The Benefits of Animal Assisted Family Visits:
AAT is an adjunct to social work practice in long term care, creating an innovative approach to support both residents and families during visitations. Animal-Assisted Family-Based Therapy facilitates effective family visits with residents living with dementia, by providing an oxytocin surge to calm the parasympathetic nervous system; creating a calm and relaxing environment for structured family visit activities that provide motor, multisensory and reminiscent therapy, while stimulating remote memories for meaningful conversations and interactions. During this facilitated visit, the social worker can address communication barriers in dementia, by role modelling effective communication strategies that are tailored to the resident’s cognitive abilities and needs as the disease progresses. The goal is to relax the resident and reduce the family’s anxiety by improving communication through the stimulation of memories that nourish connection. Ultimately making the visit more pleasurable, and improving the overall perceived success of the visit. In the end, animal assisted family-based therapy fosters quality and frequent family visitation that improves the quality of life for both the family and resident, as they live with dementia.
Evidence Based Approach to Support Residents and Families Living with Dementia
The Ontario Long Term Care Association (OLTCA, 2015A) report, This is Long Term Care explain that in response to rising demand, the government has changed the criteria for eligibility for entry into long term care (LTC) facilities which has resulted in residents coming to LTC at a later stage of their conditions and they have more complex health issues, including a larger proportion have mental health and dementia diagnoses. The OLTCA (2014) report indicates that 62% of residents live with a dementia and nearly one third have a severe cognitive impairment; and since 2008, the proportion of residents with dementia has increased by 6%, and mild or moderate cognitive impairment has risen by 8%. Additionally, the report indicates that 46% of residents exhibit some level of aggressive behaviour, and incidences have been increasing; stating there was a 14% increase in moderately aggressive behaviour, between 2010 and 2012 alone. According to the Alzheimer Society of Canada’s (ASC) terminology in Shifting Focus (2014), dementia is a general term that refers to many different diseases including Alzheimer’s disease, Vascular dementia, Frontotemporal dementia, Lewy Body dementia, Mixed dementia and others, which are caused by different physical changes to the brain. The neurological impacts of dementia include the loss of language, recognition, purposeful movement, perceptual acuity, initiative and memory (ASC, 2014). OLTCA (2015A) describes dementias as complex and multi-faceted diseases, and states as that the disease progresses, people lose the ability to interpret their environment or control their behaviour. Additionally, over 80% develop one or more behavioural or psychological symptoms, which may include agitation, wandering, repeated vocalization, inappropriate sexual behaviour, repetitive behaviour, hoarding, or paranoia. Furthermore, 46% of residents in LTC exhibit aggressive behaviour, making aggression one of the most common behavioural symptoms, according to the OLTCA (2015A); which also explains why that residents with dementia may be triggered to express verbal and physical aggression, resist care and react reflexively if they feel their personal space is being invaded, are upset by verbal and physical interactions or other unidentified triggers. According to OLTCA (2015B), LTC is in desperate need of creative and innovative solutions. In this paper, I will propose Animal Assisted Family-Based Therapy in LTC for families and residents living with dementia as an innovative approach to meet the complex needs of both the resident and their family during the transitioning into LTC and through the progression of dementia stages.
Transitioning to Long Term Care
According to Hébert, Dubois, Wolfson, Chambers and Cohen (2001), dementia progression and caregiver burden are factors associated with the decision to institutionalize an elder. Making the decision to move a family member into LTC can be a difficult and stressful experience making it important to consider the family’s psychosocial needs. According to Gaugler, Reese and Sauld (2015), admission of a relative into a nursing home can be accompanied by feelings of stress, guilt, anger, anxiety, depression, and continued burden. Bramble, Moyle and McAllister (2009) explain that “when respondents were asked how they felt when their relative was placed in LTC the reply was overwhelmingly that of loss, sadness and guilt” (p. 3121), and “these feelings were exacerbated by the sense of isolation and powerlessness in the initial days of placement, with very little sense of the facilities ‘embracing families’ and very little communication” (p. 3122). Improving the family’s adaptation to residential long-term care may improve family members' well-being as well as relatives' quality of life in the facility (Cohen et al., 2014; Gaugler, Pearlin, & Zarit, 2003; Gaugler, Reese, & Sauld, 2015). Interventions designed for families to build therapeutic relationships provide psychoeducation related to dementia and its progression, along with the exploration of guilt and stigma, while also identifying potential stressors, teaching coping strategies and building support to minimize these stressors are recommended to reduce negative experiences and promote continued family involvement (Gaugler, Reese, & Sauld, 2015).
