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Potential health benefits of pets for older adults findings from the pet assisted living study.ppt

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Study by Nancy R. Gee (WALTHAM/Cornell), Erika Friedmann & Elizabeth Galik (University of Maryland) showing positive benefits of pet assisted living in older adults with mild to moderate dementia. Presented at Gerontological Society of America Annual Scientific Meeting November 2016.

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Potential health benefits of pets for older adults findings from the pet assisted living study.ppt

  1. 1. Potential Health Benefits of Pets for Older Adults: Findings from the Pet Assisted Living (PAL) Study Human-Animal Interaction and Healthy Aging Symposium GSA 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
  2. 2. 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]
  3. 3. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 Potential Health Benefits for Older Adults: Findings from the Pet Assisted Living Study • Nancy R. Gee, PhD State University of New York, Fredonia & WALTHAM • Erika Friedmann, PhD Beth Galik, PhD University of Maryland School of Nursing
  4. 4. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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-Companion Animal Bond (HCAB) taken from the American Veterinary Medical Association (AVMA) 2006
  5. 5. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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 Pompeii Mosaic 79 AD Ancient Cave Painting
  6. 6. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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
  7. 7. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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.
  8. 8. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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.
  9. 9. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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
  10. 10. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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
  11. 11. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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
  12. 12. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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
  13. 13. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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)
  14. 14. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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)
  15. 15. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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.
  16. 16. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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.
  17. 17. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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.
  18. 18. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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
  19. 19. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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
  20. 20. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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)
  21. 21. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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
  22. 22. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 PAL Design PAL (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.
  23. 23. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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
  24. 24. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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)
  25. 25. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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
  26. 26. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 Results • Emotional Function: Depression (lower is better) Months after Start of Study 0 1 2 3 Depression 4 5 6 7 8 9 10 11 Dog Group (n = 22) Reminiscing Group (n=18) Initial 3 Months Initial 3 Months PercentDepressed 0 20 40 60 80 Reminiscing n = 18 Dog n=22 Depression Major Depression p = .065 p = .030 (Interaction p < .05)
  27. 27. Months after Start of Study 0 1 2 3 ActivitykCals 10 20 30 40 50 60 70 80 90 Dog Group (n = 22) Reminiscing Group (n=18) Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 Results • Physical Function: Physical Activity K Cals per 24 hours (Ms & SEMs) (Interaction NS)
  28. 28. Months after Start of Study 0 1 2 3 BarthelScore 50 55 60 65 70 75 80 85 Dog Group (n = 22) Reminiscing Group (n=18) Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 Results • Physical Function: Activities of Daily Living (higher is better) (Interaction p < .10)
  29. 29. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 Behavioral Results
  30. 30. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016
  31. 31. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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
  32. 32. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 Correlations Between average activities, baseline MMSE score, change in physical activity and change in depression
  33. 33. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016
  34. 34. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016
  35. 35. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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
  36. 36. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 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
  37. 37. Proprietary information: Not to be reproduced or distributed without the express consent of Mars Inc. ©Mars 2016 Funded by ISAZ/WALTHAM® Collaborative Research Award

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