Pet therapy is often used for the treatment of the elderly. The elderly commonly face problems of loneliness and isolation. Having a pet provides a sense of companionship.

In Europe and the United States, many hospitals and long term care facilities have programs where animals, mostly dogs, visit patients at the facility or at home, a mode of therapy called canine visitation therapy. These animal visits give the patients a change in their routine and provide a sense of hope. It is also beneficial in pain management.

In the case of institutionalized Alzheimer's patients, a study found that placing an aquarium of fish in the dining area, increased the nutritional intake of Alzheimer's patients. Pets provide a general sense of well being, apart from some of the specific therapeutic services that have already been discussed. Animal therapy is gaining increasing attention from the scientific community as research continues to expand its scope.

Research Support

The research evidence supporting the efficacy of AAT is slim, though anecdotal support is extensive. Although it may not be given much credence by medical personnel as a therapy with the potential to assist the progress of the patients, some institutions do at least allow it as something that will uplift the patients or distract them from their discomforts. Below are two research studies that validate the benefits of pet therapy with the elderly.

• Banks, M.R. and Banks, W. A. (2002). The Effects of Animal-Assisted Therapy on Loneliness in an Elderly Population in Long-Term Care Facilities. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 57:428-432.

Animal-assisted therapy (AAT) is claimed to have a variety of benefits, but almost all published results are anecdotal. The authors studied the resident population in long-term care facilities and determined whether AAT can objectively improve loneliness. Of 62 residents, 45 met inclusion criteria for the study. These 45 residents were administered the Demographic and Pet History Questionnaire and the UCLA Loneliness Scale. They were then randomized into three groups (no AAT; AAT once/week; AAT three times/week) and retested near the end of the six-week study. AAT was shown to have significantly reduced loneliness scores in comparison with the no AAT group.

• 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.

The effects of a therapeutic recreation intervention using animal-assisted therapy AAT on the agitated behaviors and social interactions of older adults with dementia were examined. In a pilot study, 15 nursing home residents with dementia participated in a daily AAT intervention for three weeks. Results showed statistically significant decreases in agitated behaviors and a statistically significant increase in social interaction pretest to post-test.

A dog can draw out people who have problems communicating. Dogs communicate on an instinctual, nonverbal level that is easier to relate to by people who have difficulty communicating verbally. It may take days to engage certain patients or residents in conversation. Bringing in a pet therapy dog has been shown to allow uncommunicative residents to engage almost immediately and participate in activities and therapy sooner. Dogs do not place any expectations or demands on the person and are there strictly to provide comfort. Having a dog respond in a positive manner helps people feel better. With the dog present, people want to talk about the animal, beginning a conversation about how they feel and what they think and facilitating engagement in constructive therapy.

Studies have shown that low key tactile stimulation, i.e., stroking something soft like a dog's fur, tends to calm a person, lowering blood pressure and reducing the heart rate. In addition, animals can also be excellent tools to help combat depression, a common phenomenon, especially in the elderly. Reducing loneliness, one of the triggers of depression in long term care residents, is another of the benefits of pet therapy.

Dogs seem to be aware of illness and sadness and appear to want to provide companionship and comfort; they show an abundance of intelligence and are both intuitive and compassionate. I am sure any dog owner can relate to this assumption and agree that it is a warm feeling when their dog can detect their sorrow and lick their tears away. Silence may be broken and loneliness and isolation can be overcome through merely touching and petting a companion animal. These pets offer absolute and unconditional love and a level of boundless patience no human can replicate.

Dogs and cats have a calming and therapeutic effect on people. They can help individuals to cope with the emotional issues related to their illness and offer physical contact with another living creature.

The therapeutic use of pets is considered to be a sensory modulation approach. The integration of animal-assisted therapy into practice has been discussed in nursing, psychology, and rehabilitation literature, as well as others. However, it has only in the last half of the twentieth century that professional recognition began to acknowledge the benefit of pet therapy.

Pet therapy influences the spirit-mind-body interconnectedness in many ways. Activities such as watching fish swimming in a fish tank or petting a cat or dog have been found to decrease blood pressure, lower heart rate, and reduce anxiety. Social interactions increase when pets are brought into nursing homes and mental healthcare settings. Therapeutic interactions with pets provide unconditional love, affection, and acceptance, helping people of all ages feel a greater sense of belonging and connectedness to the world. Positive experiences with pets tend to elicit nurturing instincts and behaviors.