Benefits of Continued Family Involvement
Research indicates that family visitations can have a significant impact on the health and well-being of their loved one living in LTC, and can enable a resident to cope with stressful events such as a decline in health or the adjustment to a new living environment (Thompson, Weber, & Juozapavicius, 2001). Family visits not only help to preserve the identity of the loved one, ensuring emotionally and socially enriching care (Gaugler, Zarit, & Pearlin, 2003) but the visits also help to promote participation in activities, lower psychosocial impairment and decrease agitation (Piechniczek-Buczek, Riordan, & Volicer, 2007). For residents living with dementia, research suggests family visits that are pleasurable decrease behavioral problems, psychosocial impairment, and agitation, which then helps to increase the perceived success of the visit by families (Piechniczek-Buczek, Riordan, & Volicer, 2007). Maintaining physical and intimate contact between families and their loved one is important, according to Volicer, DeRuvo, Hyer, Piechniczek-Buczek and Riordan (2008), this meaningful interaction provides a focal point and is a reminder to the resident that they are still loved; this helps to maintain comfort, ease and quality of life as the disease progresses. Supporting family members while also providing education on strategies to increase beneficial effects of visiting is showing promise in decreasing the symptoms of depression and agitation of residents; reducing the use of restraints; and possibly slowing down the global deterioration of residents (Piechniczek-Buczek, Riordan, & Volicer, 2007).
Family Involvement Patterns
According to Thompson, Weber and Juozapavicius (2001), the majority of elderly residents are not abandoned by family, and social contact is maintained through visitations. Almost two-thirds of the residents of nursing homes receive at least weekly visitors, and only a small minority never receive any visitors (Naleppa, 1996). Gaugler, Anderson, and Leach (2003) explain that a number of predictors for family involvement in nursing homes have been identified, involving the resident setting, resident function, family context, staff and resident background. Caregivers with less formal education were found to visit more and caregivers who provided at-home care for longer periods of time visited less; as well, care recipients who exhibited greater behavior problems before moving to LTC, received less frequent visits (Gaugler, Anderson, & Leach, 2003). Naleppa (1996) reports that there are several factors that influence a family’s visitation pattern, and states that visitation occurs most often when care is funded by family resources, with the elderly poor receiving fewer visitors than the more affluent residents; the family member’s distance to travel to the nursing home has a negative effect on the frequency of visitation; the gender, employment and retirement status have little effect; and nursing homes with flexible visiting hours and include families in activities, receive more visitors. In specific relation to dementia, the amount of family involvement does not significantly vary by dementia status (Cohen et al., 2015), but the activity of the visit varies. Cohen et al. (2015) report that families of residents with dementia spend significantly less time than families of residents without dementia on activities such as community outings, playing games or conversing with their loved one; and were more likely to spend time engaging in caregiver role activities to promote resident nutrition, mobility, appearance and discussing care with the staff. Not only does dementia impact the nature of family visits but also the quality and perceived success of the visit.
