Section 1
Description of Animal-Assisted Therapy for Older Adults with Depression
Animal-assisted therapy (AAT) entails interracting with animals to enable healthcare professionals to treat various health conditions, including depression. In particular, AAT is gradually becoming an adjunct to conventional treatments within healthcare settings in the improvement of the condition, promotion of recovery, and enhancement of quality of life of older adults (Franklin et al., 2022). AAT utilizes highly trained animals, such as dogs and cats, to address the emotional and physical needs of patients. Typically, this form of intervention is person-centered an entails collaboration among the clinician, animal, handler, and patient. AAT can be used to help patients attain curative, rehabilitative, and preventive goals (Olsen et al., 2016). The intervention aims to offer patients with a sense of motivation and independence as well as socialization and emotional stability. An animal’s presence has been connected to a reduction in stress levels and effective management of post-operative pain (Veilleux, 2020). Notable psychological benefits of AAT include reduced levels of depression, anxiety, loneliness, enhanced communication abilities, and increased socialization.
Older adults are susceptible to social isolation and psychological decline, and their primary psychological needs are usually not met. Thus, animals have been instrumental in countering depression and loneliness encountered by older adults. Empirical evidence indicates that interaction with animals triggers biochemical alterations in the patient’s brain, releasing neurotransmitters that enhance mood, bring relaxation, and suppress anxiety (Koukourikos et al., 2019). These alterations have proven their effectiveness in decreasing symptoms of depression among institutionalized elderly populations. In the same vein, it has been noted that the loss of independence that accompanies ageing can cause feelings of hopelessness and loss of control, which may in turn lead to increased symptoms of depression. Additionally, when the elderly populations are admitted to hospitals, changes in routine, uncertain health results, and the new environment can the depression and anxiety they commonly encounter. Primary studies investigating the impact of AAT on levels of depression have shown that the intervention can help reduce depressive symptoms among older adults (Pedersen et al., 2012; Ambrosi et al., 2019). Despite the promising outcomes of these studies, AAT has also been connected to its challenges. In particular, infection control and prevention have been the major setbacks of AAT, with researchers’ concerns being transmission of diseases and allergies linked to the intervention. As a result, further research is needed to ascertain the safest approach to the use of AAT in older patients.
Settings In Which AAT Can Be Used
AAT can be used in a variety of settings, including long-term care facilities and hospitals. According to Chang et al. (2020), this intervention can be used in various settings such as day care centers, communities, nursing homes, assisted living facilities, and residential aged care facilities. Systematic reviews have attempted to investigate the most effective setting in terms of individual settings versus group settings. Franklin et al. (2022) argue that AAT conducted in a group setting is linked to a higher likelihood of improvements in depression than in an individual setting. Moreover, some evidence suggest that AAT implemented in combined outdoor/outdoor, or exclusively indoor environments is connected to higher efficacy of AAT compared to AAT implemented in exclusively outdoor settings. Nonetheless, this outcome can be inconclusive as most of the current studies involve outdoor only or indoor only settings. Moreover, extant research that has investigated outdoor AAT entailed a single participant, restricting the generalizability of its findings (Franklin et al., 2022). To allow thorough comparisons, intensified AAT research is needed in exclusively outdoor and exclusively indoor environments. In the face of lack of enough evidence to make reliable conclusions about AAT in outdoor or indoor settings, Franklin et al. (2022) opine that a setting should be selected based on requirements of the patients and the aged care facility. For instance, where longer dog walks are organized or indoor spaces are not large enough, then outdoor surroundings are appropriate. Similarly, if patient mobility is substantially restricted or it is raining, then indoor environments are highly likely to be appropriate.
Section 2
To evaluate direct practice of AAT with older patients, a primary research article that reports empirical data has been selected. The identified research article is “Randomized controlled study on the effectiveness of animal-assisted therapy on depression, anxiety, and illness perception in institutionalized elderly” by Ambrosi et al. (2019). Although there are numerous studies that have investigated the impact of AAT on depression levels, this research article was selected because it is currently the only one using older adults with depression as participants.
