P APER 3

‘Effect of animal-assisted activity on balance and quality of life in home-dwelling persons with dementia’

Background and aim: Functional ability, which is the intrinsic capacity of the individual and the ability to social, psychological, and physical interaction with the environment, is the key for living good independent lives throughout a life-course and obtain a high quality of life. Balance is a central function in most activities of daily living, and as there is a goal that persons with dementia live at home as long as possible, there is a need for activities that might preserve balance and quality of life. The main aim of Paper 4 was therefore to examine if there would be an effect of animal-assisted activity in home-dwelling persons with dementia attending day-care centres on

73

factors related to risk of fall accidents, with balance and quality of life as main outcomes.

Methods: The study was conducted as a prospective and cluster-randomized multicentre trial with a follow–up. A total of 16 adapted day-care centres for home-dwelling persons with dementia were randomized to either animal-assisted group activity with a dog or a control group with treatment as usual. There were a total of 80 participants included, 42 in the intervention group and 38 in the control group. The intervention consisted of a 30-minute session with animal-assisted activity with a dog twice weekly for 12 weeks in groups of 3-7 participants, led by a qualified dog handler. The idea behind the intervention was that the participants’ physical functions would be enhanced by doing different physical tasks such as bending down, reaching out, lifting their arms, and throwing a ball. Trained health care workers collected sociodemographic data for age, gender, education, use of walking aids, social contact, hobbies, and animal contact sociodemographic data, and scored degree of dementia (CDR), balance (BBS) and quality of life (QUALID) at baseline. BBS and QUALID were also assessed at post-test (after 12 week of intervention), and at follow-up (12 weeks after end of intervention).

Mixed model analyses were used to investigate changes over time and differences between the groups (intervention and control group) in the outcome measures. See section 2.6.6 for detailed description of statistical analysis.

Results: Mean age in the intervention group were 84.00 (SD = 6.6) and mean age in the control group were 81.7 (SD = 7.2). It was a significant positive effect of the animal-assisted activity intervention on balance from baseline to post-test (p = 0.03). The results were also clinical significant, as 39.4% in the animal-assisted activity group improved at least 6.5 points in the BBS.

In addition, the average increase in BBS in the animal-assisted activity group of 3.16 points, suggests approximately 20% reduction in fall risk. The improvement in BBS was maintained at follow-up. No effect of the intervention was found on quality of life, however, we found a strong association between clinical improvement on the BBS and improvement in QUALID from pre-test to post-test.

Conclusion: The results indicate that animal-assisted activity might have useful clinical implications by leading to improvements in balance and thereby preventing risk of falls.

74

3.4. Paper 4

‘Engagement in elderly persons with dementia attending animal-assisted group activity’

Background and aim: The high amount of neuropsychiatric symptoms in persons with dementia and the need for meaningful activities that enhance engagement is very important, both for persons with dementia still living at home, as well as for persons with dementia admitted to a nursing home. The aim of the study was therefore to systematically map different behaviours occurring in an animal-assisted group activity with a dog, and investigate if this kind of intervention would create engagement among persons with dementia still living at home and among persons with dementia admitted to a nursing home. We also wanted to see if the intervention would have different impact on engagement among participants in the two residencies.

Methods: Only data from the intervention groups were used in the study. In total, 21 (13 women) persons with dementia in nursing homes and 28 (13 women) home-dwelling persons with dementia attending a day-care centre received animal-assisted group activity with a dog. The participants interacted with a dog and its handler for 30 minutes, twice a week for 12 weeks. A protocol was deliberately designed to be able to standardize the intervention as much as possible, both across sessions and across the different institutions. Video recordings were carried out, and behaviours were categorized by the use of an ethogram.

Analysis of variance (ANOVA) was used to test the differences in means between groups (nursing home participants and participants at day-care centre). See Section 2.6.7 for detailed description of statistical analysis.

Results: Behaviours targeted to either the dog or other people were the ones with highest mean percentage time. These behaviours were: Look at dog-activity; Smile or laugh at dog;

Conversation; Look at other people; Touch dog; Do activities with the dog; Touch people; Smile or laugh to people. Furthermore, mean values showed that actions towards the dog, such as observing it, smile, talking to it or petting it, were the behaviours with the longest duration in animal-assisted activity sessions in both populations. There was a high amount of attention to

75

the dog (looking at it), a positive attitude (smiles/laughs), a lot of action (touching the dog, do activities), and a positive affect (high amount of positive behaviour and low frequency and duration of negative behaviour) was found.

There were no significant differences between nursing home participants and day-care centre participants regarding age, gender, education level, use of walking aids, or whether the participants enjoyed having contact with animals. Mean age among persons with dementia in nursing homes were 84.8 (SD = 5.9), and mean age among home-dwelling persons with dementia were 84.1 (SD = 6.2). There were only minor differences in behaviour between nursing home participants and day-care centre participants.

When comparing the participants stratified by the degree of dementia (CDR), we only found a few differences in behaviours. Participants with severe dementia slept significantly more (F = 6.60, p = .003) than those with mild or moderate dementia, and they spent significantly less time (F = 6.74, p = .003) looking at the dog-activity than those with mild or moderate dementia.

Conclusion: Animal-assisted activity seems to create engagement and a positive affect in persons with dementia, and might be a suitable and health promoting intervention for both nursing home residents and participants of a day-care centre. For persons with severe dementia it should be considered which is more suitable, individual or group-based animal-assisted activity.

76

77