Animal-Assisted Therapy

INTRODUCTION

Statement of the Problem and Purpose of the Study

      By the year 2030, the nursing home population was estimated to reach 5.3 million, while the entire elderly community would probably be at 13.8 million (Cox, 1993).  The growing elderly population translated to the growing need for efficient assistance and treatment strategies.  In response to this need, there has been increasing attention given to animal-assisted therapy. Having pets was observed to impact humans of different ages through the bond they were able to create with each other (Swabe, 1999). The intent of this research is to analyze the effect of utilizing of pet therapies to address the physiological and psychological health problems of the elderly population. Findings from this study will provide the significance of pet therapy in the wide array of treatment and intervention strategies that were employed for the said population.

      Most of the current research that existed to measure the impact of pet therapy on humans was limited to short-term (6 months or less) period of studies. There was a gap in the literature when it came to the long-term effects of pet therapy with the quality of life of the elderly population. Quality of life could be understood in terms of physiological and psychological pain. Physiological aspects included the elders’ pain, blood pressure, heart rate, and cortisol levels. On the other hand, the effects of pet therapy on the psychological aspects included social interaction, depression, motivation and joy.

      The purpose of this study will be to test the theories of pet therapy that relates pet therapy to the physiological and psychological effects on the quality of life of the elderly, controlling for the period of time the participants could interact with the pets and observing the changes that they could undergo at the nursing home. Pet therapy would be generally defined an intervention wherein animals becomes a part of the treatment procedure of the patients (All et al., 1999) and the progress or the lack of it in terms of the physiological and psychological health of the participants will be statistically analyzed in the study.

Identification of Variables

Independent Variable

      Pet therapy will be considered as the independent variable in this study. The pets are non-bounded trained dogs accompanied by a certified animal assisted therapy (AAT) handler. The presence of the handler was minimized in regards to their effect on participants.

Dependent Variable

      The dependent variable will be the physiological and psychological effects of the independent variable on the quality of life of the elderly population.

Research Questions

The following research questions would be used to guide the research for a quantitative research study of the effect of pet therapy on the physiological and psychological effects of the patients:

1. How did animal assisted therapy influence the physiological and psychological health of the quality of life of the elderly?
2. Was there a difference determined between short term and long term effects of animal assisted therapy?
3. Will AAT have lasting effects (i.e. once the pet is removed)? Will these effects be positive or negative?

Hypotheses, Assumption and Scope

            There will be a significant and positive in the physiological and psychological aspects of the quality of life in the elderly population. Long-term AAT will have a beneficial effect on the aspects of quality of life, which includes improvements in blood pressure, heart rate, pain, stress, depression and others. This research study has the assumption that animals have an effect on human beings. The scope of this study involved an exploration of the long-term effects that these animals had on the participants. It would also be focused on the changes physiological and psychological health of the elderly as a result to animal contact.

Theoretical Framework

            There were a number of significant theories that explored the relationship of animals and humans. In this study, the long-term effects of animal-assisted therapy would be observed and analyzed according to their impact in the physiological and psychological health of the elderly. This would be done through a combination of the exchange theory and the general effect theory.

Exchange Theory

            The Exchange theory explained the numerous studies that were geared towards the effectiveness of pet therapy. According to this theory, people engage in relationships wherein the benefits outweighed the costs (Graham, 2000). Studies concerning human-animal relationships zeroed in on children, the disabled, the elderly and other special population groups. Pets gave valuable relationships to such groups because of the elements of companionship, tactile simulation, safety and non-judgmental support they provide (Graham, 2000). This theory provided a starting point as to why pet therapy was a feasible intervention used for providing assistance and treatment for the elderly.

General Effect Theory

            There were therapeutic theories that were focused on the healing effect of animal-human relationships to the patients. There was no theory that encompassed the benefits that were gained from AAT (Graham, 2000). A general effect theory by James Serpell was proposed to suggest the therapeutic value of AAT.

            Instrumental. Under this theory, the instrumental approach was applicable for those who were physically and mentally challenged. This resulted in the lack of self-esteem.  The animals functioned as an extension of themselves. It was perceived to increase confidence and self-esteem among them (Graham, 2000).  This was widely observed for horses and dogs.

