Living With Dementia

​In Long Term Care Homes


Wellness Care Farm

Julie Casey MSW, RSW

Nourishing Hearts

Program  Description

The Animal Assisted Therapy - Dementia Behavioural Support Program (AAT-DBSP)  is a clinical therapeutic nonpharmacological intervention (NPI) that works with diverse species of farm therapy animals to provide reminiscent, motor and multisensory stimulation as strategy to prevent, reduce or eliminate need-driven, dementia-compromised responsive behaviours (NDB) with the overall aim to improve the wellbeing and quality of life of long term care facility residents living with dementia. The AAT-DBSP works in collaboration with the dementia care system that creates environments where each person is seen as a unique and special human being with a rich history and is treated with dignity, respect and love.

Target Population

The ATT-DBSP is designed as  a nonpharmacological intervention that targets individuals who have diminished life skills due to dementia. Diminished life skills include social withdrawal; poor short and long term memory; reduced communication skills; and impaired spatial concepts. Individuals with diminished skills may be exhibiting behavioural and psychological symptoms of dementia (BPSD), which include apathy, vocalizations, aggressive behaviour, restlessness, wandering and intrusion.  The individuals most likely to benefit from the AAT-DBSP are individuals who have previously enjoyed looking after or being around animals; who express interest or enjoy looking at, walking, stroking or brushing the animals; who are in need of reminiscent, motor and multisensory stimulation;  who have no serious animal allergies, fears, intense dislikes; or history of being abusive toward animals.  

Evidence Based Approach for AAT and Dementia


Animal Assisted Therapy as Non Pharmacological Behavioural Support

Humans and animals have evolved together through domestication and farming practices (Olmert, 2009).  During this human-animal engagement, researchers have discovered the production of the human oxytocin hormone which has widespread neurological, biological, emotional and social effects, including attachment, trust and social processing, while also decreasing anxiety, stress and aggression (Netherton & Schatte, 2011). By stimulating the parasympathetic nervous system, oxytocin calms  the fight-flight-freeze stress response, reducing the secretion of cortisol, aldosterone and adrenaline, while also increasing pain tolerance, lowering blood pressure, increasing vagal tone, decreasing inflammation, improving wound healing, facilitating learning, and lowering anxiety (Chandler, 2012).

Animal Assisted Therapy Studies with  Individuals Living With Dementia

AAI is increasingly been researched as a therapy to help ameliorate the symptoms and impact of dementia for individuals living in long term care facilities. According to Bernabei, Ronchi, Ferla, Moretti, Tonelli, Ferrari, Forlani and Atti (2013) seven of the ten AAI studies investigating the impact on BPSD, demonstrated positive results.  Nordgren and Engstrom (2013) reported participants were filled with joy and well-being and indicated AAI effects can be an effective method to promote quality of life for people living with dementia. Majic, Gutzmann, Heinz, Lang and Rapp’s  (2013) research results exploring the impact of AAI on agitation and depression symptoms of residents with dementia, found the therapy to enhance social behaviours; stating AAT was “a promising option for treating symptoms of agitation/aggression and depression in elderly demented nursing home residents” (p. 1058).  Richardson’s  (2003) pilot study tested the AAT intervention’s effect on agitated behaviours and social interactions of older adults with dementia. Although the study was not randomized and the sample size was small;  making the results ungeneralizable, the results are promising. The outcomes indicated the AAT interventions can decrease agitation behaviours of persons with dementia. Sellers (2005) evaluation of an AAT intervention for elders with dementia in LTC facilities also demonstrated a decrease in agitated behaviours during AAT intervention. Once again, research is suggesting AAT interventions may be a viable non pharmacological intervention to decrease BPSD. According to Filan and Llewellyn-Jones (2006), current literature indicates AAT interventions for dementia has possible benefits but many factors remain unclear regarding optimal duration, dose response and cumulative effect and requires further investigation.

Animal Assisted Therapy as a Dementia Behavioural Support Intervention

Nourishing Hearts Animal Assisted Interventions provides an Animal Assisted Therapy - Dementia Behavioural Support Program (AAT-DBSP) for residents living in LTC homes in  the counties of London-Middlesex, Elgin, Oxford and Halderman-Norfolk. The AAT-DBSP is a clinical therapeutic nonpharmacological intervention (NPI) that works with diverse farm species of therapy animals to provide reminiscent, motor and multisensory stimulation as strategy to prevent, reduce or eliminate need-driven, dementia-compromised responsive behaviours (NDB). The AAT-DBSP works in collaboration with the dementia care system that creates environments where each person is seen as a unique and special human being with a rich history and is treated with dignity, respect and love.

