factsheet – people living with dementia and pets
People living with dementia and pets
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While there are number of published studies involving people living with dementia and animal assisted therapy, this field of study is still relatively new and most investigations have been carried out in residential aged care settings.
However, the research does tend to suggest that people who owned and loved animals in the past gained significant benefits from animal assisted therapies.
The American Journal of Alzheimer’s Disease and Other Dementias published a paper ‘Effects of animal-assisted therapy on agitated behaviours and social interactions of older adults with dementia’ by Nancy E. Richardson (Volume 18, Number 6, November/December 2003). This paper reported on the findings of a (New England, USA) pilot study of 15 nursing home residents with dementia who participated in a daily animal assisted intervention for three weeks. The results “showed statistically significant decreases in agitated behaviours and a statistically significant increase in social interaction pre-test to post-test.”
This pilot program was developed on the understanding that agitated behaviours were indicators of unmet needs in people with dementia (rather than agitation being a symptom of dementia). Based on this theory and the results, it could be supposed that the intervention provided meaningful activity. The pilot found that during the study the nursing staff “often engaged the participants in conversation regarding the dogs that were about to visit and, without prompting, reminisced with the participants about past pets. The nursing staff was also overheard sharing stories of their own pets with the participants. Occasionally, staff from other areas of the nursing home came by to meet the dogs and spontaneously engaged in conversation with the participants … The intervention seemed to create an atmosphere of excitement and camaraderie for everyone involved.”
The paper noted specifically that: “…A crucial component of this pilot study was the participants’ noted past interest in or ownership of animals … Recent research with older adults with dementia has highlighted the importance of matching activity with interest to sustain involvement in activities; participants who are self-selected will receive the greatest benefit from an intervention. Having animals available for visits is a quality-of-life issue for residents in nursing homes, and residents who choose to participate … will derive the greatest rewards.” (p. 357)
An article published on The Alzheimer’s Information Site (www.alzinfo.org article from the Fisher Centre for Alzheimer’s Research Foundation), ‘Therapy Pets Prove Soothing to People with Alzheimer’s’ notes that a growing number of health and aged care facilities are working with trained therapy animals and that, “Having an affectionate pet visit during a hospital or nursing home stay can be especially beneficial, particularly for someone with Alzheimer’s disease … Studies at the University of Nebraska Medical Center College of Nursing show that even a short-term visit by a therapy dog to a nursing home can ease agitation in people with Alzheimer’s. The benefits may be particularly pronounced in the early evening, or ‘sundown’ period, when many people with Alzheimer’s tend to become agitated or confused.”
In Medicine and Health/Rhode Island ‘Behavioral Issues in Alzheimer’s Disease’ (Volume 85, No. 7 July 2002) doctors Janet Grace and Deborah Cahn-Weiner wrote that behavioural problems occur in a majority of Alzheimer’s disease patients, are associated with caregiver stress, and are strong predictors of institutionalisation and staff stress. They report on research that shows benefits of behavioural and cue-based interventions for patients with mild cognitive impairment, for example, using reminder notes, visual or verbal prompts. Such interventions supported the person with dementia to do things for themselves and so feel better about themselves. Training caregivers helped to reduce their perceived burden and encouraged them to seek help, so delaying institutionalisation. Common triggers of behaviour problems include fatigue; change of environment, routine, or caregiver; inappropriate stimulation levels; loss; internal or external demands exceeding functional capacity; and physical stressors such as pain, infection or illness.
The authors also noted other studies which have shown that “the presence of pets can increase social interactions … Benefits for mood and overall wellbeing have also been demonstrated … In terms of adverse effects, the loss of a pet may cause grief, but the impact of pet loss on AD [Alzheimer’s disease] patients has not been studied.” (p. 215)
The 36-Hour Day (Nancy L. Mace & Peter V. Rabins; 4th Edition, 2006; Johns Hopkins University Press) is frequently recommended reading for family carers of people with dementia. In the chapter on recreation, the authors say “If the person has always enjoyed animals, he may respond with delight to pets. Some cats and dogs seem to have an instinctive way with brain-impaired people.” (p. 77) In discussing meaningful activity, they stress the activities must be enjoyable “even if they are simple, such as petting the dog …” (p. 78).
