Dog-assisted interventions in the care of the elderly in nursing homes

In nursing homes in Sweden, therapy dogs are sometimes used in the care of elderly people. Therapy dogs are trained dogs that often work alongside their handlers to give people in need of extra support a better quality of life.

Reading time approx. 17 minutes Published: October 24, 2023 Publication type:

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: October 24, 2023 Report no: ut202332 Registration no: SBU 2023/275

Question

What systematic reviews have been published regarding the use of therapy dogs in the care of elderly people in nursing homes?

Method

A systematic literature search was performed using the following databases: Medline (Ovid), Scopus, CINAHL, Psycinfo, and SocIndex.

Two authors independently assessed the abstracts of all identified studies.

Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

Four relevant systematic reviews with low to moderate risk of bias were identified [1-4]. The results and conclusions are presented in Table 1. In four other relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [5-8].

Table 1 Systematic reviews with low/moderate risk of bias.
Included studies	Population, Intervention, Control	Outcome and Results
RCT = Randomized controlled trial; SMD = Standardized mean difference; QE = Quasi-experimental study; QoL = Quality of life; DAT = Dog-assisted therapy
Orr et al., 2023 [1] What are the effects of animals on the health and wellbeing of residents in care homes? A systematic review of the qualitative and quantitative evidence.
34 studies published in 40 articles (18 RCTs/20 articles; 16 qualitative studies/20 articles) Relevant included studies:15 RCTs on dog-assisted interventions Setting: USA: 9 studies Spain: 2 studies South Africa / Norway / Denmark / Australia: 1 study	Population: Elderly people in residential care (quantitative and qualitative results)Staff in long term care homes for elderly people (qualitative results) Intervention: Animal-assisted interventions. Quantitative studies: Dogs n=15, cats n=1, canaries n=1, kittens and rabbits n=1. Individual or group-based. Single session up to weekly visits for 9 months. Qualitative studies: Dogs n=8, farm animals n=1, chickens n=1, personal pets of residents or volunteers n=4, various pet animals n=3, kittens n=1, rabbits=1, discussion on therapy animal experiences n=1. No separate reporting of dog-assisted interventions in qualitative studies. Control: Usual care, human visits, toy or robot animal, reminiscence therapy	Agitation (3 studies, n=175) SMD: -0.31 (95% CI, -0.68 to 0.07) No statistically significant difference in effect compared to control. Quality of Life (2 studies, n= 118) SMD: -0.06 (95% CI, -0.42 to 0.30) No statistically significant difference in effect compared to control. Loneliness (2 studies) Significantly less loneliness in intervention compared to no intervention (2 studies). No difference in effect compared to robot dog intervention (2 studies). Morale (2 studies) No difference in effect compared to no visit or human visit (2 studies) Apathy (2 studies) No difference in effect compared to reminiscence therapy or usual care (2 studies). Note: This is a summary of dog-only interventions. Please see the review for a complete list of quantitative and qualitative results and analyses.
Authors' conclusion: “The review is limited by the quality of the included quantitative studies. In particular, many of the randomised trials were small, and of short duration, with little or no follow-up. […] Another limitation of the quantitative evidence is the appropriateness of outcome measures, which may not reflect the value or impact that are important to the participants.”
Jain et al., 2020 [2] Dog-assisted interventions and outcomes for older adults in residential long-term care facilities: A systematic review and meta-analysis
43 included studies RCTs n=16, pre-post designs n=14, quasi-experimental n=9, qualitative cross-sectional n=4 Setting: Residential living facilities	Population: Older people in residential long-term care facilities Intervention: Dog-assisted interventions. Group sessions (n=16) 15-180 min.; individual sessions (n=23) 10-90 min. 1-7 sessions per week for 1-52 weeks. Control: Usual care, psychosocial groups or social visits, toy, or robot dog.	Depressive or loneliness symptoms 5 studies, n=190 SMD: 0.66 (95% CI, 0.21 to 1.11) Statistically significant difference in favour of intervention Daily living or physical functioning 4 studies, n=134 SMD: -0.11 (95% CI, -2.71 to 2.50) No statistically significant difference in effect compared to control.
Authors' conclusion: “Almost half of the quantitative studies evaluating the impact of DAI for older people in RLTCF [residential long term care facilities] found no significant changes over time, of differences between experimental and control groups, in the outcomes measured. […] The remaining 21 quantitative studies [controlled and non-controlled studies] did identify improved social functioning; reduced depression; and reduced loneliness as significant benefits of DAI for residents.[…] While this review has highlighted studies that have identified statistically significant benefits of DAI for older adults in RLTCF, it is important not to overstate these or to ignore the many studies that have been unable to produce significant results.”
Zafra-Tanaka et al., 2019 [3] Effects of dog-assisted therapy in adults with dementia: a systematic review and meta-analysis
10 included studies (6 RCT:s; 4 quasi-experimental controlled studies) Setting: Nursing homes: 5 studies Assisted living facilities: 1 study Day care facilities: 4 studies Norway: 2 studies USA: 2 studiesItaly: 2 studies Japan / Spain / Germany / Australia: 1 study	Population: Elderly people with dementia (very mild to severe) Intervention: Dog-assisted intervention, participant-led interaction. Group or individual, 10 – 90 minutes, 1 -3 sessions per week. Control: Usual care, human visitors, reminiscence therapy, toy dog.	Daily life activities No statistically significant difference in effect compared to control. 2 RCTs,n=61 SMD: 0.16 (95% CI, -0.80 to 1.12) 2 QEs, n=50 SMD: -0.13 (95% CI, -0.73 to 0.46) Depression 4 RCTs, n=184 SMD: -0.48 (95% CI, -1.93 to 0.98) No statistically significant difference in effect compared to control. 3 QEs, n=97 SMD: -0.59 (95% CI, -1.00 to -0.18) Statistically significant effect in favour of intervention Quality of Life 5 RCTs, n=151 SMD: 0.16 (95% CI, -0.41 to 0.73) No statistically significant difference in effect compared to control. Agitation 3 RCTs, n=173 SMD: -1.12 (95% CI, -2.67 to 0.43) 2 QEs, n=74 SMD: -0.44 (95% CI, -0.90 to 0.03) No statistically significant difference in effect compared to control. Cognitive impairment 2 QEs, n=50 SMD: 0.14 (95% CI, -0.45 to 0.74) No statistically significant difference in effect compared to control.
Authors' conclusion: “We found very low certainty of evidence suggesting that DAT has no effect on daily life activities, depression, QoL, agitation, and cognitive impairment; although the only RCT that evaluated apathy found an apparent beneficial effect. No RCT assessed the harms of this intervention. Given that included studies had a small sample size and important risk of bias, and that the certainty in evidence is very low, more RCTs are needed to evaluate the benefits and risks of DAT in patients with dementia.”
Stern et al, 2011 [4] The effects of Canine-Assisted Interventions (CAIs) on the health and social care of older people residing in long term care: a systematic review.
8 included studies (8 RCTs) Setting: Nursing homes, USA	Population: Elderly people (51 – 101 years) in long term care. Intervention: Dog-assisted interventions. 6 – 30 min sessions once a week. Control: No intervention, conversations with group or visitor, robotic dog. Dog-assisted intervention sessions three times a week.	Dog-assisted intervention vs. other intervention (no intervention, basic interaction, robotic dog, scripted interaction) (7 studies) No significant difference in effect on mood, activity, well-being, speech activity or loneliness. One session per week vs. three sessions per week (4 – 6 weeks) (2 studies) No significant difference in effect on loneliness and mood.
Authors' conclusion: “The current evidence base for the effects of CAIs in long term care facilities is methodologically weak and is unable to be pooled. No solid recommendations can be made but based on the results of single studies it suggests that providing CAIs in long term care facilities can provide some short term benefits to residents, both physically and emotionally, however they appear to be no more effective than other interventions such as visits from human and providing opportunities to interact with inanimate objects.”

