Therapeutic Recreation Research Article Review! NO PLAGIARISM

Journal Article Critique

“Effects of dog-assisted intervention on behavioral and psychological symptoms of dementia”

Your Name:

Month, day, year

Rec 3320

Prof. K. Petrin

Nordgren, L., & Engström, G. (2014). Effects of dog-assisted intervention on behavioral and psychological symptoms of dementia. Nursing Older People, 26 (3), 31-38.

Introduction

In this article, Nordgren and Endstrom (2014) discuss the benefits of dog-assisted intervention on the behavioral and psychological symptoms of dementia such as verbal or physical aggression and agitation towards oneself and others. Patients diagnosed with dementia are often prescribed pharmaceutical drugs such as anti-depressants, mood stabilizers, anxiolytics, hypnotics, antipsychotics or cholinesterase inhibitors to combat these behavior and psychological problems (Nordgren & Endstom, 2014). Although these medications are known to have limited effects on these symptoms and come with a large array of negative side effects including death. Non-pharmaceutical interventions are now being used both solely or in conjunction with medication to reduce the risk of negative side effects and to improve quality of life in patients with dementia. “According to the clinical guideline for dementia (National Collaborating Centre for Mental Health (NCCMH) 2007), non-pharmacological interventions should be considered for people with all types and severities of dementia with comorbid agitation” (Nordgrem & Endstrom, 2014). The authors believe DAI is a positive intervention which can decrease agitation, aggression and increase social interaction which can also be said to increase overall quality of life for the individual (Nordgrem & Endstrom, 2014).

Purpose Statement and Research Question: The purpose of this study is to illustrate how dog- assisted intervention (DAI) can provide an alternative or complement to medication treatment to reduce behavioral symptoms in people with dementia.

Variables being studied: The independent variables studied are the 20 people with dementia in the intervention group that received dog-assisted intervention. The dependent variable studied is the 13 people with dementia that did not receive any dog-assisted intervention.

Data of the population being studied: A total of 33 residents from 8 nursing homes in Sweden were recruited. 20 residents (8 men, 12 women) were included in the intervention group and 13 residents (3 men, 10 women) were included in the control group. The mean age was 81 years old (range 63-91) in the DAI group and the mean age in the control group was 83 years old (range 71-94).

Methods and Procedures:

Data was collected from eight nursing homes in the same municipality. During the time of the experiment Animal-Assisted Intervention was currently being used in four of the eight nursing homes. “All dogs and their handlers were trained and certified for their assignment through the Swedish Therapy Dog School in accordance with the requirements of the Swedish Standards Institute” (Nordgrem & Endstrom, p#).

In order to minimize risk, a control group was formed. The control group consisted of four nursing homes with similar number of residents, number of employees, and culture of the home. “They also held similar activities for residents, such as validation therapy, massage, singing, and reminiscence” (Nordgrem & Endstrom, 2014). It is important to note that the control group had no contact with intervention dogs, besides resident “visiting” dogs.

In order to be able participate in either the control group or intervention group one must have a diagnosis of any type of dementia and have been a resident of the nursing home for at least 4 weeks before the start of the study. Other criteria for entering the DAI group was: not being allergic to dogs, not having expressed anxiety towards dogs earlier in life, becoming aggressive or getting upset when one came in contact with dog (Nordgrem & Endstrom, 2014). “A good candidate could be a resident who had started to wander or seemed to be upset and angry with the staff or fellow residents” (Nordgrem & Endstrom, 2014).

Intervention protocols were personalized to each participant based on need. A referral from a physician, occupational therapist or physiotherapist was necessary before a dog therapy team worked with the resident. Each protocol included 10 sessions and based on the referral would the duration of the session (45-60minutes); frequency (once or twice a week); and ability to be trained (cognitive, physical, or psychosocial) be implemented. “Intervention protocols included activities such as walking or playing with the dog, petting the dog, feeding the dog treats, talking to it, brushing it, reminiscing about previous pets or talking to the pet handler” (Nordgrem & Endstrom, 2014). The intervention is goal orientated and purposes to improve a person’s ability in areas such as communication, memory, language, increased self-esteem, focus and concentration, balance and muscle strength, fine motor skills, and movement.

Assessments of behavioral and psychological symptoms in the intervention group were performed before the DAI began (baseline); immediately (one to seven days) after completion of session; and three to six months after completion of the DAI (follow up). Assessments of the control group were performed at study inclusion (baseline); and three and six months after inclusion (follow up). Assessments of each participant, regardless of group, were always made by the same staff nurse. Two measuring instruments were used for assessment the MDDAS and CMAI (Nordgrem & Endstrom, 2014).

The CMAI assesses 29 agitated behaviors. The behaviors are divided into three groups: physical aggressive behavior (score range 11-77); physical non-aggressive behavior (score range 10-70); and verbal agitation (score range 8-56). The MDDAS is designed to be answered by caregivers based on observations of the participant, and is rated on three-point scale (3=never, 1=some times a week, and 0=never). The MDDAS has been used in several studies of older people and people with dementia (Nordgrem & Endstrom, 2014).

Results and Conclusions:

During the study period seven participants in the intervention group died and two moved away. In the control group, two participants died and three moved away. Intervention group changes were not significant. The author believes it could be because of a small sample size. Despite not much of a significant change some positive tendencies were observed: “The CMAI mean score for physical non-aggressive behaviors decreased from 18.5 at baseline to 15.3 at follow up immediately after the intervention (which indicated fewer symptoms). Mean and Median MDDAS scores for behavioral symptoms decreased from 15.3 and 13.5 respectively at baseline to 13.1 and 12.0 respectively at follow up immediately after the intervention. The CMAI mean score for verbal agitation increased significantly from 17.2 at baseline to 20.6 at follow up six months after intervention” (Nordgrem & Endstrom, 2014).

In conclusion, since dementia is a progressive incurable disease it is difficult to keep participants in the trials in order to get a clear picture if the intervention is in fact working. There are no general conclusions to make from this study although we can take some positive suggestions from it. DAI can be a positive alternative or a complement to pharmaceuticals to reduce behavioral and psychological symptoms in people with dementia. The author suggests, some issues need to be addressed in future studies, such as sample size (Nordgrem & Endstrom, 2014).

Personal Statement:

I agree with the author’s idea that DAI is a great intervention to use for people with dementia if they fit the qualifying criteria such as not being afraid of dogs, no dog allergies etc. This intervention would work best for individuals who have had pets (dogs) in the past and have had past happy memories that may be reminisced on. The author made an important point about expanding this study to a much larger sample size and could possibly benefit from a longer duration of the program. These patients can and will most likely develop bonds with these animals and if it is cut off within just 6 months’ time their behavior is likely to become worse due to sadness or depression.

I believe that dog-assisted intervention can be used in essentially all TR settings, with important criteria in place weeding out people with allergies and anxieties towards animals, because the bonds and love dogs in particular give people is incomparable. Dog assisted intervention can help a wide range of people with social skills, self-confidence, motivation, hygiene, self-care, motor skills, balance, movement, and healthy relationship skills amongst a few. I would like to see this intervention used with individuals with physical limitation in physical rehab. I believe the motivation to care for the dog will push the individual to realize they can surpass their own limitations.

References

Nordgren, L., & Engström, G. (2014). Effects of dog-assisted intervention on behavioral and psychological symptoms of dementia. Nursing Older People, 26(3), 31-38.

National Collaborating Centre for Mental Health (2007) Dementia: The NICE-SCIE Guideline on Supporting People with the Dementia and their Carers in Health and Social Care. www.scie.org.uk/publications/misc/dementia/dementia-fullguideline.pdf