The combination of pleasure and meaningful activity provided by pets is reinforced by the Alzheimer’s Association of Queensland, whose article “Activities to try” notes that “Pets are an important part of many people’s life. Not only are they good companions, but helping with their care can give the person a sense of usefulness, worth, and responsibility. Having a dog with a strong homing sense is a good pet to take for a walk for the person likely to wander and get lost on their own.” (www.alzheimersonline.org/alzheimers/activities/try.php)
A recent and widely publicised study published in the New England Journal of Medicine by geriatrician Dr David Dosa (July 26, 2007) led to the publication of the popular nonfiction book Making the Rounds with Oscar (Headline Review, 2010) by the same author. Oscar is a cat who has lived in the dementia unit of Steere House Nursing and Rehabilitation Centre, Providence, Rhode Island, since 2005 when he was a kitten. His claim to fame is that he can sense when a person is very close to death and will spend those last hours on the dying person’s bed, curled up close to them and seeming to comfort them. The report in the Journal of Medicine noted that “Thus far he has presided over the deaths of more than 25 residents … His mere presence at the bedside is viewed by physicians and nursing home staff as an almost absolute indicator of impending death, allowing staff members to adequately notify families. Oscar has also provided companionship to those who would otherwise have died alone.” (p. 329)
In Making the Rounds with Oscar (which is dedicated to ‘families and caregivers of dementia patients everywhere’) Dosa expands on the role of Oscar in the lives of the residents, families and staff at Steere House. The book is as much about people living with dementia as it is about this extraordinary cat – it provides a sympathetic an illuminating picture of dementia; its impact on family and carers, professional caregivers, and the affected individuals. Recalling a conversation with the son of one of his patients, Dosa writes:
“I asked Jack if he had any last thoughts about his experiences. He thought for a while before responding.
‘You have to learn to love the person they become and find moments of happiness in the little things,’ he said. ‘That’s why those animals at Steere House are so important. Dementia is all about comfort and distraction. I always felt OK about leaving my mother and Barbara because they had excellent care, each other, and they had their cats.’
“Standing at the doorway as I took my leave, I shook Jack’s hand. Before I could go, he offered one last thought.
‘You know, Oscar the cat was not just a distraction for my mother,’ he said. ‘He was my distraction as well.’” (p. 188)
The above examples of research involving the issues of people with dementia and companion animals are consistent with the findings of the focus group discussion facilitated by the Cat Protection Society of NSW with Hunter region community aged care sector workers (27 April 2010, Wallsend) as a part of the Community Pets Pilot Program.
Participants in the focus group identified:
- There is a balance of risks and positives that needs to be considered and training needs to be provided on how to manage these
- Risks to the pet include over/under feeding, lack of exercise for pet, keeping the animal confined to the property (e.g. client forgetting to shut gates and letting the dog roam free), forgetting to provide adequate water, forgetting the animal is there
- Many clients only have one visitor a fortnight which increases the risk of these things happening/not happening
- Risks to the client include dealing with pet food (one person put an unopened tin of food in the oven; risk of mistakenly consuming pet food); falls; young dogs not trained properly (and therefore developing inappropriate behaviours or aggression); unhygienic environment if cleanliness not maintained
- Positives include providing companionship and comfort
- One client would talk about their dog in the context of a previously owned dog (long since deceased) – this led to reminiscence which the care worker could use as a positive diversion therapy when the client’s behaviour became challenging
- One client had a daughter living next door and she would feed and look after the client’s dog. The client adored the dog and every occasion of encountering the dog provided a new delight; excellent diversion therapy and excellent for the client’s emotional wellbeing
- Pet ownership seems to encourage friends/neighbours/family to increase contact with the person – social contacts are maintained because the other people are concerned for the pet and also because it gives them a ‘reason’ to visit. Likewise, clients can be more receptive to receiving company because of the presence of a pet
- Pet ownership can provide motivation – the person understands the pet needs them and this provides them with purpose (this is an important factor for many pet owners, not just those with dementia).
This combination of evidence-based research and empirical observations suggests that there are positive benefits of companion animals to people with dementia who in the past owned and/or liked animals.
What does this mean for people with dementia and their pets in a community based setting?
Benefits of companion animals to people with dementia
- Research shows that behaviour therapy and memory cues can be used effectively for people with mild cognitive impairment so we can help people care for their pets with interventions such as reminder notes and pictures or diagrams
- Routine is beneficial for people with dementia
- Pets provide companionship and emotional support
- Caring for companion animals provides meaningful activity (purpose, self-worth)
- Companion animals can be used for reminiscence
- Companion animals can be used to distract a person who is agitated
- Companion animals increase social interactions
- The benefits are limited if caregivers are unsupportive
- The benefits are most likely for people who had a past interest in/ownership of companion animals
- Training caregivers can reduce their burden of stress.
