Cronin and Mandich (2016) highlights a case study of Margie who is a seventy three year old woman living with mild stage Alzheimer’s disease. She currently lives with her husband, her caregiver who has a hard time balancing caring for his wife and maintaining his heart condition. Margie gets lost when she goes for walks outside and doesn’t remember her home address or remembers taking her phone with when she goes for a walk. She often gets agitated and aggressive when she is restricted from doing something. Margie has poor balance and has a fear of falling because she doesn’t use grab bars when performing routine tasks. Margie is enrolled in a dance class, exercise programs and activities to support her participation in activities of daily living to help her improve her balance and overall improve her quality of life. This is conducted by a physical therapy assistant and an occupational therapy assistant (Cronin and Mandich, 2016, p.102-103, 118). Margie will be the case study for an intervention plan in this paper.
Alzheimer’s disease is one of the most challenging disease for both patient and caregiver. Maintenance of this disease is paramount because it is a disease that deteriorates with age. Cognitive function is the primary domain affected because Margie is forgetful, not well oriented to time and has difficulty learning new tasks. Physical function is also affected because of poor motor skill performance in addition to her old age which can make activities of daily living difficult. These two domains affected; cognitive and physical domain will require an intervention plan that will improve and its functions.
Animal Assisted Therapy is a supportive intervention plan mostly used in conjunction with other treatment plans that will alleviate loneliness, agitation and improve general health. It is simply the deliberate incorporation of animals such as dogs, cats, horses or aquatic animals in the treatment plan of a patient. The use of an animal in therapy may be beneficial because animals seem to have a natural affinity to create a bond with humans. A therapy animal will seek affection and interaction with the client promoting a warm and safe atmosphere. A cure is not likely to be observed from a therapy animal, but some key aspects of quality of life and patient management may be enhanced (Hart, n.d).
Animal Assisted Therapy
According to the Centre for Disease Control (2018), Alzheimer’s disease (AD), a type of dementia, is an irreversible, progressive brain disease that affects an estimated five million and seven hundred thousand Americans. It is the sixth leading cause of death among all adults and the fifth leading cause for those aged sixty five or older. AD is a progressive and an age dependent disease that leads to the irreversible loss of neurons, particularly in the cortex and hippo-campus (McKhann, Drachman, Folstein, Katzman, Price and Stadlan, 1984).
There is not a clear casual factor for AD. The pathological factors of AD are; the existence of dense intraneuronal neurofibrillary tangles and extracellular amyloid plaques. Epidemiological researches show that increasing age and a positive family history of dementia are the definite risk factors for AD (Turner, 2006). In Alzheimer’s disease, brain cells degenerate and die. It is diagnosed by a steady decline in memory and mental function (Cronich and Mandich, 2016). This degeneration begins to show itself in very early clinical signs and symptoms. For example wandering and getting lost, losing personal belongings, mood changes, etc. This signs and symptoms varies from person to person (National Institute on Aging, n.d).
Margie wanders about and gets lost whenever she is outside even though she used to enjoy walking. She is often forgetful and lacks the ability to learn new tasks. She has problems executing activities of daily living such as bathing and dressing and also not aware of her environment as well as time. Alzheimer’s is a degenerative disease characterized by progressive loss of function. Cognitive function is the primary clinical manifestation of Alzheimer’s disease. Wilson, Segawa, Boyle, Anagnos, Hizel and Bennett (2012) showed cognitive impairment in people with AD which accelerates during the course of the condition.
Margie, a seventy three year old woman expresses a fear of falling when performing routine tasks. As people age, there is a reduction in muscle tone and strength, physical capability and motor function and balance (Morison and Newall, 2012). Keller and Engeldhardt (2013) studied people of different ages and found that muscle strength is reduced with people over the age of forty.
Alzheimer’s disease is a disease dependent on multiple factors, it is important to treat this disease with nonpharmacological treatment in addition to pharmacological treatments. These treatment options do not reverse the disease significantly but focus on improving the symptoms and reducing progression rate (Chu, 2012). The known pharmacological treatments are the acetylcholinesterase inhibitors, N-methyl-D-aspartate receptor antagonists and other neurotransmitters (Weller and Budson, 2018). The nonpharmacological treatment includes lifestyle strategies such as physical activity and socialization and diet.