Motor and  Multisensory Stimulation

According to Cruz, Marques, Barbosa, Figueiredo and Sousa (2011) with the progression of dementia, there is a lack of appropriate environmental, sensory and social stimulation which causes a simulation deprivation that leads to continued deterioration of motor and sensory skills. Motor stimulation are specific exercises to improve mobility and delay the decline of activities of daily living. AAI activities such as the petting, grooming and walking of the therapy animal, provides meaningful and motivating movements.  Multisensory stimulation are activities that stimulate the senses without the need for higher cognition which helps to reduce behaviours and apathy while also increasing alertness and engagement. Human-animal interaction provides visual, olfactory, auditory and tactile stimulation through direct and indirect contact.

Reminiscence  Therapy


Reminiscence therapy according to Kim, Cleary, Hopper, Bayles, Mahendra and Azuma (2006), is the process of recalling personal experiences from the past and because with dementia there is a greater preservation of remote rather than recent memories; the act of reminiscing can improve function by “decreasing demands on impaired cognitive abilities and capitalize on the preserved ones” (p. 1). AAI provides opportunity to stimulate remote memories of companion pets, animals of all types and farm experiences. The stimulation and sharing of past memories is done through talking, visual augmentative communication tools, as well as art, music and trivia activities.

Aging Population in Ontario and Agriculture Connection

Ontario is a major agricultural region of Canada, possessing just over half of the country’s best agricultural land (Encyclopedia Britannica, 2016) and 90% of those farms are located in southern Ontario (Southern Ontario Tourism, 2015). Livestock farming includes cows, pigs, sheep, goats, chickens and other various fowl. Direct and indirect exposure to farming and diverse livestock is a common experience of living in southern Ontario. The older the population the more direct experiences with farms either from adult farming experiences and/or childhood memories. Farming is a nature based activity and research indicates nature can be healing for people; offering many emotional, mental, physical, social and spiritual benefits. According to Davis and Atkins (2004),“Recent studies have suggested that spending even small amounts of time in a natural environment can improve an individual’s attention span, mental clarity, and physical and emotional well-being” (p.214). Even if individuals did not have a direct experience with farming, Olmert (2009) states, there is still a part within humans as a species, that wants to be back on the farm and is evident in the increasing demand for “farm life” experience being offered to the public as a theme parks. The AAI with farm animal species as therapy animals,  brings the “farm-like” experiences and therapeutic benefits to the LTC homes.

The Appropriateness of Farm Animal Species as Therapy Animals

Although dogs are the most common therapy animal species (Chandler, 2012),  Chimo Animal Assisted Therapy (2015) explains there is no best animal for use in Animal Assisted Therapy (AAT) because different species bring different strengths, it is up the therapist’s use of their skills to identify and incorporate appropriate therapy animals into a treatment session; stating “the truth is that many types of animals can be used in AAT, and a well-qualified therapist will be able to direct the session, while encompassing the animal’s behaviour, to best benefit the client” (para. 2). This perspective is supported by Chandler (2012),  “any farm animal is appropriate for therapy as long as it is healthy and not aggressive” (p. 72). The therapeutic benefits of farm animals have been recognized but have historically been associated with care farming rather than AAT specifically. Berget, Ekeberg and Braastad (2008) studied the impact of AAT with farm animals for persons with psychiatric disorders, with the results indicating increased coping abilities of the participants following the AAT intervention.  Mallon (1994) study of the therapeutic benefits of farm therapy animals at Green Chimneys, a residential behavioural treatment centre for children indicated farm animals were beneficial component to overall treatment plan.  For residents living with dementia, farm therapy animals have the potential to provide remote farm memory stimulation and attends to the common and calming human experience that is drawn to the farm.

Care Farming

Care farming is an up and coming yet historically grounded, innovative therapeutic use of farming practices. Care farms provide health, social or educational care services for individuals from one or a range of vulnerable groups while providing supervised, structured program of farming-related activities.
Care farming is showing promising therapeutic benefits 
for people living with dementia and mental health challenges. Regular attendance and participation in activities and chores at a dementia-friendly Care Farms could enable people with dementia to realize a number of health, functional, psychological, social, and spiritual benefits. The variety and naturally integrated qualities of Care Farms promote the well-being and health of participants with dementia (Eilon Caspi Ph.D., 2015).
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References

Berget, B., & Braastad, B. O. (2011). Animal-assisted therapy with farm animals for persons with psychiatric disorders. Annali Dell'Istituto Superiore Di Sanità,47(4), 384-390.