Description of the Research Methodology
This research was a quantitative study. Ambrosi et al. (2019) used randomized controlled trial (RCT) as their study design. Characteristically, RCTs are often conducted to offer definitive evidence of an intervention (Gray & Grove, 2020). In terms of the study population, the study entailed two completely randomized groups from a National Health Service-accredited long-term care facility in northern Italy. The treatment group was comprised of 17 participants and the control group had 14 subjects. The inclusion criteria for the selection of participants were patients aged 65-90 years, a sore of 5 or above on the 15-item Geriatric Depression Scale (GDS-15), institutionalized for at least 2 months, absence of animal allergies and willingness to interact with the dog. On the other hand, the major exclusion criterion was inability to interact with the medical team due to multisensory impairment. The sampling method used in this study was random sampling. Ambrosi et al. (2019) reports that 17 participants were randomly assigned to the treatment group and 14 participants to the control group. Essentially, there was no substantial variance in the participants’ ages as well as any pretreatment evaluations between the control and treatment groups.
Various measurements were used in this research. For instance, participants completed the GDS-15, Illness Perception Questionnaire-Revised (IPQ-R), Generalized Anxiety Disorder 7 (GAD-7), and Positive and Negative Affect Schedule (PANAS) for measurement of depression, illness perception, mood, and affect. Moreover, inter-and intra-group analysis of data was conducted before and after treatment. An observational methodology was created to document verbal and non-verbal interactions among the dog handler, the elderly, and the dog. Furthermore, Real Statistics release 5.5 was used for statistical analysis to establish whether there was a substantial variance in terms of P-value. T-square test and t-tests were further used to compare assessment scores between the control and treatment groups. These tests were conducted to guarantee that the two groups’ separation was unbiased.
Summary Of the Article, Its Findings, And Conclusions
This study aimed to ascertain the effectiveness of dog-assisted therapy (DAT) on anxiety and depression in institutionalized older adults. Given that the study investigated other variables such as anxiety and illness perception, this evaluation will focus on impact of the intervention on depression among the study participants. Ambrosi et al. (2019) were able to establish promising findings. They found that after administering DAT to the treatment group, the scores on the GDS-15 reduced by an average of 33.5%, showing a substantial reduction in depression. According to the researchers, the reduction in the GDS-15 was large as the affect size was bigger than 0.80 as detected by t-test. In the same vein, Ambrosi et al. (2019) reported that DAT was instrumental in counteracting symptoms of lack of motivation and social withdrawal often observed in institutionalized older adults who are depressed.
The investigators concluded that based on the substantial reduction in the GDS-15 scores after DAT treatment, the study’s findings indicated that the efficacy of the intervention in combating depressive symptoms. Essentially, the researchers argued that the increase in interactions with the dog handlers across the study indicate that the dog serves as a social interaction facilitator, producing positive emotional reactions. Ambrosi et al. (2019) attached one major limitation to the study. They asserted that the samples were chosen from a single long-term healthcare facility. Nonetheless the investigators stated that the facility is a nationally accredited clinical institution. Thus, as opposed to privately settings, its patients constitute a wide clinical and sociodemographic population, indicating that the results have a far-reaching relevance.
Significance Of the Findings for Direct Practice with Older Adults
The findings made by Ambrosi et al. (2019) have significant implications for direct practice with older adults. To begin with, an RCT is a form of experimental study that produces the robust empirical evidence for practice from a single study or source (Gray & Grove, 2020). Thus, there is strong evidence warranting the applicability of DAT in hospital settings in the treatment of older adults with depression. Thus, the findings show that healthcare institutions, including nursing homes, should offer a place where various relational and clinical aspects of patients’ lives, particularly older adults with depression, are considered addressed. More importantly, this move can help develop a sense of psychological well-being, which can be nurtured by the sensitive and soothing presence of a dog.
Section 3
Why And How AAT Will Be of Value to Older Adults
Older adults dwelling in residential long-term care facilities (RLTCFs), including nursing homes, are among the largest populations of high dependency care globally. The effect of long-term conditions, decreased chances of social contact, and multimorbidity usually lead to a multifaceted range of needs, calling for a holistic approach (Jain et al., 2020). Typically, visiting healthcare practitioners and RLTCF staff are responsible for ensuring that these care needs are availed to the patients. AAT has been recognized as a complementary intervention that provides easy implementation and purposeful engagement as part of present treatment programs. Animals act as vital transitional objects in supplementing missing interaction via “filling a void” (Kamioka et al., 2014, p. 373). It has been noted that animals, such as dogs, offer an impetus for “talking stick” or conversation which offers a chance for older adults to show affection and reveal their personalities. As a result, carers are able to have unknown hints of the older individual’s personal life experiences, leading to the enhancement of reciprocity. Besides, interaction time with a dog enables the carers to reach the older adult on a cognitive level as opposed to just responding in a traditional way to physical care needs. As a result, it can be deduced that the presence of an animal has a catalytic effect on the patient-therapist relationship, contributing to the establishment of trust between them.