Quality of Family Visits
Family visits are an important aspect of institutionalized living and have been found to have a positive influence on the resident’s psychosocial well-being (Naleppa, 1996); as well as providing insight into a resident’s life satisfaction (Thompson, Weber, & Juozapavicius, 2001). Although visitations are critical to the resident’s well-being, the visits are not always a pleasant experience for family members, especially if their loved one is living with dementia. Martin-Cook, Hynan, Chafetz and Weiner (2001) report that family members indicate that the resident’s mental status, difficulty communicating with the resident, agitation, and not knowing what to do made visitations difficult. Research indicates that dementia can impact the quality and perceived success of the visitations by the family members. According to Reslock (2015), when families visit residents with cognitive decline, many family members struggle with “feelings of guilt, anxiety and awkwardness and can feel frustrated by an inability to hold a "current time" conversation, the unexpected reactions to physical contact and the fact that their loved one may shift between recognizing them and viewing them as strangers” (p. 24). Piechniczek-Buczek, Riordan and Volicer (2007) states that it is important to promote both quality and frequency of family visits with residents living with dementia, explaining that “it is likely that if the family members perceive that the visit was successful, they will be more likely to visit more frequently and the successful visit may have more impact on the demented relative” (p. 167). Additionally, Piechniczek-Buczek, Riordan and Volicer (2007) report that family members are able to identify personal, interpersonal, or environmental domain factors that affect their experience during visits with their relatives living with cognitive impairment. Personal factors are defined as characteristics associated with the resident with dementia and his or her interaction with the family member; interpersonal factors are defined as interactions between residents and staff, and between family and staff; and environmental factors are defined as characteristics of the visiting space, the effect of other residents’ presence, and the availability of programs for residents. (Piechniczek-Buczek, Riordan & Volicer, 2007). This writing will look at how factors in the personal domain impact family visits.
Personal Domain Factors that Impact the Quality of Family Visits
Establishing a special connection during visitations is viewed as an important personal aspect of the visit, which provides the family with a sense of satisfaction. Piechniczek-Buczek, Riordan and Volicer (2007) explain, “Connection was not synonymous with recognition as the latter is frequently lost in the more advanced cases of dementia. Connection was rather associated with experiencing a special bond, which would differ depending on the stage of the illness” (p. 167). Furthermore, the lack of connection, ability to display emotions and inability to communicate due to deficits are considered to be obstacles to successful visits; whereas positive facial expressions of the resident and their involvement in activities are indicators to the family that their loved one is content and adjusted to the environment, providing a sense of relief and gratification for family members (Piechniczek-Buczek, Riordan, & Volicer, 2007).
The organization and structure of visits also has an impact on the quality and perceived success of the visit. Martin-Cook et al. (2001) report that visits with family led to a significantly lower number of agitated behaviors displayed; this decrease in agitation was hypothesized to be due to the structure of the visit, stating that “the ability to initiate and sustain purposeful activity is impaired in dementing illness, residents’ behaviors are likely to appear more purposeless, confused, and agitated when they are left on their own to fill time. During visits, the family member provides structure and focus for the resident” (p. 165). Having an established visitation agenda provides concrete and meaningful tasks that gives purpose for the visit, it can help to ease the family’s anxiety associated with visiting, and it increases the opportunity for family members to experience gratitude when the tasks are accomplished (Piechniczek-Buczek, Riordan, & Volicer, 2007; and Volicer, DeRuvo, Hyer, Piechniczek-Buczek, & Riordan, 2008). LTC facilities play a vital role in the accessibility and encouragement of activities that involve residents and their families. Thompson, Weber and Juozapavicius (2001) state that facilities require creative programming that encourages family members to participate in a different type of visitation. In Piechniczek-Buczek, Riordan and Volicer’s (2007) study, families emphasized the importance of having resources available to be incorporated into their visits in order to make the encounter more interesting and variable.
The frequency of family visitations can also be impacted by the internal experiences of the visiting family members. According to Gladstone, Dupuis and Wexler (2006) emotional difficulty and feelings of guilt during the visit are associated with reduced visits, stating that “this discomfort was experienced in more than one way; for some, visiting triggered a sadness at watching their relative deteriorate” (p. 97), and “for others, visits were an unsettling time because they had to brace for the unpredictable behaviour of their relative” (p. 97).