            Passive. This involved watching animals such as fishes and birds. The absorption that was involved in the animal activity induced a state of relaxation for the patients (Graham, 2000). However, these benefits were observed to be short-termed and lasted as long as the animals were observed. Since the activities of animals, compared to humans were unpredictable and random, they could sustain a person’s interest.

            Anthromorphic. This category involved animals as pet companions wherein there was a bonding potential between the patient and the animal (Graham, 2002). There was a significant therapeutic benefit because the animal was initially perceived as another person. Attachment, devotion and love towards a person could be directed towards the animal. The psychological and physical well being was hinged on the feeling that they were respected, needed and loved by the others (Graham, 2002). Animals seemed to effectively supply this. The research would focus evaluating whether the anthromorphic of the general effect theory when examining the effect of AAT on the physiological and psychological well-being of the participants.

Definition of Terms

Elderly patient population – They are individuals who were aged 65 and above and were considered as one of the fastest growing groups in the population that need assistance and treatment (Cox, 1993).

Assisted living –A type of long-term care facility for elderly or disabled people who are able to get around on their own but who may need help with some activities of daily living, or simply prefer the convenience of having their meals in a central cafeteria and having nursing staff on call (medicinenet.com)

Animal assisted therapy – A direct intervention that included pet visitation. Animal became a part of the treatment process or the treatment team that was designed to promote the improvement of the physical, social, emotional and cognitive functioning of the patient (All et al., 1999). It was divided into three categories: the provision pets as companions for people living alone or in assisted living facilities, the provision of resident pets for resident of institutions, the provision of visiting animals to stimulate the residents’ interests (All et al., 1999).

Quality of life (based on physiological and psychological) – The quality of life for elderly people were observed in terms of physical environmental factors, subjective satisfaction, socio-economic factors, personality factors and health status factors. Health status factors were further classified into the physical well-being, functional ability and mental health of the elderly person (Bond & Corner, 2004). Personality factors included the psychological well-being, morale, life satisfaction and happiness of the elderly person (Bond & Corner, 2004). It was also understood as the basic provisions for happiness (Bond & Corner, 2004).

Long-term study – In contrast to short term studies that were conducted within a period of six months or less, anything that was more than six months was considered a long term period by which a study would be conducted.

REVIEW OF RELATED LITERATURE

Background for Pet Keeping

            The human penchant for keeping animals as pets was considered to be universal and dated back to the period wherein livestock and animal husbandry was practiced (Swabe, 1999). Humans and animals had developed from a functional to a therapeutic relationship with each other. Pet-keeping was more than acquiring or keeping an animal as a pet. It was something that could provide as an emotional crush to their owners for the absence of human relationships and more commonly, a pure need for companionship (Swabe, 1999).

The Need of the Elderly

            The elderly population had been increasing in number of the population of many countries. Health care literature responded through the increase in focus in successful ageing and treatments for disorders occurring in later in life (Pachana, 1999). The ageing process was perceived to encompass biological, psychological and social aspects of the being. There were new levels of psychological and biological disorders that were encountered during this stage. There were so many areas by which the elderly needed medical attention for. The discovery of different treatments and interventions were significant in addressing the need of this group.

Animal-Assisted Therapy

            Animals were seen to play an important part in society. Approximately more than half of the households in the United States had a companion animal and half of them had more than one animal in their homes (All et al., 1999). The earliest record of animals used in the healthcare industry was by Florence Nightingale in 1860 (All et al., 1999). She suggested that small pets provided companionship and pleasure for the sick patients that were confined in their beds for a long time. York Retreat was the first institution that recorded the therapeutic use of animals for patients with psychiatric problems (All et al., 1999).  Animals were often used as a means of intervention for different levels of care, from pediatrics to geriatrics, and from prevention to healing. This was an approach that as based on human-animal bond that used a holistic approach to care for individuals with chronic illnesses and disabilities.

            The earliest pet therapy programs included the pets of volunteers that were brought to hospitals, nursing homes and long-term care facilities on a regular basis (Heimlich, 2001). Such programs were already designed to provide positive therapeutic outcomes to improve the quality of life of the patients. Most of the physical effects of human-animal interaction reflected that pets were effective in reducing the person’s blood pressure (Heimlich, 2001).

