Animal assisted interventions in dementia: effects on quality of life and neuropsychiatric symptoms.

Dementia is a very challenging disease, with severe impact on both the person
and his or her family. The cognitive and functional decline is usually
accompanied by neuropsychiatric symptoms like agitation, aggression, apathy and
anxiety. Carers are often struggling to connect with people with dementia in a
meaningful way. The quality of life of people with dementia is often diminished
and very difficult to influence. Nowadays professionals are more inclined to
use complementary interventions (like music therapy) in dementia care. Animal
assisted interventions are a complementary intervention in which animals are
used to influence internal and external factors of specific target groups, like
children with autisme or people suffering from PTSS syndrome. Research shows
that animals have a positive effect on basic human needs like (physical)
contact, social interaction and support, feeling needed and useful, attachment,
stress reduction, self-esteem and internal motivation. It is also known that
stroking dogs has a positive influence on blood pressure and hormonal status.
There is no reason to assume that these psychological and physiological effects
will be different for people with dementia. On the contrary, compared to
humans, animals have several advantages that might be additionally beneficial
to people with dementia. Especially the non-verbal communication, the
unconditional attachment, the stimulation of multiple senses (in dementia care
also known as 'snoezelen') and the attractiveness as a stimulus are important
animal qualities in the interaction with people with dementia. Anecdotal
information from nursing homes indeed shows effects along these lines, yet
unfortunately systematical, methodologically sound research is lacking. This
study aims to provide in this hiatus and to contribute to establishing animal
assisted interventions as an meaningful complementary intervention in dementia
care.

The objective of this study is to determine the effects of protocolled
interventions with a visiting dog or FurReal Friend (robotic toy animal) on
quality of life and neuropsychiatric symptoms in patients with dementia.

The study design is a mixed-methods randomised controlled trial. Due to the
nature of the study blinding is not possible.

Participating clients are randomly divided in three groups:
- a controlgroup with a protocolled regular social intevention (drinking
coffee), once a week.
- a group with a protocolled intervention with dogs, once a week.
- a group with a protocolled intervention with a robotic toy animal (FurReal
Friend Lulu), once a week.
The protocolled aspect of the interventions consists of a specific, recurrent
protocol of introduction and supervision. This means that all clients are
situated in a circle and the intervention (dog/Lulu) is introduced to each
client individually. Each client is asked what he/she wants to do with the dog
or Lulu (e.g. pet, stroke, watch, play) and this is repeated in a circular
pattern. In the control group clients also sit in a circle while drinking
coffee (or something similar) and are also addressed individual in turn.
The intervention will run for 8 weeks, followed by a 4 week follow-up period
without intervention. The total duration of the study is 12 weeks.

All participating clients in the intervention groups will be enrolled in a
weekly activity with a duration of 45 minutes, during 8 weeks. Subsequently,
when possible depending on dementia stage and symptoms, they will be subjected
to blood pressure measurements 2 times a week, weight measurement once a week
and a once-only interview.
All other measurements are done by proxy via the designated formal carers.
Clients in the dog group risk being bitten or scratched or the transfer of
zoonotic diseases. These risks are minimized by using specifically trained and
selected dogs only, that are all fully vaccinated, treated for parasites en
have regular veterinary checkups. Furthermore, all dog handlers are
specifically trained in working with people with dementia and in recognizing
stress signals in their dogs. A diversional therapist will be present at all
times to monitor the welfare of the clients.