The interactive social conditions of the visit is another factor that impacts the frequency of visits. Gladstone, Dupuis and Wexler (2006) reports that several family members “attributed the decline in their visiting to their relative's unawareness of how often they visited or whether they came at all or to the relative's unresponsiveness to them during visits” (p. 98); additionally it was noted that family members may interpret their relative’s unresponsiveness as meaning that the current amount of contact was not necessary and therefore cut back the frequency of their visits. The difficulties in carrying out a conversation with their loved one was another reason given for reduced visits, “family members felt that they had to do all the initiating of conversation, that their relatives would repeat themselves often (as one son stated, ‘We're just in a loop with the conversation’), that there was little to talk about with the relative, or that the content of conversations was ‘irrational’” (Gladstone, Dupuis, & Wexler, 2006, p.98). Communication difficulties are also reported by Bramble, Moyle and McAllister (2009), stating that families “expressed an interest in learning how to communicate better with the person with dementia” (p. 98).
Communication and Social Skills
As noted earlier, dementia is a progressive disease causing cognitive impairment, which impacts a person’s social skills and subsequently their ability to interact socially becomes limited (Chappel, Kadlec, & Reid, 2014; Marx, Cohen-Mansfield, Regier, Dakheel-Ali, Srihari, & Thein, 2010). According to Murphy, Gray and Cox (2012), communication difficulties include reduced vocabulary, word-finding difficulties, problems with reasoning, repetition of thoughts, lack of coherence, losing track of topic, and distractibility. Chappel, Kadlec and Reid (2014) reports that despite the progressive context restriction for individuals living with dementia, social interaction remains a basic need and is an important component of quality indicators in LTC facilities; and additionally explain that a lack of interaction can lead to loneliness and social isolation. According to Goldfein and Wille (2003), the impaired and progressively limited social skills associated with dementia create a dilemma for families attempting to maintain a meaningful connection as cognitive and linguistic patterns change; often leading to feeling of dissatisfaction and alienation. There is growing evidence that social skill decline and some impacts of dementia could potentially be slowed through the promotion and delivery of key dimensions of care, which includes, family involvement (Chappel, Kadlec & Reid, 2014). Educating family members on communication changes, adjusting conversational expectations, appropriate stage-specific communication alternatives and providing exposure to examples of effective communicative strategies can help to improve the social interaction (Goldfein & Wille, 2003), and ultimately, the quality of the visit.
Stress and Coping Ability
The Progressively Lowered Stress Threshold model hypothesizes that behavioral symptoms of dementia are the result of person-environment interactions that trigger stress; and according to Richards and Beck (2004), individuals living with dementia have a lowered stress threshold and are less able to cope and manage stress as their disease progresses. From a Coping Skills Theory perspective, stimuli can be a stressor that challenges the individual, and motivates a response and/or modifications to the situation; furthermore, stressors are considered any environmental, social, or internal demand that requires the individual to utilize physical and psychological resources, along with strategies and techniques for coping to then readjust their usual behavior pattern (Deyell, Hood, & Carruthers, 2002). With the accumulation of stressors, along with the depletion of individual resources create an environment that increases the possibility of psychological distress, frustration and responsive behaviours.
The Need-Driven Compromised Behaviours Model conceptualizes dementia-related behaviors as an individual’s means to communicate needs, and their quality of life can be improved if the needs are responded to appropriately. Dementia compromised behaviors, according to Kolanowski (1999), are an interaction of background factors (individual characteristics) and proximal factors (environmental triggers) that precipitate behaviors, which are “the most integrated and meaningful response cognitively impaired individuals can make, given the limitations imposed by the dementing illness, the strengths preserved from their abilities and personality, and the constraints, challenges, or supports offered by the immediate environment” (p. 7). Learning to adapt their communication to the social, psychological and biological changes they experience while living with dementia, reflects a Lifespan approach to aging where growth is believed to be possible and development is a continual process of adaptation, using the abilities they possess (Ryan, O’Rouke, Ward, & Aherne, 2011).