AAT has further been associated with valuable contributions to older adult’s physiological, psychosocial, and behavioral domains, which in turn lead to improvements in the mental statuses of these people. Regarding the physiological domain, AAT plays a critical role in the reduction of older adults’ responses of cardiovascular stress by bringing a sense of relaxation. In terms of the psychosocial domain, interacting and boding with an animal motivates older adults to engage in certain tasks such as walking the animal with a chain or brushing it, which help them feel independent and respected as well as raise their self-esteem. Concerning the behavioral domain, AAT not only increases the interaction between the animal and the older adult, like touching or talking to the animal, but also interactions between and among older adults, like discussing about the animal. These benefits are critical to the reduction of negative emotions linked to depression.
Specific Issues and Concerns to Consider in Serving Older Adults
In serving older adults, it is quite important to consider specific issues and concerns, including ageism and elder abuse. In particular, ageism is an act of discriminated that stem from prejudice against the elderly. Empirical evidence suggests that ageism is a common issue in every culture globally (Olsen et al., 2016). Typically, ageist attitudes reduce older adults to limited or inferior positions. When ageism occurs in healthcare, assisted living facilities, or the workplace, the impacts of discrimination can be extreme. It can make the elderly feel dismissed by a physician, have a sense of powerlessness and a feeling of lack of control in their daily routine, or fear losing a job. Although ageism happens in various settings, it is usually rampant in assisted care facilities and during clinical care, areas that are synonymous with vulnerable adults. Within the clinical setting, medical professionals may offer less aggressive treatment according to the patient’s age as opposed to the probable outcome. In the same vein, professionals may believe that the elderly require “a rest,” failing to encourage mental or physical activity despite the benefits associated with physical activity for all ages (Olsen et al., 2016, p. 1314). Such misconceptions can result in misdiagnosis, leading to poor treatment outcome.
Older adults who need living assistance are also vulnerable to elder abuse or neglect. Abuse and mistreatment of older adults is among key social problems in the contemporary world. Elder abuse happens when a caregiver deliberately denies care to an older individual or harms the individual in their charge. Carers can be relatives, health professionals, employees of nursing care or senior housing, friends, or family members. Older adults can be subjected to numerous forms of abuse including physical abuse, like shaking or hitting, sexual abuse, such as coerced nudity or rape, emotional or psychological abuse, like humiliation or verbal harassment and financial exploitation. One of the most effective approaches to addressing these issues is developing awareness of attitudes about aging as well as age-related stereotypes. This approach can help those working with older adults become aware of their age-related biases and understand how best to provide age-sensitive care.
Healthcare professionals and other staff serving older adults should also consider ethical concerns related to this group; informed consent and confidentiality. Caring for the older people’s mental health usually involves a judgement on their mental capacity to cooperate with or understand a treatment. For those who cannot give direct consent due to extreme cognitive decline, is suggested that a surrogate caregiver be allowed to give consent on behalf of the older adult (Welfel, 2015). In terms confidentiality, it is crucial to understand that when coordinate the older adults’ care, healthcare professionals may need to share patient information with organizations, other professionals, and families. In the course of treatment, healthcare professionals can receive constant pressures from the family to reveal information. Although it might be beneficial for the older person, they have right to confidentiality just like younger adults (Welfel, 2015). If the patient’s safety or life is endangered due to injury, abuse or neglect, either by another person or self-imposed, professionals can break confidentiality. Nonetheless, it is suggested that legal consultation be sought first.
Section 4
Specific Plan for Two Sessions of the AAT and Goals for Each Session
The specific plans for the two sessions of the AAT for an adult with depression entails 40-minute weekly sessions. The preferred animal will be a dog due to its interactive abilities with humans. The goal of the first session will be to establish a working relationship/agreement with the patient. In this regard, I will ensure that I explain what I am offering to the patient, my counselling modality, limitations in confidentiality, complaints procedure, non-maleficence, duration of the sessions, and time boundaries (Ambrosi et al., 2018). The goal of the second session would be to determine the uniqueness and importance of the patient by extracting all potential knowledge and information concerning the patient’s problems or grievances to ensure that no crucial information is left out. I understand that any missing information can disastrously impact entire therapeutic process.