A nonpharmacological intervention plan that will improve physical and cognitive function is needed. A plan that will allow her continue to explore the outdoors, reduce wandering, improve balance through physical activity and subsequently reduce the burden on her husband. The animal assisted therapy can improve these function deficits and her activities of daily living.
According to the American Veterinary Medical Association (n.d), Animal-Assisted Therapy (AAT) is a goal focused intervention plan in which an animal meeting specific standards is a vital part of the treatment process. Animal-assisted therapy is delivered and/or directed by health or human service providers working within the scope of their profession. Animal-assisted therapy is designed to promote improvement in human physical, social, emotional, or cognitive function. Animal-assisted therapy is provided in a variety of settings, and may be group or individual in nature. Animals used in this therapy include but not limited to dogs, dolphins, horses, etc. It is applied for both preventive and therapeutic requirements. The human and animal interaction is the reason for the effect of the Animal assisted therapy. The strong bond elicited by humans and animals is the vital aspect that makes this therapy effective. The effects of this therapy have been used to treat various conditions such as depression psychosis, Alzheimer’s, etc.
Animal Assisted Therapy and its Effect on Elderly Patients with Alzheimer’s disease
Banks and Banks (2002) commented that animal assisted therapy reduced loneliness in elderly patients which can lead to cognitive impairment. An animal such as a dog keeps humans company and is a source of happiness. This is a good therapy for Margie. A therapy dog may help her find her way home and not wander because dogs always know their homes, will hear her phone ring and help her find it and overall keep her from being lonely when her husband is not able to.
Animal Assisted Therapy also improves physical function. Raina, Waltner-Toews, Abernathy, Woodward and Bonnet (1999) showed that guiding animals increase physical activity and social support. Guiding animals can help Margie maintain balance by grabbing unto its leash, increase physical activity by going for walks and in crossing the street thereby finding their way home in good health. It can also help by improving her orders in activities of daily living such as bathing the animal and caring for the animal in general. Leisure activities is important in maintaining quality of life. It enhances cognitive function and overall health and wellbeing (Cronin and Mandich, 2016, p 397). An ill person playing with an animal increases the healing ability of the condition as play improves mobility and social interaction.
As Alzheimer’s disease progresses, mood changes, agitation, reduced mobility, memory loss are seen. As with Margie who loves the outdoors and often lashes out on her husband for restricting her from going outside. A therapy animal may be the only way she communicates with her environment, an animal’s touch or rub may stop her agitation, make her feel more secure and stop her from going outside without her caregivers permission. Therapy dog visitations can reduce agitation and blood pressure in both patient and caregiver and increase relaxation (Williams and Jenkins, 2006). Margie can be enrolled in dog therapy sessions and this can significantly help her in participating in leisure activities and improving safety awareness.
Conclusion
Cognitive function is the primary clinical manifestation of Alzheimer’s disease. In Margie’ case, she has difficulty sequencing activities of daily living, can’t learn new tasks and sticks to routines familiar to her. Physical function is also affected as mobility as hindered. Margie is getting old and her muscle strength is declining, Alzheimer’s speeds it up because the disease reduces leisure activity and increases isolation. Animal assisted therapy can enhance cognitive as well as physical function. A therapeutic animal for example a dog may inform the patient about her position or surrounding, or what she should do next by barking or behaving differently or non-verbally without agitating the patient.
Yakimicki, Edwards and Richards (2018) studied patients with dementia and enrolled with animal assisted therapy using dogs, they found that their agitation reduced and quality of life improved. Margie may be able to perform activities of daily living and also perform tasks not only familiar but unfamiliar to her through animal assisted therapy. She would also be relaxed and calm reducing agitation and aggression.
Enrolling Margie in the animal assisted therapy will improve her balance by reducing her fall risks and physical activity by participating in leisure activity such as smiling, playing, and going for walks, bathing and feeding and furthermore significantly reduce the burden on her husband/caregiver.
References
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