Review of the literature produced for the Korian Foundation for Ageing Well by Jan Chrusciel (public health doctor), Aude Letty (general delegate of the Korian Foundation), Didier Armaingaud (Korian group medical, ethics and quality Director), Paul-Emile Haÿ (Korian France senior medical Director) and Stéphane Sanchez (public health doctor at Troyes hospital).
The interest of IAAs in nursing homes
EFFECT ON COGNITIVE FUNCTIONS
A Japanese study of 10 patients with cognitive disorders of various etiologies showed an improvement in cognitive functions after six months of an intervention by volunteers assisted by dogs, with an impact on activities of daily living in some patients.
However, the organic and progressive nature of cognitive disorders does not allow us to hope for such an improvement in the majority of cases. In fact, several studies have not shown any significant difference before and after an IAA using the MMSE (Mini-Mental State Examination) and MOSES (Multidimentionnal Observation Scale for Elderly Subjects) scores.
EFFECT ON BALANCE AND AUTONOMY
A Norwegian randomised study showed a decrease in the risk of falling in elderly people with cognitive impairment participating in an animal-assisted activity programme. The activity consisted of bi-weekly 30-minute sessions for 12 weeks during which group participants could play with, wash and feed a dog under the supervision of a dog handler.
IAAs have a stimulating effect on the elderly person and lead to an increase in their motor activity, thus providing them with additional resources to support themselves.
Supervised participation in these IAA activities would increase self-confidence and encourage a return to social activities. It would thus enable residents of nursing homes to exchange more with each other and to become more involved in their environment.
EFFECT ON FEELINGS OF LONELINESS AND SOCIAL ISOLATION
It has been well established that IAAs reduce the feeling of loneliness of residents who are more inclined to communicate in the presence of an animal, even after it has left.
The resulting improvement in interpersonal relationships may facilitate the work of facility staff, creating a climate favourable to the therapeutic relationship.
EFFECT ON ANXIETY AND BEHAVIOUR
Two studies were carried out in order to verify the impact of an IAA with a cat or a dog on 7 patients (5 with Alzheimer's disease and 2 with cognitive disorders) compared to a control group of 20 patients with cognitive disorders but also on 58 elderly patients hospitalised in a psychiatric unit.
They revealed a decrease in the scores for aggressiveness, anxiety and care burden, but also a decrease in the tendency to irritable behaviour.
A study including 10 patients suffering from a severe form of Alzheimer's disease also showed a decrease in anxiety following a dog-assisted intervention.
EFFECT ON DEPRESSIVE SYMPTOMS, SOCIAL RELATIONSHIPS AND QUALITY OF LIFE:
A study by Bernabei (2013) showed a decrease in depression scores on the GDS (Geriatric Depression Scale) following an IAA. This result should nevertheless be taken with caution as the scores were also decreased in the control group and the comparison between groups did not reach significance.
A multi-centric randomised study by D'Olsen et al (2015) showed that a 12-week dog-assisted intervention had a positive effect on the quality of life of patients suffering from dementia, with a persistence of the effect 3 months after the intervention...
Group activities involving a dog could thus improve the well-being and quality of life of residents with cognitive impairments. In this context, the animal could be a resource allowing the person to respond to their need to communicate while improving interactions between residents.
Some studies even show an improvement in language or a decrease in inappropriate behaviour.
Real or robotic animals
Robotic animals are designed to interact in a similar way to real animals. They are not subject to certain disadvantages associated with them such as the need for a qualified attendant, allergenic potential, hygiene problems, risk of infection or cost of living. The ability of robotic animals to interact with the environment is evolving, in particular thanks to recent advances in artificial intelligence.
Although the literature on the use of robotic animals is still in its infancy, it seems to show similar effects to real animals. Indeed, a controlled trial conducted in Australia shows the potential of a robotic animal to stimulate and capture the attention of residents without, however, showing differences in agitation scores. Interventions using the Paro robot have also shown an effect on verbal communication and quality of life at least in the short term.
Several studies even suggest an improvement in mood among nursing home residents.