Scientific Research Project 1

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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>