Some of the common goals of pet therapy include:

• The facilitation of communication and social interactions
• To facilitate the expression of feelings
• To brighten mood and affect and lessen anxiety
• To help to explore grief and loss issues
• To help to improve reality orientation
• To help to improve the ability to cooperate 
• To increase the ability to trust
• To help learn appropriate forms of touch 
• To help to improve self-esteem and self worth
• To provide an opportunity to show affection

Pet therapy has been found to be beneficial for people of all ages. Children are automatically drawn towards animals. Through interaction with animals, children learn nurturing, responsibility, and empathy. Children learn how to take care of the animal and come to understand that animals share feelings and emotions similar to their own, such as pain, joy and fear. Pet therapy has been found to be of great benefit when dealing with abused children and those with psychiatric problems and learning disabilities. These children sometimes have those who experience difficulty opening up and verbally communicating with doctors, nurses, and other healthcare workers. Such children have been known to respond and communicate with an animal, making pet therapy a valuable diagnostic tool.

For children with Attention Deficit Disorder and other learning disabilities, animals provide a unique point of concentration that helps them focus. As interaction with the animal increases and becomes more complex as, for example, with horseback riding, children learn more skills and are exposed to greater intellectual stimulation. Animal Assisted Therapy has also been found useful in helping children with communication problems, anxiety and behavioral issues. Studies show that children respond better to a pet than an inanimate toy - they are more playful and more aware of their social environment with a living animal.

The use of horses and horseback riding for therapeutic purposes has shown successful results in improving the physical condition of both children and adults with cerebral palsy, muscular dystrophy, Downs' syndrome, multiple sclerosis, and similar conditions. Therapeutic horseback riding helps children and adults with neuromuscular deficits by improving balance, posture, movement, and muscle strength.

The enjoyment of animals as companions dates back many centuries, perhaps even to prehistoric times. The first known therapeutic use of animals started in Gheel, Belgium in the ninth century. In this town, learning to care for farm animals has long been an important part of an assisted living program designed for people with disabilities.

Pet therapy, the practice of using animals with patients for therapeutic benefits, first became popular in the 1970s. Since then, scientists have continued to research the benefits of this form of therapy, which has acquired the name Animal Assisted Therapy (AAT) to acknowledge the variety of animals, such as cats, dogs, dolphins, and horses, being used for therapeutic purposes.

Some of the earliest uses of animal-assisted healing in the United States were for psychiatric patients. The presence of the therapy animals produced a beneficial effect on both children and adults with mental health issues. It is only in the last few decades that AAT has been more formally applied in a variety of therapeutic settings, hospitals, hospices, nursing homes, and outpatient care programs.

Animal therapy is a way of bringing animals and people together for healthy interaction. Taking docile, trained animals to hospices, medical centers, children's hospitals, retirement centers, and even to home-bound patients enhances memory and social interaction. As a natural stress reducer, animal therapy is an excellent means of providing non-pharmacologic stress reduction.

Animal therapy has been identified as promoting shorter hospital stays and dramatically improving the participant's sense of wellbeing. Studies have shown that physical contact with a pet can lower blood pressure, reduce heart rate, and reduce pain as there is evidence that petting an animal causes endorphins, the chemicals that suppress pain, to be released.

Many skills can be learned or improved with the assistance of a therapy animal. Patient rehabilitation can be encouraged by such activities as walking with a dog or throwing objects for the dog to retrieve. Fine motor skills may be developed by petting, grooming, or feeding the animal. Patient communication is encouraged by the response of the animal to either verbal or physical commands. Activities such as writing or talking about the therapy animals or past pets develop cognitive skills and improve communication. Creative inclusion of an animal in the life or therapy of a patient or resident can make a major difference in the resident's comfort, progress, and recovery.

This is a story I have read many times that I thought I would share in case you have not heard it. It provides an important message about the importance of a positive attitude and a spirit of inquiry.

The first day of school our professor introduced himself and challenged us to get to know someone we didn't already know. I stood up to look around when a gentle hand touched my shoulder. I turned around to find a wrinkled, little old lady beaming up at me with a smile that lit up her entire being.

She said, "Hi handsome. My name is Rose. I'm eighty-seven years old. Can I give you a hug?"

I laughed and enthusiastically responded, "Of course you may!" and she gave me a giant squeeze. "Why are you in college at such a young, innocent age?" I asked.

She jokingly replied, "I'm here to meet a rich husband, get married, have a couple of children, and then retire and travel.

"No seriously," I asked. I was curious what may have motivated her to be taking on this challenge at her age.

"I always dreamed of having a college education and now I'm getting one!" she told me.

After class we walked to the student union building and shared a chocolate milkshake. We became instant friends. Every day for the next three months, we would leave class together and talk nonstop. I was always mesmerized listening to this "time machine" as she shared her wisdom and experience with me.

