Canine-Assisted therapy and quality of life in people with Alzheimer-type dementia: pilot study

Abstract

According to the World Health Organization (WHO), dementia affects approximately 47.5 million people in the world, and 7.7 million new cases are diagnosed every year (World Health Organization, 2018). In the period 1990–2008, around 600,000 people in Spain were diagnosed with dementia, of whom 400,000 were diagnosed with Alzheimer’s disease (De Pedro-Cuesta et al., 2009), exerting a significant impact on families, costs, and health and welfare services. As indicated by the Director-General of the WHO, Tedros Adhanom Ghebreyesus, the prevalence of dementia is an alarming problem throughout the world, and as a result, “we must pay more attention to this growing challenge and ensure that all people living with dementia, wherever they live, receive the care they need.” The goal of the Global Action Plan on the public health response to dementia 2017–2025 (World Health Organization, 2018) is to improve the lives of people with dementia, their careers, and families, while decreasing the impact of dementia on communities and countries, which represents a major challenge due to worldwide population aging. Alzheimer’s disease is defined clinically by causing dementia and corresponds to 50–60% of all dementias, being the most prevalent (Alameda et al., 2012; Claassen, 2015). No curative treatment is currently available and the disease generates high healthcare, social, and family costs (Leon-Salas and Martínez- Martín, 2010). Correct diagnosis permits identification of the treatable causes of dementia, where these exist, or the possibility of slowing the process in other cases (American Psichiatric Association, 2002; Costa and Castiñeira, 2016). It is essential to establish a suitable therapeutic plan (pharmacological and nonpharmacological) in order to maintain independent functioning for as long as possible and safeguard the quality of life of patients, their family members, and caregivers through participation and engagement in stimulation, help, and support activities (Flynn and Roach, 2014; Hu et al., 2018). Non-pharmacological approaches include therapy for patients and their families, associations for patients’ relatives, day care centers, and various economic subsidies, all aimed at providing comprehensive care for patients while mitigating the physical and psychological fatigue associated with caring for a person with dementia (Patel et al., 2014; Casey et al., 2017). Tom Kitwood (Kitwood, 1997) developed the concept of “personcentered care for people with dementia” based on the idea that besides neurological damage, dementia treatment should also target aspects such as the personality, history, health, and social environment of each person. Studies conducted using this model in patients with Alzheimer-type dementia (ATD) have found that it helps maintain quality of life for a longer period of time (Sjögren et al., 2012; Yakimicki et al., 2018). This approach includes animal-assisted therapy, defined as “an intervention in which an animal is incorporated as an integral part of the treatment process, in order to promote an improvement in physical, psychosocial, and/or cognitive functioning of the person treated” (Delta Society, 1992). Other studies have used technological elements such as robots with an animal appearance, since some patients and workers may be scared of, allergic to, or averse to animals, which would hinder implementation of such therapies (Valenti Soler et al., 2015; Moyle et al., 2016). The few studies that have used dogs with subjects with dementia have obtained positive results as regards quality of life, finding an improvement in physical, behavioral, and psychological symptoms (Sellers, 2005; Moretti et al., 2011; Nordgren and Engström, 2012, 2014; Olsen et al., 2016; Tournier et al., 2017). However, most studies in the literature reviewed were conducted with patients with mild to moderate dementia, and there is little information available on patients with severe dementia. In line with the person-centered care model, which values all people as individuals with a unique history, is committed to promoting their independence, and recognizes the influence of their social environment and the importance of support available to them (McCormack, 2004; Nolan et al., 2004), the aim of the present study was to determine whether canine-assisted therapy maintained or changed the quality of life of people with severe ATD over time. And the hypothesis “The intervention program in Dogs Assisted Therapy (TAP), increases the quality of life of people with dementia.”