Implementation Plan for the AAT
Each of the two 40-minute AAT sessions will involve one dog, the patient, the dog handler, and myself as the healthcare professional. During the sessions, patients will with their normal care, including pharmacological treatments (Ambrosi et al., 2018). During Social interaction will concentrate on verbal and non-verbal cues towards the dog handler or the dog (Ambrosi et al., 2018). Verbal cues will include patient emitting vocalizations or sounds towards the dog, or speaking to the dog (Olsen et al., 2016). Non-verbal cues will entail patient stocking or petting the dog, or throwing or giving the dog a toy or food. At intervals of two minutes, I will be recording if one or more of the two forms of interactions happened. Furthermore, I will calculate the sum total of each form of interaction during every AAT session (Olsen et al., 2016). After session two, I will ask the patients to fill a short questionnaire concerning their emotional state using a 5-point Likert scale as well as their willingness to see the animal in the following AAT session.
How I Will Know Whether My Intervention Has Been Successful
One of the ways that I will use to know whether my intervention has been successful is via the assessment of the responses given in the questionnaires administered above. Positive responses will indicate potential success while negative responses will indicate probable failure. Additionally, I will use the GDS-15 to compare the patients’ GDS scores before, during, and after the sessions (Ambrosi et al., 2018). A decrease in the scores will be an indication of my intervention’s success.
References
Ambrosi, C., Zaiontz, C., Peragine, G., Sarchi, S., & Bona, F. (2018). Randomized controlled study on the effectiveness of animal-assisted therapy on depression, anxiety, and illness perception in institutionalized elderly. Psychogeriatrics, 19(1), 55–64. https://doi.org/10.1111/psyg.12367
Chang, S. J., Lee, J., An, H., Hong, W., & Lee, J. Y. (2020). Animal‐Assisted Therapy as an Intervention for Older Adults: A Systematic Review and Meta‐Analysis to Guide Evidence‐Based Practice. Worldviews on Evidence-Based Nursing, 18(1), 60–67. https://doi.org/10.1111/wvn.12484
Franklin, M., Parnell, T., Versi, N., & Pope, R. (2022). Animal Assisted Therapy for Older Adults in Aged Care Facilities: A Rapid Review. Internet Journal of Allied Health Sciences and Practice, 20(1), 1–30. https://doi.org/10.46743/1540-580x/2022.2052
Gray, J. R., & Grove, S. K. (2020). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). St. Louis, MO: Elsevier.
Jain, B., Syed, S., Hafford‐Letchfield, T., & O’Farrell‐Pearce, S. (2020). Dog‐assisted interventions and outcomes for older adults in residential long‐term care facilities: A systematic review and meta‐analysis. International Journal of Older People Nursing, 1–19. https://doi.org/10.1111/opn.12320
Kamioka, H., Okada, S., Tsutani, K., Park, H., Okuizumi, H., Handa, S., Oshio, T., Park, S.-J., Kitayuguchi, J., Abe, T., Honda, T., & Mutoh, Y. (2014). Effectiveness of animal-assisted therapy: A systematic review of randomized controlled trials. Complementary Therapies in Medicine, 22(2), 371–390. https://doi.org/10.1016/j.ctim.2013.12.016
Koukourikos, K., Georgopoulou, A., Kourkouta, L., & Tsaloglidou, A. (2019). Benefits of Animal Assisted Therapy in Mental Health. International Journal of Caring Sciences, 12(3), 1898–1905. http://www.internationaljournalofcaringsciences.org/
Olsen, C., Pedersen, I., Bergland, A., Enders-Slegers, M.-J., Patil, G., & Ihlebaek, C. (2016). Effect of animal-assisted interventions on depression, agitation and quality of life in nursing home residents suffering from cognitive impairment or dementia: a cluster randomized controlled trial. International Journal of Geriatric Psychiatry, 31(12), 1312–1321. https://doi.org/10.1002/gps.4436
Pedersen, I., Martinsen, E. W., Berget, B., & Braastad, B. O. (2012). Farm Animal-Assisted Intervention for People with Clinical Depression: A Randomized Controlled Trial. Anthrozoös, 25(2), 149–160. https://doi.org/10.2752/175303712×13316289505260
Veilleux, A. (2020). Benefits and challenges of animal-assisted therapy in older adults: a literature review. Nursing Standard, 36(1), 28–33. https://doi.org/10.7748/ns.2020.e11625
Welfel, E. R. (2015). Ethics in counseling & psychotherapy. Cengage Learning.
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