Scientific Research Project 1
6/8/2015
1
DOG THERAPY IN NURSING
HOME PATIENTS Erin M. & Kelly G.
ABSTRACT
Six weeks of dog therapy has been shown to improve depression and increase the quality of life in nursing home patients with mental illness. In this study, we hypothesize that all nursing home patients will benefit, especially if the time period is extended to 12 weeks. Sixty minutes of dog therapy once a week is being administered to 40 residents from a private, for profit, medium-sized nursing home to measure the effect on depression. Another 40 residents will be in the control group, with men and women being evenly divided among both groups. The oxytocin level will be measured and the Mini-Mental State Examination (MMSE,) Geriatric Depression scale (GDS), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) will be administered before and after the therapy to determine the effect of the dog therapy.
FIRST PRINCIPLES: PET THERAPY
Definition: “a guided interaction between an
individual and a trained animal.” (Giorgi)
Purpose: to help a person cope with or recover from
a health problem or mental illness.
Can play a role in the psychological, educational
and physical rehabilitation of mentally ill patients.
Dates back to the 1960s and was introduced by the
psychiatrist Boris Levinson (Moretti et al. 125).
In the late 1970s, the therapeutic use of pets had
lost its experimental connotation and nowadays it
follows specific operational protocols (Moretti et al.
125).
FIRST PRINCIPLES: PET THERAPY
Dogs and cats are most commonly used in pet
therapy. Other animals like fish, guinea pigs,
horses and birds have been used (Giorgi, Rovner).
Benefit to patient: The interaction with animals
has been shown to increase the level of the
hormone oxytocin, which makes people feel
happy, and decrease blood pressure (Rovner).
Risks to patient and the animal through bites to
the patient and rough handling of the animal
(Giorgi).
Side effects: allergic reaction to dander
FIRST PRINCIPLES: PET THERAPY
Pet therapy is administered through regular
meetings between the patient and the animal
and the animal handler.
Pet handler is usually the pet’s owner.
The goals for the patient determine:
the type of animal
frequency of meetings
length of meetings
length of therapy
FIRST PEER-REVIEWED ARTICLE
(MORETTI ET AL.)
Goal: examine the effects of animal-assisted
therapy on the passivity, engagement, and mood
of nursing home residents in Northern Italy.
Sample: 21 mostly female elderly patients
Mean age: 84.7 years
Affected by mental illness (Alzeheimer’s disease,
vascular dementia, secondary dementia, mood
disorders, psychotic disorders)
Experimental group: 10 subjects who had contact
with dogs
Control group: 11 subjects who saw dogs but
didn’t interact with them.
3 dogs visited the experimental group for 90
minutes per week for 6 weeks.
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FIRST PEER-REVIEWED ARTICLE
(MORETTI ET AL.)
Measurements were done at the beginning and end of the
study.
Mini-Mental State Examination (MMSE)
15-items Geriatric Depression Scale (GDS)
Results and Conclusion:
It was shown that pet therapy improved depressive symptoms
by 50% and a “tendency towards improvement of mean MMSE
scores twofold higher in the pet-group than observed for
controls.”
A positive correlation on the quality of life of patients who
received the pet therapy also was observed.
All participants reported the experience on satisfaction
questionnaires administered at the end of the experiment.
All patients reported the experience as enjoyable,
recommended the experience to other elderly patients, and
said that the pets had a calming effect on them.
SECOND PEER-REVIEWED ARTICLE (LE
ROUX AND KEMP)
Study looked at the effect of animal assisted
activity or therapy dogs on 16 elderly patients in
long-term care facilities.
8 were in the experimental group and met with a
companion dog once a week for 30 minutes
8 were in the control group and didn’t meet with the
companion dog.
The same dog was used for all visits.
The control group never saw the therapy dog
because the interactions were done in a separate
room, apart from the rest of the residents in the
facility.
The weekly visits occurred on the same day and
at the same time over a 6 week period.
SECOND PEER-REVIEWED ARTICLE (LE
ROUX AND KEMP)
The dog was on a leash and the residents could
pet, groom, touch, and talk with the dog when
they wished for 30 minutes.
Residents were either in a wheel chair or used
crutches.
Measurements: Beck Depression Inventory (BDI)
and Beck Anxiety Inventory (BAI) was
administered before and after the experiment.
Each is a 21 item self-reported questionnaire.
SECOND PEER-REVIEWED ARTICLE (LE
ROUX AND KEMP)
Results:
There wasn’t a difference between the experimental group and the control group on the initial BDI and
BAI tests.
Significant differences were observed between pre-
and post-BDI scores.
Non-significant differences were observed between
pre- and post-BAI scores.
Conclusion: Therapy dogs helped lower
depression levels among elderly patients, but
didn’t have an effect on anxiety.
LIMITATIONS TO THE STUDIES
Limitations to the 1st peer-reviewed article study by Moretti et al.:
Not randomized nor double-blind
Small number of subjects
Timer period was “short-term” (6 weeks) and only 2 tests were used for the measurements.