References

Orr N, Abbott R, Bethel A, Paviour S, Whear R, Garside R, et al. What are the effects of animals on the health and wellbeing of residents in care homes? A systematic review of the qualitative and quantitative evidence. BMC Geriatr. 2023;23(1). Available from: https://doi.org/10.1186/s12877-023-03834-0.
Jain B, Syed S, Hafford-Letchfield T, O'Farrell-Pearce S. Dog-assisted interventions and outcomes for older adults in residential long-term care facilities: A systematic review and meta-analysis. Int J Older People Nurs. 2020;15(3):e12320. Available from: https://doi.org/10.1111/opn.12320.
Zafra-Tanaka JH, Pacheco-Barrios K, Tellez WA, Taype-Rondan A. Effects of dog-assisted therapy in adults with dementia: A systematic review and meta-analysis. BMC Psychiatry. 2019;19(1). Available from: https://doi.org/10.1186/s12888-018-2009-z.
Stern C, Konno R. The effects of Canine-Assisted Interventions (CAIs) on the health and social care of older people residing in long term care: a systematic review. JBI library of systematic reviews. 2011;9(6):146-206. Available from: https://doi.org/10.11124/01938924-201109060-00001.
Cipriani J, Cooper M, DiGiovanni NM, Litchkofski A, Nichols AL, Ramsey A. Dog-Assisted Therapy for Residents of Long-Term Care Facilities: An Evidence-Based Review with Implications for Occupational Therapy. Physical & Occupational Therapy in Geriatrics. 2013;31(3):214-40. Available from: https://doi.org/10.3109/02703181.2013.816404.
Lundqvist M, Carlsson P, Sjödahl R, Theodorsson E. Patient benefit of dog-assisted interventions in health care: A systematic review. BMC Complement Altern Med. 2017;17(1). Available from: https://doi.org/10.1186/s12906-017-1844-7.
Borgi M, Collacchi B, Giuliani A, Cirulli F. Dog Visiting Programs for Managing Depressive Symptoms in Older Adults: A Meta-Analysis. Gerontologist. 2020;60(1):E66-E75. Available from: https://doi.org/10.1093/geront/gny149.
Dincer B, Bahçecik N, Sollami A. Effect of animal assistant therapy on quality of life in older adults: A meta-analysis. Geriatr Nurs. 2022;43:38-44. Available from: https://doi.org/10.1016/j.gerinurse.2021.11.005.

