Animal therapy has become increasingly popular in dementia, as it shows positive effects in the behaviour, mood and quality of life in people with dementia. This has been recently extended to robotic animals which seemingly show similar positive effects in people with dementia.
But what is the scientific evidence for the effectiveness of such animal and robot therapies to reduce behavioural symptoms and increase the quality of life in people with dementia? And are robots as effective in reducing those symptoms as living animals?
A recent meta-analysis addressed this question and found striking results.
Animal therapy is one type of animal-assisted interventions, of which there are three types:
- Animal-assisted activities – refer to any activities involving animals. This is a very broad range of activities and can simply involve someone bringing an animal to an activity. Animals are often not trained for these activities but support them.
- Animal-assisted therapies – refer to interventions involving animals that are aimed at improving certain patient outcomes and are incorporated into rehabilitation programs. Animals in animal-assisted therapies have often some form of training in providing the interventions so that it assures the health outcomes.
- Service animal programs – refer to programs that utilise trained animals to help people with physical disabilities to overcome functional difficulties in their activities of daily living. Service animals are highly trained, such as guide dogs for visually impaired people.
When talking about animal therapies in dementia we have to understand therefore that we are talking about animal-assisted therapies, as many people get it confused with animal-assisted activities. The key difference is that the therapy involving the animal is to provide a specific health outcome in the participants.
Research studies have shown that animal-assisted therapies can reduce symptoms such as anxiety, stress and even depression in people with mental health conditions. At the same time participants in such therapies also often report a higher quality of life to people who do not receive animal-assisted therapy.
It has been therefore suggested that animal-assisted therapies can also help with some of the most common behavioural symptoms common in dementia, such as agitation and depression. On top of that, there have been anecdotal reports that the quality of life of people with dementia is improved by animal-assisted therapies.
But what is the scienitific evidence for such animal-assisted therapies to reduce behavioural symptoms in dementia and improve the quality of life?
Several clinical trials have investigated whether animal-assisted therapies can change behavioural symptoms in dementia, particularly for agitation and depression. Unfortunately, the data from these clinical trials have been mixed to date, with some trials showing positive effects for people with dementia, while other trials showing no or even adverse effects.
A recent meta-analysis* examined the evidence across all clinical trials for animal-assisted therapy in dementia. The study only included trials which were conducted with a very strict methodology to provide definitive evidence for animal-assisted therapies in dementia.
The results from the meta-analysis were clear cut by showing that animal-assisted therapies seemingly have no effect on agitation and quality of life in people with dementia. However, there was a robust effect for animal-assisted therapy to reduce depression in people with dementia.
Interestingly, the authors not only investigated trials using living animals but also robotic animals. The results were identical for the robotic animals, by showing reduction in depression but no effect on agitation or quality of life in people with dementia. However, the effects were slighlty weaker than the therapies using living animals. Still, it is striking that robotic animals corroborated the living animals findings.
Robotic animals have been increasingly used in dementia. The most common robotic animal for therapy in dementia is PARO (http://www.parorobots.com/). PARO is a seal-shaped robot responding to light, temperature, touch, and posture. Importantly, its sensors allow PARO to monitor people with dementia’s emotional changes and health status and react to them directly.
Instead of it being a passive soft toy, PARO provides therefore direct feedback to the person with dementia. It should provide therefore similar feedback as a living animal. The meta-analysis results corroborate this notion as robotic animals reduce only depression and not agitation in people with dementia – as did the living animals.
At first robotic animals were considered by many to be ‘gimmicks’ in dementia care but clinical trials and the above meta-analysis further consolidate the notion that robotic animals might have a place in dementia care. In particular, as robotic animals reveal similar results in health outcomes as living animals in dementia, while at the same time overcoming potential limitations of living animals, such as cost, hygiene and safety considerations. Clearly robots or robotic animals will not replace living animal or human therapy but it provides another option to improve the health outcomes for people with dementia.
How about the quality of life in people with dementia?
The most surprising finding of the meta-analysisin the clinical trial seems to be that any of the animal-assisted therapies did not have a positive effect on the quality of life of the people with dementia. We would usually assume that having an animal – living or robotic – should improve our quality of life but that was not the case. The results showed a small effect on the quality of life only which was not statistically significant, which means this needs to be further investigated in the future.
Taken together, the good news is that animal-assisted therapies can have a positive effect on one of the most common symptoms in dementia – depression. That robotic animals can have a similar effect is a truly novel finding and opens the door to explore robotics in dementia care further, as it might complement existing dementia care and provide a companion for the person with dementia throughout their disease.
* Park S, Bak A, Kim S, Nam Y, Kim HS, Yoo DH, Moon M. Animal-Assisted and Pet-Robot Interventions for Ameliorating Behavioral and Psychological Symptoms of Dementia: A Systematic Review and Meta-Analysis. Biomedicines. 2020 Jun 2;8(6):150. doi: 10.3390/biomedicines8060150. PMID: 32498454; PMCID: PMC7345589.