Limitation of the 2nd peer-reviewed article study by Roux and Kemp:
Small number of subjects
Didn’t address social interaction & loneliness of residents
Didn’t distinguish between dog owners vs. non-dog- owners
MOTIVATION AND PROPOSED STUDY
FEATURES
Motivation: Due to the limitations of the 2 peer- reviewed articles, a new study is being proposed.
Changes to be made:
Larger sample with both men and women in equal numbers
Longer length of study: 12 weeks
Not limited to subjects with mental illness
Social interaction & positive attitude toward dogs will be included.
4 psychological tests will be used (MMSE, GDS, BAI, BDI)
Subjects will be in a private nursing home in the United States which has better care and removes confounding variables.
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IMPORTANCE OF PROPOSED STUDY
Pet therapy, in particular dog therapy, is an
inexpensive way to help remove depression.
Depression can affect both mental and physical
health.
Pet therapy is non-invasive, drug free, and
requires little equipment and set-up.
If a study with a large representative sample
demonstrates the large benefit of dog therapy,
then it can be incorporated into a regular event
in nursing homes and may be paid for by
insurance companies.
HYPOTHESIS
If nursing home patients are allowed to interact
with a dog once a week for 60 minutes over a 12
week period, then the patients will have a higher
oxytocin level and be less depressed and anxious.
MAIN MANIPULATED VARIABLE AND
CONFOUNDING VARIABLES
Main manipulated variable: amount of time
interacting with therapy dogs.
Values for main manipulated variable: 0 hours/week
and 60 minutes/week.
The 60 minute time period is in-between the two in the peer-reviewed articles (30 and 90 minutes).
Confounding variables
Personal feelings about dogs. Only those who like
dogs will be selected to participate in the study.
Dog and dog handlers. The different dogs and handlers will rotate among the subjects so that all
subjects are exposed to all dogs and handlers.
CONFOUNDING VARIABLES
Confounding variables continued:
Loneliness can be eliminated by having subjects regularly interact with other residents at meal times.
Interaction outside of meals also will be recorded. Attendance to social activities in the home will be gathered
from the staff of the nursing home.
Visits by family and friends will be gathered through the visitor logs.
Genetics & predisposition to depression and mental health diseases are true confounding variables that can’t be removed.
Physical illnesses and ailments may affect oxytocin levels, blood pressure, and mental health. So, subjects suffering from major changes in health will be removed from the study.
CONSTANTS
Health care, quality of food, daily comforts are
constant so that related factors won’t affect
measurements.
Each subject will be physically with other
residents at meal time.
Same trained golden retrievers and the same
handlers for all visits with the dogs rotating
among the subjects in the experimental group.
60 minute sessions over a 12 week period.
The same tests are used at the start of the
experiment and at the end.
SAMPLE
80 participants in a medium-sized, for profit,
private, nursing home.
40 men & 40 women
Randomly divided among the experimental group and
control group so that each has 20 men and 20 women
There will be a variety of ethnic and
socioeconomic backgrounds due to the size of the
nursing home.
Experimental group: 40 subjects that will have
dog therapy.
Control group: 40 subjects that will stay in their
room and not see the dogs at all.
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SAMPLE SELECTION
Subjects selected through an in-take survey.
Subject requirements:
Like dogs or be a previous dog owner
No allergy to dogs
Have enough cognitive function to complete the
intake survey and 4 tests
Must have regular visitors
Must be able to eat outside their rooms and join other
residents in the dining room
Not limited to those with Alzheimer’s disease or depression like in the peer-reviewed papers.
INFORMED CONSENT & ETHICS
Subjects or those with legal power to make decisions for the subjects will be informed of all aspects of the experiment.
Purpose, requirements of study, potential harm
Written permission will be obtained to participate.
Subjects may withdraw from the study at any time and for any reason.
No animals or humans will be harmed by this experiment.
Approval of the protocol will be obtained by the appropriate ethical review boards.
All personal data will remain confidential.
PROCEDURE
A private, for-profit, nursing home with at least 150 residents will be selected.
Informational and in-take surveys will be given to every resident to complete within 1 week. To encourage the completion of the survey, a raffle ticket
for $50 will be given to those who complete it in time.
Subjects will be told that the goal of the survey is how social interaction affects depression.
The survey will ask for basic information: Name, age, length of time living at the home, mental and
physical health, and the qualifications in the Sample section
Visitor log will be examined to determine which residents had visitors in the last 3 months.
If selected, the resident will have to sign legal papers acknowledging informed consent as stated in the last slide.
PROCEDURE Once 40 male subjects and 40 female subjects meet the
requirements, they will be randomly divided into the
control and experimental groups.
All subjects will have the oxytocin levels measured, and
take the MMSE, GDS, BDI and BAI tests over several
days as to not tire them out.
Dog therapy will begin for the experimental group soon
after the initial measurements are taken.
Subjects in the experimental group will meet weekly for
60 minutes with dogs and handlers in a room in the
nursing home.
Because of the large number of subjects, two different
sessions will be held twice a week. Each session will
have 10 subjects from the experimental group.