Search Strategies

Medline via OvidSP 27 April 2023

Title: Trained visiting dog for the frail elderly in the residential care facilities
Search terms		Items found
Population:
1.	(((longterm or long-term or elderly or "old people" or nursing or residential) adj4 (care or home* or facilit)) or "assisted living" or "old adult*").ab,bt,kf,ti.	252 197
2.	Assisted Living Facilities/	1588
3.	Nursing Homes/	3 9095
4.	Long-Term Care/	28 322
5.	Dementia/	61 002
6.	Alzheimer Disease/	116 753
7.	Cognitive Dysfunction/	34 622
8.	(dementia or Alzheimer* or ((cognitive or memory) adj4 (decline or dysfunction or loss))).ab,bt,kf,ti.	172 058
9.	Or /1-8	491 140
Intervention:
10.	Therapy Animals/	29
11.	Animal Assisted Therapy/	548
12.	((dog* or animal* or canine or pet) adj3 (therap* or assisted or visit*)).ab,bt,kf,ti.	9690
13.	#10 OR #11 OR #12	9840
Study types: systematic reviews and meta-analysis
14.	((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys" or metaanalys).ti,bt,ab.) not (editorial/ or letter/ or case reports/))	426 877
Final result
15.	9 AND 13 AND 14	48
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp= Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf.; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other.; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase

Scopus via scopus.com 27 April 2023

Title: Trained visiting dog for the frail elderly in the residential care facilities
Search terms		Items found
Population:
1.	TITLE-ABS-KEY (((longterm OR long-term OR elderly OR “old people” OR nursing OR residential) W/4 (care OR home* OR facilit)) OR “assisted living” OR “old adult*”)	566 792
2.	TITLE-ABS-KEY (dementia OR Alzheimer* OR ((cognitive OR memory) W/4 (decline OR dysfunction OR loss)))	476 301
3.	1 OR 2	995 565
Intervention:
4.	TITLE-ABS-KEY ((dog* OR animal* OR canine OR pet) W/3 (therap* OR assisted OR visit*))	19 739
Study types: systematic reviews and meta-analysis
5.	TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analy" OR metaanaly ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”))	624 808
Combined sets:
6.	3 AND 4 AND 5	78
Final result
7.	3 AND 4 AND 5	78
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords) ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other.; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words.; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range.; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase

CINAHL via EBSCO 26 April 2023

Title: Trained visiting dog for the frail elderly in the residential care facilities
Search terms		Items found
Population:
1.	TI ((((longterm OR long-term OR elderly OR “old people” OR nursing OR residential) N4 (care OR home* OR facilit)) OR “assisted living” OR “old adult”)) OR (dementia OR Alzheimer OR ((cognitive OR memory) N4 (decline OR dysfunction OR loss)))	212 063
2.	AB ((((longterm OR long-term OR elderly OR “old people” OR nursing OR residential) N4 (care OR home* OR facilit)) OR “assisted living” OR “old adult”)) OR (dementia OR Alzheimer OR ((cognitive OR memory) N4 (decline OR dysfunction OR loss)))	251 162
3.	SU ((((longterm OR long-term OR elderly OR “old people” OR nursing OR residential) N4 (care OR home* OR facilit)) OR “assisted living” OR “old adult”)) OR (dementia OR Alzheimer OR ((cognitive OR memory) N4 (decline OR dysfunction OR loss)))	262 792
4.	#1 OR #2 OR #3	386 000
Intervention:
5.	TI ((dog* OR animal* OR canine OR pet) N3 (therap* OR assisted OR visit*))	1130
6.	AB ((dog* OR animal* OR canine OR pet) N3 (therap* OR assisted OR visit*))	1987
7.	SU ((dog* OR animal* OR canine OR pet) N3 (therap* OR assisted OR visit*))	1753
8.	#5 OR #6 OR #7	3536
Study types: systematic reviews and meta-analysis
9.	((TI((systematic N3 review) OR "meta analys" OR metaanalys) OR AB((systematic N3 review) OR "meta analys" OR metaanalys) OR SU((systematic N3 review) OR "meta analys" OR metaanalys)) OR (PT "Systematic Review" OR PT "meta analysis")) NOT (MH "Case Studies" OR PT "Commentary" OR PT "Editorial" OR PT "Letter")	233 039
Combined sets:
10.	4 AND 8 AND 9	47
Final result
11.	4 AND 8 AND 9	47
TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); MH = Exact subject heading, indexed keywords; TX = All text; PT = Publication type; Nn = Near. Proximity operator retrieving terms within n words from each other.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase

PSYCINFO via EBSCO 27 April 2023

Title: Trained visiting dog for the frail elderly in the residential care facilities
Search terms		Items found
Population:
1.	TI (((longterm OR long-term OR elderly OR “old people” OR nursing OR residential) N4 (care OR home* OR facilit)) OR “assisted living” OR “old adult*”)	44 311
2.	AB (((longterm OR long-term OR elderly OR “old people” OR nursing OR residential) N4 (care OR home* OR facilit)) OR “assisted living” OR “old adult*”)	97 800
3.	DE (((longterm OR long-term OR elderly OR “old people” OR nursing OR residential) N4 (care OR home* OR facilit)) OR “assisted living” OR “old adult*”)	14 745
4.	TI (dementia OR Alzheimer* OR ((cognitive OR memory) N4 (decline OR dysfunction OR loss)))	73 017
5.	AB (dementia OR Alzheimer* OR ((cognitive OR memory) N4 (decline OR dysfunction OR loss)))	133 050
6.	DE (dementia OR Alzheimer* OR ((cognitive OR memory) N4 (decline OR dysfunction OR loss)))	91 713
7.	or/1-6	233 990
Intervention:
8.	AB ((dog* OR animal* OR canine OR pet) N3 (therap* OR assisted OR visit*))	2079
9.	TI ((dog* OR animal* OR canine OR pet) N3 (therap* OR assisted OR visit*))	933
10.	DE ((dog* OR animal* OR canine OR pet) N3 (therap* OR assisted OR visit*))	0
11.	#8 OR #9 OR #19	2194
Study types: systematic reviews and meta-analysis
12.	TI((systematic n3 review) OR "meta analys" OR metaanalys) OR AB((systematic n3 review) OR "meta analys" OR metaanalys) OR SU((systematic n3 review) OR "meta analys" OR metaanalys) OR (MR "Systematic Review" OR MR "meta analysis")	90 136
Combined sets:
13.	7 AND 11 AND 12	29
Final result
14.	7 AND 11 AND 12	29
TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); DE = Exact keyword; TX = All text; MR = Methodology; Nn = Near. Proximity operator retrieving terms within n words from each other.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase

SOCIndex via EBSCO 27 April 2023

Title: Trained visiting dog for the frail elderly in the residential care facilities
Search terms		Items found
Population:
1.	TI (((longterm OR long-term OR elderly OR “old people” OR nursing OR residential) N4 (care OR home* OR facilit)) OR “assisted living” OR “old adult*”)	15 864
2.	AB (((longterm OR long-term OR elderly OR “old people” OR nursing OR residential) N4 (care OR home* OR facilit)) OR “assisted living” OR “old adult*”)	30 646
3.	SU (((longterm OR long-term OR elderly OR “old people” OR nursing OR residential) N4 (care OR home* OR facilit)) OR “assisted living” OR “old adult*”)	9565
4.	TI (dementia OR Alzheimer* OR ((cognitive OR memory) N4 (decline OR dysfunction OR loss)))	5996
5.	AB (dementia OR Alzheimer* OR ((cognitive OR memory) N4 (decline OR dysfunction OR loss)))	9339
6.	SU (dementia OR Alzheimer* OR ((cognitive OR memory) N4 (decline OR dysfunction OR loss)))	7015
7.	or/1-6	43 253
Intervention:
8.	AB ((dog* OR animal* OR canine OR pet) N3 (therap* OR assisted OR visit*))	230
9.	TI ((dog* OR animal* OR canine OR pet) N3 (therap* OR assisted OR visit*))	109
10.	SU ((dog* OR animal* OR canine OR pet) N3 (therap* OR assisted OR visit*))	160
11.	#8 OR #9 OR #10	296
Study types: systematic reviews and meta-analysis
12.	TI((systematic N3 review) OR "meta analys" OR metaanalys) OR AB((systematic N3 review) OR "meta analys" OR metaanalys) OR SU((systematic N3 review) OR "meta analys" OR metaanalys)	12 158
Combined sets:
13.	7 AND 11 AND 12	3
Final result
14.	7 AND 11 AND 12	3
TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); Nn = Near. Proximity operator retrieving terms within n words from each other.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase

Page published October 24, 2023

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