Over the course of the year, Rose became a campus icon and she easily made friends wherever she went. She loved to dress up and she reveled in the attention bestowed upon her from the other students. She was living it up.

At the end of the semester, we invited Rose to speak at our football banquet. I'll never forget what she taught us. She was introduced and stepped up to the podium. As she began to deliver her prepared speech, she dropped her three by five cards on the floor.

Frustrated and a little embarrassed, she leaned into the microphone and simply said, "I'm sorry. I'm so jittery. I gave up beer for Lent and this whiskey is killing me! I'll never get my speech back in order so let me just tell you what I know."

As we laughed, she cleared her throat and began: "We do not stop playing because we are old; we grow old because we stop playing. There are only four secrets to staying young, being happy, and achieving success. You have to laugh and find humor every day. You've got to have a dream. When you lose your dreams, you die. We have so many people walking around who are dead and don't even know it!"

"There is a huge difference between growing older and growing up. If you are nineteen years old and lie in bed for one full year and don't do one productive thing, you will turn twenty years old. If I am eighty-seven years old and stay in bed for a year and never do anything, I will turn eighty-eight. Anybody can grow older. That doesn't take any talent or ability."

"The idea is to grow up by always finding the opportunity in change. Have no regrets. The elderly usually don't have regrets for what we did, but rather for things we did not do. The only people who fear death are those with regrets."

She concluded her speech by courageously singing "The Rose." She challenged each of us to study the lyrics and live them out in our daily lives.

At the year's end, Rose finished the college degree she had begun all those years ago. One week after graduation, Rose died peacefully in her sleep. Over two thousand college students attended her funeral in tribute to the wonderful woman who taught by example that it's never too late to be all you can possibly be.

What can we take away from this story? What was Rose's message?

"GROWING OLDER IS MANDATORY, GROWING UP IS OPTIONAL"

Long-term care has been considered many not to have evolved as quickly or as profoundly as other points along the health care continuum. However, many models have been and are continuing to be developed that provide a radically new way of viewing the care of older residents who often must live out their days in a care facility. One example is the Eden Alternative.

The Eden Alternative is an organization based on the core belief that aging should be a continued stage of development and growth, rather than a period of decline.

Founded in 1991 by Dr. William Thomas, a Harvard-educated physician and board-certified geriatrician, the Eden Alternative is being used in the U.S., Canada, Europe, and Australia. The staff and management of the facilities using this model work toward culture change through a dedication to improving the quality of life for those in their care.     

The Eden Alternative shows how companionship, the opportunity to give meaningful care to other living things, and the variety and spontaneity that mark an enlivened environment can succeed where pills and therapies often fail. Places that have adopted the Eden Alternative typically are filled with plants, animals and are regularly visited by children.    

Studies have shown that the Eden Alternative has been a tool for improving quality of life and quality of care for those living in long term care facilities. In those that have adopted Eden as an organizational-wide philosophy, there is often improved staff satisfaction and retention and significant decreases in the overuse of medications and restraints. Most importantly, Elders, supported by their caregivers, are better able to direct their own lives and feel a greater sense of control over their environment.
    
For more information, go to the Eden Alternative's Web site.

The introduction to the Macklin Intergenerational Institute on Aging states:

"The Macklin Intergenerational Institute provides compassionate care and spontaneous exchanges that result in contact between and among the generations. It's called intergenerational programming - a place where the young and old come together to share their talents, knowledge, and resources allowing their unique personal knowledge, experiences, and expectations to shape their interactions. Intergenerational programming offers an opportunity for generations to come together and to celebrate the uniqueness of one another. The Macklin Institute's mission is: To continually improve the lives of all ages through multi-age programming, care, community relationships, and creative communication."

Dr. Vicki Rosebrook of the Macklin Institute has developed an experiential learning workshop during which participants are provided with exercises that allow them to experience the functional limitations of an elderly person. Physical limitation, visual and auditory impairments, sensory distortions, cognitive impairments, and profound personal losses are all accurately simulated to replicate the experience of the older adult. Once the "impairments" are put in place, participants are given tasks to accomplish in their "aged" state.

Walking with corn kernels in their shoes, having joints tightly bandaged to limit movement, wearing glasses smeared with oil, wearing heavy gloves to minimize finger and hand movement all contribute to diminish capacity and functional ability. All frustrate the participant who begins to understand...and hopefully develop empathy and compassion for...the elderly.