            Cole and his colleagues (2007) conducted a study based on the assumption that AAT improved physiological and psychological aspects in patients that were hypertensive. Their study was made to determine whether a 12-minute hospital visit with a therapy dog could improve the hemodynamic measures of the patient and decrease state anxiety for patients with advanced levels of heart failure. They found out that AAT improved the cardiopulmonary pressures, neurohormone levels and anxiety in the patients that were hospitalized with heart failure (Cole et al., 2007).

            There was a study wherein adult college students with depression were exposed to AAT and yielded positive results (Parshall, 2003). They used the Beck Depression Inventory to measure the depression of the students. Compared to the group that did not experience AAT, the group that had this experienced showed significant improvements in their moods.

            Similar to the therapeutic effects gardening could provide for the patients, animals were also positively associated with patients that were institutionalized (Pachana, 2002). Some nursing care facilities had resident companion animals that were in the premises. These animals included tropical fishes, hamsters, dogs, cats and birds. AAT was something that went beyond the causal interactions between pets and people. It was conducted to cause the prescribed effect on patients according to professional standards (Pachana, 2002).

            Animal-assisted activities (AAA) were perceived to impact the well-being of patients. Physical benefits included the moderation of the blood pressure changes and survival of heart attacks (Pachana, 2002). There were decreased risks of cardiovascular diseases and the improve aspects of mobility. Studies reflected that when older adults did not own a pet, they had experienced more stressful life events in comparison to pet owners (Pachana, 2002). A study of patients with Alzheimer’s disease even reflected that the presence of a dog improved communicative behavior for the patients (Pachana, 2002).

            Kawamura and his colleagues (2007) conducted a long-term study that theorized that AAT had a significant effect on patients with dementia. Pet visitations were conducted twice a month. The participants were able to freely feed, hold and play with the dogs. Results of the study reflected that the motor function increase over the 12 months of observation and improvements in the mental functions were also observed (Kawamura et al., 2007). The review of related literature reflected the impact animals had on people, especially when they were sick and prone to physiological and psychological disorders.

METHODOLOGY

Research Design

            The study will be conducted within a quantitative research design. This was a design that was meant for the discovery of developing knowledge through the employment of strategies of inquiry in the form of experiments or surveys (Creswell, 2003). The aim of quantitative approaches will be to identify a cause and effect or perform reduction of specific variables, hypotheses and questions. The data collection of this research design involved predetermined instruments that would yield statistical data.

            The aim of the quantitative research design would be to construct statistical models to classify what was being observed. Since the researcher of this study was already aware of what was to be determined, this research design was utilized. This design would function to test the hypothesis of the research through seeking precise measurement and analysis of concepts.

            The aim of this research would be to measure the effect of animal-assisted therapy on the quality of life of the elderly population. The effect of this study could be statistically qualified according to the construction of what the quality of life was. The quality of life was classified in aspects of the individuals’ physiological and psychological health. The measurement of the person’s well being required the use of statistical data analysis in order to present valid and objective results for the effectiveness of AAT.

Sampling

            The sample size would be determined according to the population of the nursing home or long-term care facility that would be selected in this study. It the population will be feasible for the researcher to handle, the sample would be as large as the entire population of the nursing home or care facility. However, if the population is too large, random sampling would be conducted.

Data Collection

Self-Report Questionnaire

            A questionnaire would be designed based on the existing studies that were created on AAT. However, the questionnaire would be customized in order to fit the objectives of this study, which is to measure the quality of life of the patients. The questionnaire was a tool that provided quantitative and numeric description of the attitudes and opinion of the population (Creswell, 2003).

Observation

            The nursing staff will chart the weekly psychosocial observations that were observed from the participants. The nursing staff needed to be the same individuals that would do this week after week. The notes of the resident nurses would serve as the observation notes that would track the progress or the lack of it for the patients.

Physiological Measurements

            At the beginning of the study, the participants would undergo a physical check-up that would determine the state of their physiological well being. This would serve as the baseline for the study’s results. This same physical examinations would be determined in the middle and the end of the data collection period of the study. Included in these physiological test measurements would be the employment of saliva tests to determine the cortisol levels of the patients.

