methodologies for the care of the institutionalized elderly to reduce their isolation, improve their social life, their attention abilities and their residual abilities. Informed consent from the patients and approval by the ISS Ethical Committee has been sought.

The project was developed in two nursing homes in Rome (Parco delle Rose e Istituto San Michele). In the initial phases of the project a number of meetings with the resident physicians, nurses and psychologists have been conducted to agree on the intervention protocols and coordinate the ISS activities of the dog-pet operators couples. During these meetings the patients have been selected, also on the basis of their ability to actively being engaged in the therapies. Following the selection, all recruited subjects have been familiarized with the dogs. Those subjects who did not feel confident in dealing with the animals were not included in the project. Informed consent was collected from all subjects before starting the therapy sessions. These were conducted twice per week and consisted of a socialization session. In the San Michele RSA, in addition to the socialization session, in a group of elderly the dog has been introduced in the physical therapy session. All therapy sessions have been videotaped and a specific ethogram of interaction between dog and patient has been developed to evaluate the efficacy of the therapy over time. In addition, changes in physiological parameters are currently being assessed, such as stress hormones, resulting from the therapies, and other work includes correlating these data with a general assessment of mental and physical abilities of subjects participating in the project, comparing them with other residents of the nursing home not involved in the therapies. In addition, all elderly subjects were administered specific questionnaires to assess the effectiveness of the intervention program with the dogs on their overall cognitive and emotional well being and the levels of stress hormones in their saliva measured.
All residents were happy and curious to participate in the project and to interact with the dogs. The daily activities, often conducted without enthusiasm or even with boredom have been enlightened by the opportunity to take part in the therapies. The presence of the dogs was extremely motivating. This was particularly so in the case of the subjects undergoing their physical therapy session. The presence of a dog helped them to find the strength to leave their rooms and go to the gym. During the therapy, the dog was a positive motivator to walk or move and allowed the subject not to pay too much attention to their difficulties and to their handicap.

In the socialization sessions, the activities performed with the dog have been extremely successful and engaging. So much so that, in some instances, also those who had not been included in the therapy asked to participate and pressed the operators to be enrolled in the study. The presence of the dog is a source of stimulation, pleasure and fun. The operators make sure that, among the many types of interaction, the participants feed the dogs and brush them slowly. This, together with throwing the ball, is a particularly important activity, especially for those who have difficulties moving their arms or hands, since it stimulates these patients also physically. Most importantly, however, these sessions are a fundamental occasion for elderly individuals to meet with the others and socialize in a structured way. The presence of a dog increases responsiveness, facilitates mental alertness, and enhances an outward focus on the environment. The atmosphere in the presence of dogs becomes fresh and colored favoring positive thinking also in those subjects that have a tendency to be more isolated and that show a depressed mood. Indeed, this activity is able to stimulate cognitive functions in those elderly subjects which are characterized by a certain degree of dementia, reducing the sense of isolation often characterizing subjects living for long periods in nursing homes.

Each encounter lasted about 2 hours. While it had been planned to include the presence of a single couple dog-operator jointly with a psychologist specialized in Activities and Therapies performed with animals, a second couple of dog-operator and two more psychologists have been used in order to keep up the great participation, much greater than expected. Indeed, in some cases it has been difficult to prevent the participation of some elderly that had not been formally enrolled in the project.
In some cases, the sessions have been conducted also in the presence of the relatives, who were very interested in understanding and participating in the socialization sessions. This seemed an important part of the project because it made the subjects even more willing to participate and informed the families on their activities and resulted in a very positive feedback both for the operators and the participants.

The results of the Project were presented in the Course "Terapie e Attività Assistite in Italia: attualità, prospettive e proposta di linee guida" organized at the Istituto Superiore di Sanità on November 18-19.2009. Results are also published on the ISS WEB page and on the ( WEB site.

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