Agitation and Family Visits
Agitation is a common symptom of dementia that it has significant influence on the social environment, impacting the visit experience. According to Martin-Cook et al. (2001), behavioral disturbances occur in 70-90% of persons with dementia, with the influence of both psychosocial and environmental factors; furthermore, agitated behaviors are related to impaired cognition and negative quality of social interactions. The social environment impacts the quality of the interaction and interestingly, it is reported that when touch accompanies a verbal request, cognitively impaired residents display increased attention, appropriate verbal and action responses and fewer agitated behaviors (Martin-Cook et al., 2001). Burgener, Jirovec, Murrell, and Barton (1992) found that relaxed and smiling behaviours of caregivers are linked to calm and functioning behaviours of residents. Martin-Cook et al. (2001) reports that higher ratings of displeasure for families were related to increases in agitation following a visit; stating that “it may be that visitors who found visits to be unpleasant communicated that feeling, and influenced the residents’ subsequent behavior” (p. 166). Since calm, smiling, and pleasant social interactions are related to positive behaviors in cognitively impaired residents, creating a pleasant environment that assists in effective communication in a structured family visit has the potential to increase the family’s enjoyment of visits while also reducing agitation in residents (Martin-Cook et al, 2001).
Animal-Assisted Therapy as Non Pharmacological Intervention
Majic, Gutzmann, Heinz, Lang and Rapp (2013) report that non-pharmacological strategies have been suggested for the treatment of behavioral and psychological symptoms of dementia. According to Nordgren and Engstrom (2013), non-pharmacological treatments, as an alternative or complement to medications are needed. At presenr, there is a growing number of alternatives being recognized as non pharmacological interventions, including physical training, caregivers’ singing, music therapy and animal assisted interventions. Animal assisted interventions are increasingly being implemented in LTC as a non pharmacological intervention, specifically to help ameliorate the symptoms of dementia.
During 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 (AAT) is defined as a goal-oriented, planned and structured therapeutic intervention delivered by health, education and human service professionals, with a focus to enhance physical, cognitive, behavioral and/or socio-emotional functioning (International Association of Human-Animal Interaction Organizations (IAHAIO), 2014). According to Bernabeiet al. (2013) seven of the ten AAT studies investigating the impact on the behavioural and psychological symptoms of dementia (BPSD) demonstrated positive results. Nordgren and Engstrom (2012) report that AAT can help to decrease agitated behaviors and increase social interaction among people with dementia; reporting the presence of a dog can reduce aggression and agitation, while also increasing the amount of smiles and laughter, along with significantly more social behaviors such as looks, leans, and touches. Hendy (1977) additionally reports that visits with pets increased both alertness and smiling in residents. AAT participants are reported by Nordgren and Engstrom (2013) to be filled with joy and well-being, and the authors indicated AAT effects could be an effective method to promote quality of life for people living with dementia. Majic, Gutzmann, Heinz, Lang and Rapp’s (2013) research exploring the impact of AAT on agitation and depression symptoms of residents with dementia found that 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, limiting generalizability, the results are promising. Sellers’ (2005) evaluation of an AAT intervention for elders with dementia in LTC facilities also demonstrated a decrease in agitated behaviours during AAT interventions. Research suggests that AAT interventions may be a viable non pharmacological intervention to decrease BPSD and appears to be a promising strategy to enhance social behaviours.
AAT to Improve Social Interactions
AAT has been identified to aid in the social interaction of the cognitively impaired in the following ways: (a) reminiscences to stimulate long-term memory; (b) increased social interactions; (c) providing a stimulus for verbal responses; (d) sensory stimulation; and (e) providing a vehicle for nonverbal communication and emotional expression (Curtright & Turner, 2002). Due to the fact that so many individuals have fond memories of animals within their personal history, Curtright and Turner (2002) report that the presence of animals within the environment may lead to accessing early life memories, which could potentially enhance communication by taking advantage of intact cognitive processes and automatic responses. AAT as a structured activity includes socializing, feeding, petting and grooming the animal, while also discussing previously owned pets and animal experiences (Cherniack & Cherniack, 2014). Additionally, as Cherniack and Cherniack (2014) note, research is indicating that AAT can have a positive effect on cognition and mood in cognitively impaired older persons and can improve their ability to socialize, leading to longer conversations and improved social interactions.