According to Dr. Rosebrook, "Participants are empowered to identify and challenge common myths and stereotypes related to aging, participate in simulated experiences as an Elder, and develop strategies to help build enhanced Elder relationships."

http://www.mackliniginstitute.org/xtremeaging.aspx

It has been said that touch can reach through isolation and help alleviate feelings of loneliness and separation. Touch becomes especially important for those confined to health care institutions who may receive few visitors from the outside world. Though basic needs are met, these individuals often remain starved for the nurturing that is available through touch and skin-to-skin human contact.

Basic touch has become lost in the maze of modern medical technology, pills, and paperwork. Back rubs were once routinely administered by nurses as a non-invasive therapeutic tool to promote rest and relaxation. Touch techniques are particularly effective in providing comfort care and in enhancing quality of life for those who reside in a nursing home or extended care facility environments.

Touch and old-fashioned backrubs have been demonstrated to produce significant results in long term care residents. For example:

- Back rubs worked wonders for those confined to wheelchairs, for people in chronic pain and for residents exhibiting irritability or even anger.
- Hand massage or face stroking seemed to help those exhibiting anxiety, worry, sadness and fearfulness.
- Massaging the temples, scalp and forehead helped reduce headaches and tension, and shoulder and neck massage seemed useful for those exhibiting tiredness, irritability or mild upset.

Nursing manuals have long prescribed massage to prevent pressure sores, a chronic problem for the frail elders who spend most of their time in a bed or wheelchair. Even very gentle massage can improve circulation.

The use of touch to residents of health care facilities also has significant psychosocial benefits, including:

- one-on-one attention
- skin-to-skin contact
- tactile and sensory stimulation
- an opportunity for social interaction
- nurturing
- comfort
- reassurance

At least half the population in most skilled nursing facilities suffers from some form of dementia. Massage and touching provides therapeutic support by increasing body awareness and helping to ground those who are confused and disoriented. It can help focus attention, redirect energy, and promote calming.

http://www.massagetherapy.com/articles/index.php/article_id/192

Decreased mobility, functional impairment, and multiple losses frequently lead to depression. It has been well established in the literature that the suicide rate among people over 65 is higher than any other age group. For more on this serious issue, read the information provided on the National Strategy for Suicide Prevention's Web site.

Chronic and acute health conditions requiring medical attention, a gradual decline in functioning, increased dependency on others, and the need to live in a residential environment that may not be the desire of the elderly individual are extremely stress-producing. Excessive and prolonged stress lowers resistance to viruses and can lead to more acute, chronic, or even life-threatening health problems.

Stress affects the physical body by causing muscular tightness, tension, stiffness and restricted energy flow. Continued stress can lead to muscle spasms, as well as bodily contraction, restricted movement and rigidity. Other signs of stress may include headaches, backache, fatigue, insomnia, stiff neck, cold hands and/or feet, perspiration, shortness of breath, constipation, etc. Physical stress tends to produce more emotional stress, thus setting up a cycle of disease, discomfort, and anxiety which can generate feelings of confusion, frustration, isolation, and vulnerability for the elderly. Such feelings eventually lead to inertia, despondency, withdrawal, and may even lead to a failure to thrive syndrome with gradual deterioration and even death. 

Stereotypes abound about the aging process and the experience of older adults. I thought I would share some of them and provide the counterpoint of reality.

Myth 1: To be old means to be ill.

Rates of chronic illness and disability actually do increase with chronological age. However, even with functional deficits many older adults are still able to live independently in their own homes until they reach a very advanced age. Those that do not, still maintain a high degree of independence in care facilities. Despite limitations on activity, older people adapt in many ways, for example, by relying on a cane or walker or by using a hearing aid.

Myth 2: Older people have diminished cognitive abilities and cannot learn.

It has been said that older adults lose millions of brain cells each day. However, neurobiology has shown that the human brain actually retains a high degree of functionality and the ability to learn new things even into advanced age. This means older people can make changes that will improve their lives. There is significant data showing how changes in health behavior have delayed disability and diminished the need for long-term care. We must continually provide cognitive stimulation and new information that will assist older adults in making informed decisions in later life.

Myth 3: Successful aging is based on heredity.  

The Human Genome Project and other advances in genetics have clarified the role of genetics as an influence on aging and health and it is becoming clearer that genetic factors actually play a smaller role in old age than they do earlier in life. In fact, it is not genetics but social and behavioral factors within our control that play the largest role shaping health and well-being. As aging adults learn this, they are able to focus on health promotion behaviors that will improve quality and duration of health and life.

Myth 4: It is too late for the elderly person to make changes.