Sessions will be scheduled around meal times.
PROCEDURE
During the sessions, the subjects in the experimental
group may stroke, talk, and play with the dogs.
Experimenters will record the subjects behavior.
The dogs will rotate among the subjects with the time
period dictated by the number of available dogs.
The control group subjects will remain in their rooms
and may not see the dogs at all.
Experimenters will have nurses check on them to see what
they are doing and record the information.
During each week, additional data will be recorded:
Attendance at social events and communal meals.
Visits (# and length) by outside visitors
PROCEDURE
After 12 weeks of dog therapy, al subjects will
have their oxytocin level measured and take the
MME, GDS, BDI and BAI tests in the same way
as they did earlier for the initial tests.
Same length of time and time period
The subjects will be paid $120 ($10/week) for
their participation.
Results will be discussed with them after the
data analysis, especially if it will impact the
subject’s health.
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SAMPLE BIAS
To decrease sampling bias, the number of subjects is
representative, and a larger number than in
previous studies.
The subjects have been randomly divided into the
experimental group and the control group by sex.
The control group and the experimental group have
equal number of men and women.
Hopefully with the larger number of subjects, the
incidences of clinical depression and mental illnesses
will be evenly divided between the two groups.
EXPERIMENTER BIAS
To prevent experimenter bias, the experiment will mostly
be double-blind.
The subjects won’t know the true purpose of the test, though
they may talk among themselves that some of them are seeing
dogs and some of them are not.
We will advise that the subjects not discuss the therapy as
part of the consent form.
One set of experimenters will be collecting weekly data.
A different set of experimenters will assess the final
oxytocin level and 4 psychological tests and will not know
whether the subject is in the control or experimental group.
The subjects will be assigned a random number and be
identified by that number. The experimenters will not
know the identity of the subject whose test they are
analyzing.
SUBJECT BIAS
To remove subject bias a limited amount of information about the experiment will be given to participants. They will be told that the goal is to measure the effect of social
interaction on depression. They will not be told that the main manipulated variable is the time
spent in dog therapy because the control group will never see the dogs.
If they expect to interact with dogs, it may introduce bias into the experiment.
The survey questions relating to an allergy to dogs, liking dogs, and being a dog owner will be mixed into other general background questions so as to not indicate that dog therapy will be used.
The subjects will be told that all precautions will be taken to prevent any harm through social interaction, but unexpected events may occur. Because the dogs are trained as therapy dogs and have a handler, the
chance of a bite is minimal. Analysis
ERRORS
Data will be collected and analyzed by at least 2 experimenters to reduce personal error.
The instrument used to measure the oxytocin level will be new and calibrated before the experiment to ensure precision and accuracy.
The same instrument for the oxytocin level will be used for measurements before and after the experiment to remove through cancellation systematic errors.
The same 4 tests to measure cognitive status and depression will be taken before and after the experiment.
The procedure of the 4 tests will be the same before and after the experiment to remove error and bias. i.e., in terms of the hours spent each day and the time
period to take the tests
ANALYSIS
The changes in oxytocin level and MMSE, GDS, BDI and BAI test results will be calculated for each subject.
The mean, median, standard deviation, and mode will be calculated for the experimental group and the control group.
The statistical test between populations will be calculated using the mean and standard deviation of both the experimental group and the control group to determine if they are statistical different.
The latest version of the statistical package for social sciences (SPSS) will be used.
The effect of outside visitors, extra participation in nursing home social activities, and the lack of participation in the dog therapy sessions for experimental group members will be analyzed, too.
ANALYSIS
If the experimental group is less depressed and
has a higher oxytocin level than the control
group, then the hypothesis is true.
If the changes in the experimental group are the
same as the control group, then the hypothesis is
false.
If the experimental group is more depressed and
has lower oxytocin levels than the control group,
then the hypothesis is false.
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REPLICATION
The study will be replicated one other time in a
different city and in different nursing homes.
Research notes and information will be posted to
other researchers who would like to replicate the
study.
REFERENCES
1. Le Roux, Marieanna and Kemp, Rene. “Effect of a companion dog on depression and anxiety levels of elderly residents in a long-term care facility.” Psychogeriatrics 9. (2010): 23-26. Print.
2. Giorgi, Anna Zernone. “Pet Therapy”. Healthline, 21 October 2013. Web. 2 June 2015. <http://www.healthline.com/health/pet-therapy#Overview1>
3. Moretti, Francesca, Diana De Ronchi, Virginia Bernabei, Lucia Marchetti, Barbara Ferrari, Claudia Forlani, Francesca Negretti, Cleta Sacchetti, and Anna Rita Atti. "Pet Therapy in Elderly Patients with Mental Illness." Psychogeriatrics 11. (2011): 125-129. Print.
4. Rovner, Julie . “Pet Therapy: How Animals And Humans Heal Each Other”. NPR Morning Edition, 5 March 2012. Web. 30 January 2015. <http://www.npr.org/blogs/health/2012/03/09/146583986/pet- therapy-how-animals-and-humansheal-each-other>