The impact of different dog-related stimuli on engagement of persons with dementia.

Nursing home residents with dementia often lack the skills needed for successful communication, with the result being that social interactions become limited. In fact, Cohen-Mansfield et al1 found that nursing home residents with dementia were alone during 22% of their waking hours. One way to promote social interactions in the nursing home is through animal-assisted therapy (AAT),2,3 which involves interaction with a trained animal facilitated by a human handler. Outcomes of AAT include providing relaxation and pleasure or providing rehabilitation.3 Animal-assisted therapy is well suited for nursing home residents with dementia as it provides social interaction that is not dependent on the resident’s level of cognitive functioning; that is, a dog will provide companionship regardless of a resident’s state of awareness. A dog is a nonjudgmental listener and would not react negatively to hearing repetitions of the same phrase or story. The literature contains many anecdotal reports of positive results from AAT in persons with dementia as well as some published findings from controlled studies. When comparing a group of 7 persons in a closed psychiatric ward (6 with dementia, 1 with schizophrenia) with matched controls, Walsh et al4 found that the presence of a visiting dog resulted in fewer loud or aggressive outbursts (such that the noise level on the unit was lower) as well as a reduction in heart rate (suggestive of a calming effect) in the experimental group. The study participants reverted to their former behaviors after the dog was removed. In an experimental, within-participant repeated-measures design, Churchill et al5 studied persons with dementia who manifested increased agitated behavior in the evening hours (“sundown syndrome”). Study participants were observed during 2 conditions—dog with researcher and researcher alone (control condition). Analysis revealed that the frequency and duration of socialization behaviors (eg, leans, smiles, looks toward, tactile contact, and verbalization) increased and agitation decreased in the presence of the dog relative to the control condition. The authors reported that interaction with the dog was linked with less confusion and served to stimulate reminiscence and memories, distracting the participant from agitation during the sundowning hours. Other investigators have corroborated the findings of Churchill et al5 in other samples of nursing home residents with dementia, reporting increases in socialization and decreases in agitation as a result of AAT.6–10 Additionally, AAT has been reported to improve apathetic state11 and improve emotional well-being12 in nursing home residents with dementia. A link between study participants’ past interest in or ownership of animals and positive outcomes has been reported.8, 13 As it is not always practical to bring live animals to nursing homes, some researchers have focused on robotic animals or plush animals (also called stuffed animals) for their residents. In 2004, Libin and Cohen-Mansfield14 compared an enhanced robotic cat (NeCoRo) to a plush cat in a study of 9 agitated nursing home residents with dementia. Statistically significant decreases in agitation (relative to baseline) were seen with the plush cat, and a similar trend was seen with the robotic cat. In addition, statistically significant increases in interest and pleasure were found with the robotic cat, and while test statistics for the plush cat were not significant, the authors reported a trend in the same direction. Tamura et al15 compared a metal robotic dog (AIBO) with a plush motor-driven toy dog in a group of 13 persons with severe dementia in a geriatric health care facility. Statistical analyses were not provided for this study; however, results suggest that the study participants responded to both dogs with social behaviors (eg, talking, watching, clapping, touching, and caring for the dog), with more of these behaviors being directed at the plush motor-driven toy dog. In addition, fewer interventions on the part of the occupational therapist were observed with the plush motor-driven toy dog than with the metal robotic dog. Recently, in a group of nursing residents with neither cognitive impairment nor a diagnosis of Alzheimer’s disease, AIBO was compared with a live dog and results showed that AAT with either led to similar improvements in loneliness relative to a control group.16 Banks et al16 noted that some residents and staff were initially reluctant to interact with AIBO but that this resistance dissipated with exposure. The present study focused on dogs and was conducted to provide further empirical evaluation of AAT in a group of 56 nursing home residents with dementia. Filan and Llewellyn-Jones,3 in a literature review of AAT for persons with dementia, noted that the AAT studies in nursing homes to date have been limited by small sample sizes (ranging from 7 to 28 persons; 1 study included 62 persons). We included a standard poodle as well as 2 miniature schnauzers (one was 11 pounds and the other was 25 pounds) in our study because it is conceivable that residents may have a preference for a dog on the basis of size. As some residents may be afraid or allergic to dogs, we also included a variety of dog-related stimuli—a plush dog, pictures of dogs to color with markers, a robotic dog, and a puppy video—and evaluated the engaging value of these stimuli. In addition, we looked at the influence of a past preference for dogs on our response measures. Indeed, it has been shown that interventions based on past identity roles result in greater interest, pleasure, and involvement than the typical structured activities for residents with dementia.17