Motor, Multisensory and Reminiscent Stimulation Through AAT
According to Cruz, Marques, Barbosa, Figueiredo and Sousa (2011), the progression of dementia, may lead to a lack of appropriate environmental, sensory and social stimulation, which causes simulation deprivation that leads to continued deterioration of motor and sensory skills. Motor stimulations are described as specific exercises to improve mobility and delay the decline of activities of daily living, and multisensory stimulation is described as activities that stimulate the senses without the need for higher cognition which helps to reduce behaviours and apathy while also increasing alertness and engagement (Cruz et al., 2011). Casey (2016) suggest that AAT activities such as the petting, grooming and walking the therapy animal provide meaningful and motivating movements, while also providing visual, olfactory, auditory and tactile stimulation through direct and indirect contact.
Reminiscence therapy, according to Kim et al. (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). AAT provides stimulation of remote memories and an opportunity to share meaningful experiences with animals (Nordgren & Engstrom, 2013). Reminiscent therapy is a strength-based approach that builds on a resident’s preserved abilities rather than cognitive impairments. Woods et al. (2012) report that reminiscence is gaining importance in the care of people with dementia, due to its potential to draw on early remote memories which often remain intact for people with dementia. Studies on reminiscence therapy suggest that the therapy can help to improve cognition and mood in people with dementia, as well as having a positive effect on quality of life (O’Shea et al. 2014).
Family-Based Intervention in Social Work
Social workers have the opportunity to play an important role in creating a social environment that promotes frequent and successful family visits with residents living with dementia in LTC facilities. As noted earlier, transitioning a loved one into institutionalized care can be a very stressful process that requires attention to not only the needs of the new resident, but also the psychosocial needs of the family members. Naleppa (1997) state that “families can be a client at the time of placement and crisis, when the family is in need of heightened support” (p. 106); additionally, a practice model combining psycho-educational training, psychosocial support and resources for ongoing activities is suggested to promote and maintain the active involvement of the family. According to Gaugler, Anderson, and Leach (2003), “Social workers have the unique opportunity of establishing rapport and contacts with family members across the long-term care continuum” (p. 23), and should be involved in “addressing how families can most enjoy their visits and positively influence quality of life on the part of residents” (p. 23). Additionally it is noted that matching appropriate activities to each family member has led to increased family involvement and enhanced family visits. Gaugler, Anderson and Holmes (2005) emphasize the need for multi-component approaches to enhance family adaptation and involvement following the institutionalization of an elderly relative; stating that state-of-the-art in family-based intervention in LTC are flexible and tailored to diverse needs. Bramble, Moyle and McAllister (2009) encourage interactions and engagements with a focus on innovative professional education programmes tailored to dementia care as an approach to help to reduce some of the distress for families, and improve quality care outcomes for the person with dementia.
Guiding Theories for Social Work Practice
From the Activity Theory of Aging perspective, promoting and having activities accessible creates an environment that optimizes opportunities for health, participation and security in order to enhance quality of life as people age (WHO, 2012). A positive relationship has been associated between the level of social participation of older persons and their life satisfaction, according to Litwin (1997); furthermore it is noted that this view of aging assumes that social activity provides older people with the role supports necessary for reaffirming their self-concept. “The activity approach negates the image of pathological aging; that is, it stresses productivity and deemphasizes debility” (Litwin, 1987, p. 4.) Security, is an important aspect of active aging, requiring activities to be designed to ensure the protection, dignity and care that respects the physical, social and emotional needs of residents (Stenner, McFarquhar, & Bowling, 2011). Social work combined with AAT, creates safe relationship opportunities between the animal, therapist, resident and family, while also providing motivation for meaningful activity and social participation; meeting both the resident and their family where they are at, by modifying activities to each individual’s need, ability and interest.