Bernabei, V., De Ronchi, D., La Ferla, T., Moretti, F., Tonelli, L., Ferrari, B.. . Atti, A. R. (2013). Animal-assisted interventions for elderly patients affected by dementia or psychiatric disorders: A review. Journal of Psychiatric Research, 47(6), 762-773.

Caspi, Eilon, (2015).Potential Therapeutic Benefits of Participation of People with Dementia in Care Farms. Dementia Behavior Consulting LLC. Retrieved from:http://dementiabehaviorconsulting.com/?attachment_id=583

Chandler, C. K. (2005). Animal assisted therapy in counseling. New York: Routledge.

Chimo Animal Assisted Therapy. (2015). What types of animals are used in ATT? Retreived from http://www.chimoproject.ca/chimo/2011/05/10/what-types-of-animals-are-used-in-aat

Cruz, J., Marques, A., Barbosa, A. L., Figueiredo, D., & Sousa, L. (2011). Effects of a motor and multisensory-based approach on residents with moderate-to-severe dementia. American Journal of Alzheimer's Disease and Other Dementias, 26(4), 282-289.

Davis, K. M. & Atkins, S. S. (2004). Creating and teaching a course in ecotherapy: We went to the woods. Journal of Humanistic Counseling, Education, & Development, 43(2), 211-218.

Encyclopedia Britannica.( 2016) Ontario. Retrieved from http://www.britannica.com/place/Ontario-province

Filan, S. L., & Llewellyn-Jones, R. H. (2006). Animal-assisted therapy for dementia: A review of the literature.International Psychogeriatrics, 18(4), 597-611.

Hanrahan, C., (2013). Social work and human animal bonds and benefits in health research: A provincial study. Critical Social Work, 14(1).  Retrieved from http://www1.uwindsor.ca/criticalsocialwork/SWhumananimalbonds

Kim, E. S., Cleary, S.J., Hopper, T., Bayles, K. A., Mahendra, N., Azuma, T., & Rackley, A. (2006). Evidence-based practice recommendations for working with individuals with dementia: Group reminiscence therapy. Journal of Medical Speech-Language Pathology, 14(3), xxiii-xxxiv.

Kolanowski, Ann M ,PhD., R.N. 1999. An overview of the need-driven dementia-compromised behavior model. Journal of gerontological nursing 25, (9) (09): 7-9.

Majić, T., Gutzmann, H., Heinz, A., Lang, U. E., & Rapp, M. A. (2013). Animal-assisted therapy and agitation and depression in nursing home residents with dementia: A matched case-control trial. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 21(11), 1052-1059.

Mallon, G. P. (1994). Cow as co-therapist: Utilization of farm animals as therapeutic aides with children in residential treatment.Child & Adolescent Social Work Journal, 11(6), 455-474.

Netherton, E., & Schatte, D. (2011). Potential for oxytocin use in children and adolescents with mental illness. Human Psychopharmacology: Clinical and Experimental, 26(4-5), 271-281.

Nordgren, L., Engström, G., Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala universitet, & Centrum för klinisk forskning i Sörmland (CKFD). (2014). Animal-assisted intervention in dementia: Effects on quality of life. Clinical Nursing Research, 23(1), 7.

Olmert, M. D. (2009). Made for each other: The biology of the human-animal bond. Cambridge, MA: Lifelong Books/Da Capo Press.

Richards, K. C. and Beck, C. K. (2004), Progressively Lowered Stress Threshold Model: Understanding Behavioral Symptoms of Dementia. Journal of the American Geriatrics Society, 52: 1774–1775. Retrieved from http://onlinelibrary.wiley.com.proxy1.lib.uwo.ca/doi/10.1111/j.1532-5415.2004.52477.x/pdf

Richeson, N. E. (2003). Effects of animal-assisted therapy on agitated behaviors and social interactions of older adults with dementia. American journal of Alzheimer's disease and other dementias, 18(6), 353-358.

Sellers, D. M. (2006). The evaluation of an animal assisted therapy intervention for elders with dementia in Long-term care.Activities, Adaptation & Aging,30(1), 61-77.

Southern Ontario Tourism. (2015). Agriculture in Ontario. Retrieved from http://www.soto.on.ca/history_of_ontario/agriculture_in_ontario.html

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