Method for Protection of Human Subjects

            Patients who would serve as participants need to sign a basic professional information statement and informed consent before participating in this study (Chandler, 2005). The description the study in terms of what were required of the patients would be explained before the consent would be signed. It was also considered to be unethical to exclude other treatments in order to prove AAT is successful (Parshall, 2003). Instead, it should be viewed as a supplement to other proven methods. Obvious issues of allergies to animals, potential injuries from the animal like biting should be considered carefully.

DATA ANALYSIS

            The data analysis, which would be utilized, would involve a logistic regression analysis using SPSS. This was something that mirrored the successful studies that were conducted in the past  (Kawamura et al., 2007). The regression analysis involved a statistical technique that identified the relationship between two or more variables. This tool provided an equation for the relationship between the variables. In this case, the analysis would be conducted to show a relationship between AAT and the quality of life of the elderly population. The regression analysis would reveal the dependence of the dependent variable for the independent variable. The data that would be analyzed through this method included the observation notes and the physiological tests that would be conducted the resident nurses. The tests would be compared over a period of time.

            Other data analysis methods that would be employed included the Positive and Negative Symptoms Scale (PANSS) and the Brief World Health Organization Quality of Life Assessment (WHOQOL-BREF) to analyze the significant impact of AAT on the quality of life perception of the patients based on observations and self-reported results (Villalta-Hill et al., 2009). The data that would be analyzed would be the self-directed questionnaire that would be disseminated by the researcher for the participants.

APPLICABILITY TO NURSING

            It was important for the nursing community to be develop an awareness for the effectiveness and implications of the AAT intervention for the elderly. It is perceived play a growing role in healthcare. It is important to understand such implications in order to benefit from the positive effects that this therapy could have on the patients. Since nurses served as the front liners to providing healthcare, they would also be the ones that would closely work with the patients and facilitate AAT. Their knowledge as to AAT’s effect on the patients’ well being would be beneficial for the patient and for their profession. This study will benefit the area of geriatric nursing because of the implications that it will produce for the effect of AAT on the quality of life of the elderly population in terms of physiological and psychological development.

References

All, A. C., Loving, G. L., & Crane, L. L. (1999). Animals, horseback riding and implications for rehabilitation therapy. The Journal of Rehabilitation, 65(3), 49.

Bond, J. and Corner, L. (2004). The quality of life and older people.  England: Open University Press.

Chandler, C. (2005). Animal assisted Therapy in Counseling. New York: Routledge.

Cox, C. (1993). The frail elderly: Problems, needs, and community responses. Westport, CT: Auburn House Paperback.

Cole, K., et al., (2007).  Animal-assisted therapy in patients hospitalized with heart failure. American Association of Critical-Care Nurses 16, p. 575-585.

Creswell, J. (2003). Research design: Qualitative, quantitative, and mixed method approaches. California: Sage.

Fine, A. (2006) Handbook on animal-assisted therapy. USA: Elsevier.

Graham, B. (2000). Creature comfort: Animals that heal. New York: Promethus Books.

Heimlich, K. (2001). Animal-assisted therapy and the severely disabled child: A quantitative study. The Journal of Rehabilitation, 67(4), 48+.

Kawamura, N., Niiyama, M., Niiyama, H.  (2007). Long-term evaluation of animal-assisted therapy for institutionalized elderly people:  A preliminary result. Psychogeriatrics 7 (1), p. 8-13.

Pachana, N. A. (1999). Developments in clinical interventions for older adults: A review. New Zealand Journal of Psychology, 28(2), 107.

Pachana, N. (2002). Designing therapeutic environments for residential care facilities, in Geriatric Residential Care. Hill, R. et al (Eds).  Mahwah, NJ: Lawrence Erlbaum Associates.

Parshall, D. P. (2003). Research and reflection: Animal-assisted therapy in mental health settings. Counseling and Values, 48(1), 47+.

Swabe, J. (1999). Animals,disease, and human society: Human-animal relations and the rise of veterinary medicine. London: Routledge.

Villalta-Gil, V. et al. (2009).  Dog-assisted therapy in the treatment of chronic schizophrenia inpatients Anthrozoos 22 (2), 149-159.