Animal welfare issues
- Need daily fresh food and water (and walks for dogs)
- Need to be desexed, microchipped, and registered
- Need to be confined to the property
- Need clean place for toileting (kitty litter box that is regularly cleaned or garden that is kept free from faeces)
- Need to be in manageable numbers
- Need annual vet health checks and vaccinations
- Need to be regularly flea and worm treated
- Need to be regularly groomed (frequency depends on species and breed)
- Need contingency plans for when they can no longer be cared for in the home (either temporarily or permanently)
Care recipient welfare issues
- Suitability of the pet – untrained puppies and dogs, and unsocialised cats can present physical risk
- Risk of personal consumption/use of pet products
- Hygiene – if regular cleaning of litter is not undertaken, this will lead to inappropriate toileting by cats presenting a health hazard; dog fæces left in garden will present a health hazard; regular vacuuming to reduce fur/hair build up
- If pets are not kept healthy they can present risks to person e.g. parasites, ringworm
- Aggressive behavioural response by pet to aggressive or unusual behaviour demonstrated by person with dementia
- Risk of falls
Issues for care workers
- Conflict between duties: pet care versus person care
- Time and resource allocation
- Care workers who don’t like animals or who are afraid of animals or who are allergic to animals
- Infection control/cross-contamination – might need to do tasks in ‘wrong’ order (e.g. clean up after pet before preparing food)
- Physical risk from protective pets (e.g. cat or dog displaying ‘guarding’ behaviour).
Some solutions and ideas
Some challenges are great and some are smaller. Finding the time and resources to assist a person with dementia (or any person receiving aged care in the home) with pet care is not a primary (funded) task for care workers. Some organisations may be able to do this better than others – some will find it easier to match pet-friendly care workers with pet-owning clients; some will find the additional resources to assist, to a greater or lesser extent. It may be that it is a matter that needs a community response and identification of other service providers – voluntary or paid; human welfare or animal welfare – to fill the gap in helping people with pet care.
Meanwhile, there may be some relatively simple actions that could be useful in assisting a person with dementia with pet care.
Critical is identifying that pet ownership is a significant attachment and needs to be considered in person-centred care planning at the outset. Whether or not it will be possible for the care planning team to meet those needs does not discount the importance of its consideration.
Planning is the key: planning for the daily care of the animal; the weekly care; the monthly care; the yearly care; the future care. When there is a documented list of what needs to be done, when, how and by whom, there is a greater chance that it will be done – and when contingency plans are in place, ‘emergencies’ are manageable.
Animal Care Plan
For the person, an animal care plan supports routine; self-sufficiency; self-worth and meaningful activity. For the animal, it supports their health and welfare (and animals also benefit from routine). For caregivers, it makes assisting the pet-owner with pet care so much easier.
At the outset, it is important to make sure the animal is desexed, microchipped, and registered. If the pet is not desexed, this will lead to behavioural problems in the animal and unwanted litters of puppies or kittens. Microchipping and registration are legal requirements (under the Companion Animals Act) and ensure that lost pets can be reunited with their owners. All these important papers, plus other vet documents such as vaccination certificates, should be kept in one secure file.
Annual vaccination is an important part of contingency planning, as most boarding facilities/kennels require evidence of current vaccination before an animal will be accepted for boarding.
A list of emergency contacts – for veterinary care and for emergency boarding – should be kept on file and by the phone. Contingency arrangements (e.g. boarding; neighbour to care for pet) for temporary care should be documented, as well as arrangements for permanent care should the person no longer be able to care for their pet (e.g. permanent placement with family member; rehoming; pound or shelter). For more information see our factsheet Planning for Your Cat.
All pet items including food, flea & worm treatments, grooming implements, etc. should be stored in one secure place with perhaps a picture of the pet on the outside to indicate where it is. Depending on the person’s cognitive capacity, this storage may need to be locked.
Signs/pictures reminding to ‘close the gate’ should be placed on any gates outside the property; similarly ‘close the door’ inside.
The care plan should be simple and include:
- A daily health care chart noting what needs to be done on a daily basis (food, water, walks for dogs, disposing of droppings from garden/litter box)
- Weekly – kitty litter change; check collar & lead are in good condition
- Monthly – flea and worm treatment; grooming (may need to be more frequent depending on breed)
- Yearly – vet check up and vaccinations
For a sample care chart, see our factsheet Assisting with Pet Care.
In an ideal situation where the care recipient has a good network of friends, neighbours, or relatives, these people could be put on a roster to assist with pet care. They should be made familiar with the requirements of the health care plan and know where the pet/s’ documents and supplies are stored, and then they can actively engage with the pet owner in ensuring the best possible outcomes for the person and their pet.
The Cat Protection Society of NSW gratefully acknowledges the support of the Australian Government Department of Health and Ageing for funding assistance with the Pets and Community Care Pilot Program.
While all care has been taken in preparing this document, it is intended to provide general information only and should not be taken as constituting professional advice. Mention of a product or business does not mean endorsement by Cat Protection.