A Person-Centred Care approach moves beyond the physical act of providing care and involves the whole person and their social, cultural and individual identity; it appreciates people with dementia as individuals with unique histories, values, like, beliefs and strengths and incorporates a person’s unique abilities, preferences and choices into their care plan (Danylyshen-Laycock, 2012). Operating from a strength-based perspective, activities focus on “strengths-oriented aspects such as what people hope for in their lives, what they are good at, what they value, and what is supportive in their environment, they can best help participants reach their goals and aspirations” (Heyne & Anderson, 2012, p. 107). According to Heyne and Anderson (2012), strength is defined as the quality or state of being strong and the capacity for exertion and endurance in the face of challenge or adversity, through the use of internal and external personal qualities, characteristics, talents, skills, environments, interests, and aspirations. Rather than focusing on deficits created by the aging process and specifically dementia as a progressive disease, AAT builds on an individual’s strengths such as remote memories, interests, experiences and motivations associated with their own animals from their past or with the therapy animal in session.
In order to set residents and families up for success, the Social Cognitive Theory principle of self-efficacy needs to be considered. According to Wise (2002), social cognitive theory explains how human behavior is the result of multiple interacting personal, environmental, and behavioral factors; additionally, personal factors are defined as residing within the individual, and environmental factors are characteristics of situations which reside outside the individual, including the physical and social environment. A person’s self-efficacy interacts as a personal behavioural factors influencing the experience and “perceptions of self-efficacy influence what activities people attempt, how much effort they expend on those activities, and how long they persevere when obstacles are encountered. Those who are efficacious try new activities, expend more effort, and persevere longer” (p. 337). This self-efficacy can then be generalized across activities and situations, where people are more efficacious toward situations where their strengths are necessary for success (Wise, 2002). Self-efficacy is connected to a higher quality of life and greater psychological well being, according to Wise (2002), “Those with stronger perceptions of personal efficacy recovered quicker and exhibited higher levels of functioning” (p. 339). Efficacy is central to all person-centred and strength-based approaches, including AAT activities that are tailored to individuals in order to maximize their strengths and nourish self-efficacy.
AAT Family-Based Intervention as an Innovative Social Work Practice
AAT is increasingly being utilized in health care settings and could potentially be one of the innovative approaches to help reduce behavioural and psychological symptoms of dementia. When combined as an adjunct to family-based interventions, AAT has the potential to improve the quality and success of family visits with residents living with dementia, while also helping with continuity, to maintain meaningful relationships. Seller (2005) explain that AAT is an effective intervention because the animal is an adjunct to therapy, as a focal point for the therapy session and the animal acts as a bonding agent. The author states, “This promotes the relationship between the elder and therapist. The use of an animal as a creator of immediate intimacy may be based upon the animal’s ability to provide the attention that is the foundation of all social interactions” (p. 63). Piechniczek-Buczek, Riordan and Volicer (2007) state that care providers in LTC facilities should make every effort possible to improve the quality of family visits for the residents with dementia. I propose AAT could be an adjunct to social work practices in LTC, creating an innovative approach to support both residents and families during visitations. Animal-Assisted Family-Based Therapy could facilitate effective family visits with residents living with dementia, by providing an oxytocin surge to calm the parasympathetic nervous system; creating a calm and relaxing environment for structured family visit activities that provide motor, multisensory and reminiscent therapy, and that stimulate remote memories for meaningful conversations and interactions. During this facilitated visit, social workers could address communication barriers in dementia, by role modelling effective communication strategies that are tailored to the resident’s cognitive abilities and needs as the disease progresses. The goal is to relax the resident and reduce the family’s anxiety by improving communication through the stimulate of memories that nourish connection; ultimately making the visit more pleasurable, and improving the overall perceived success of the visit. In the end, animal assisted family-based therapy could foster quality and frequent family visitation that improves the quality of life for both the family and resident, as they live with dementia.
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