We now understand that adopting healthy lifestyle behaviors can provide a positive return even into old age. Quitting smoking allows human lung function to approach normal after only a few years, even for those who quit smoking in middle age or later. Implementing an exercise regime has been shown to increase muscle mass and bone density well into old age and improved eating habits have been shown to reverse or ameliorate certain medical conditions.

Myth 5: The elderly do not have much to offer society.  

More and more older people are attracted by what is called "productive aging," whether by extending years of paid employment or by engaging in productive roles in their families and communities. If older people are allowed to believe they have little to contribute, they may overlook ways in which their expertise and life experience can be useful to others. As education levels rise, physical health remains more robust into the senior years, and guaranteed pension income becomes more uncertain, it is likely that many more older people will continue to work well beyond what been normal retirement age.

As people age, there is a gradual slowing of physical and mental capabilities. Joints become worn, making them susceptible to conditions such as arthritis, bursitis, and tendinitis. The skin loses its elasticity and moisture, making it more friable and susceptible to injury. Lung capacity decreases as does blood flow to the brain. Decreased mobility contributes to poor circulation and the gradual loss of muscular strength and tone. Changes in physical and mental acuity, including hearing deficiencies and visual impairments, lead to a diminution of functional ability.

Growing older also means facing a number of irreversible and stress-producing life changes like retirement, relocation, and the loss of a life partner. These losses are permanent, as opposed to losses earlier in life from which we are more likely to recover. In addition, the losses come with increasing frequency, providing less time to adjust between events. Chronic illness and functional limitations create greater dependency on others and often trigger depression and anxiety about the future.

As life spans increase, the number of people requiring long-term health care is also increasing. Many people find themselves in a long term care facility for rehabilitation after an accident or injury or to convalesce after a serious illness. Older adults, however, may live out their lives confined to care facilities. These men and women may be unable to care of themselves or they may suffer from a chronic illness and need ongoing medical attention and nursing care. Care from a family member may not be an option because there is no one available or because family members are unable to provide the care that is needed.

This series of blogs will focus on the some issues faced by older adults and will highlight important issues relevant to those in the long term care environment.

As nurses continue to work in multidisciplinary teams, it is imperative to develop effective communication skills for the timely delivery of quality patient care. It is also necessary for nurses to have realistic expectations regarding what they can accomplish and when to seek help. Administrators and managers are in ideal position to role model the benefits of effective communication as well as to be able to provide staff support in developing these skills.

Nurses prefer a consistent working environment in which there is a formal chain of command, mechanisms to guide their daily work (e.g., policies and procedures), and recognition and rewards for their work efforts. In nursing, insufficient staffing, heavy patient workloads, and patient safety concerns have all been recognized as universal problems for nurses and the health care system that lead to role overload and burnout in nurses. 

Essentially, nurses want and need sufficient resources to accomplish their work. Managers and administrators are optimally positioned to openly communicate with staff about how to best provide a safe and rewarding work environment.  The strategies discussed provide a basis for testing and evaluating approaches to reducing role conflict and ultimately enhancing job satisfaction and retention among nurses and nursing assistants.

An organizational environment that provides open communication and joint problem solving between staff and managers is associated with less role conflict among nurses. Job dissatisfaction and turnover are the primary significant negative organizational outcomes of role conflict. Other negative outcomes include absenteeism, less professional behavior, lack of commitment to the organization, psychological strain, emotional exhaustion, depersonalization toward patients while providing nursing care, stress, and burnout.  These negative employee and organizational outcomes provide the basis upon which to develop strategies for reducing role conflict. 

Leadership behaviors should provide the following: an organizational environment that supports open discussion of ideas among all levels of staff, articulation of clear goals, visibility and availability to staff, reasonable standards for high performance, and emphasis on team relationships.  Support from managers and administrators as well as peers is an effective mediator of role conflict. 

Initiating a supportive discussion format for staff in which they are able to meet both informational and emotional needs is an important strategy. This might be implemented through separate meetings or by allowing staff meetings to evolve into a dialogue that not only communicates pertinent information but includes discussions among and with staff regarding their emotional needs. This strategy should also be implemented between managers and staff during one-to-one interactions.

Of great importance is role clarity and feedback regarding job performance expectations and the understanding of reciprocal role expectations of nursing and non-nursing work group members. Sharing job descriptions across disciplines may be an effective strategy that will allow staff to articulate expectations for themselves and others in specific patient care situations. 

It appears the real crux of the issue for managers and administrators in reducing role conflict is the need to facilitate team-building across all members of the health care team. Team development exercises play an important role; these exercises might involve role playing, practicing effective communication techniques, and interactive assignments to enhance team work. Certainly, all nurses would benefit from learning team-building strategies in continuing education programs provided by long term care organizations.