Horses Lead the Way to Stress Reduction in Dementia Sufferers

Equine-assisted therapy alleviates anxiety in dementia patients

By William Benda, MD

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Reference

Debelko-Schoeny H, Phillips G, Darrough E, et al. Equine-assisted intervention for people with dementia. Anthrozoos. 2014; 27(1):141-155.
 

Design

Randomized pretest-posttest crossover design involving grooming, interaction with horses in an indoor arena, and painting the horse with finger-paints following Native American traditions.
 

Study Participants

The study included 16 attendees with a diagnosis of early to moderate Alzheimer’s disease or dementia attending one adult day-services center in a Midwest metropolitan area of the United States. Level of function was determined by the Mini Mental State examination. Male to female ratio was approximately 1:1, and the majority of participants were African American. This group was compared to a control group receiving usual treatment.
 

Primary Outcome Measures

There were 2 outcome measures: pretest and posttest scoring on the Nursing Home Behavior Problem Scale and salivary cortisol levels, which normally increase under stress and decrease when stressful conditions are relieved.
 

Key Findings

Behavioral problems were reduced in the intervention group in comparison to the control group. Measures assessed preintervention to postintervention showed that participants exhibited fewer disruptive behaviors in contrast to the control group on days they worked with the horses. Cortisol levels were elevated after the intervention in participants with higher Mini Mental State Examination scores. This measurement is used as a physiological measure of coping with stress.
 

Practice Implications

The literature is becoming rife with studies examining the effect of animals, primarily dogs, in addressing the chronic social and behavioral issues with Alzheimer’s disease and dementia. Positive outcomes are noted in increasing social engagement and communication and decreases in verbal aggression and anxiety interaction,1,2 as well as decreases in agitation, depression, and sleep disturbance.3-6 To date, however, the effect of interaction with horses and these patients has not been studied. This paper is an excellent opener. Currently, there are 5.4 million individuals with Alzheimer’s disease in the United States, and by 2050, this number is predicted to grow to 16 million people.7 While none of our current therapies, either therapeutic or pharmaceutical, help much, the above studies strongly suggest that interaction with a dog does.
Horses are the chemotherapy of the animal-assisted therapy world, without the toxicity.
So why on earth would we want to employ a 2000-lb horse when a 70-lb Labrador retriever would work just as well? I can tell you from my years of research with horses and kids with cerebral palsy that horses have a much more powerful presence than dogs, cats, goats, or in my mind, humans. This is why they are utilized in conditions that span everything from mental to emotional to physical to spiritual disabilities. Horses are the chemotherapy of the animal-assisted therapy world, without the toxicity. To my memory, not one article I have reviewed in the past 20 years has reported a single sneeze from any subject—adult or child. What is of even greater wonder is that none of the authors seem to fathom what may well be the strongest clinical merit of such therapies: patient motivation. Those of you who are parents or have a parent will attest to the willpower of a 4-year-old autistic child or 84-year-old progenitor who does not wish to participate in therapy, but imagine the will of a child or elder who is desperate to pet a dog or groom a horse. The animal, it turns out, is only half of the hypothesized mechanism of action. The subject’s passionate desire to participate is the other half.
 
So I am going to firmly prod all of you clinicians to not worry about the need for endless confirmatory studies and to refer your patients, specifically your pediatric and geriatric patients, to the nearest animal-assisted therapy center. Perhaps we can use the power of the market to move the research forward rather than the conventional other way around. Trust me; your patients have nothing to lose—except, perhaps, a lot of suffering.

About the Author

William Benda, MD, is a practicing emergency medicine physician, lecturer, writer, and researcher committed to the integration of alternative and conventional medicine. He is the first medical doctor to be elected to the Board of Directors of the American Association of Naturopathic Physicians and currently teaches at Southwest College of Naturopathic Medicine. His clinical work has focused on patients with breast cancer, animal-assisted therapy, and physician health and well-being; his research on equine-assisted therapy for children with cerebral palsy has been funded by the National Institutes of Health. He serves as Associate Editor of both the Journal of Alternative and Complementary Medicine and Integrative Medicine—A Clinician’s Journal.

References

  1. Fick KM. The influence of an animal on social interaction of nursing home residents in a group setting. Am J Occup Ther. 1993;47(6):529-534.
  2. Fritz CL, Farver TB, Kass PH, Hart LA. Association with companion animals and the expression of noncognitive symptoms in Alzheimer’s patients. J Nerv Ment Dis. 1995;183(7):459-463.
  3. Kogan LR. Effective animal-intervention for long term care residents. Activit Adapt Aging. 2001;25(1):31-45.
  4. Steed HN, Smith BS. Animal assisted activities for geriatric patients. Activit Adapt Aging. 2003;27(1): 49-61.
  5. Richeson NE. Effects of animal-assisted therapy on agitated behaviors and social interactions of older adults with dementia. Am J Alzheimers Dis Other Demen. 2003;18(6):353-358. 
  6. Filan SL, Llewellyn-Jones RH. Animal-assisted therapy for dementia: a review of the literature. Int Psychogeriatr. 2006;18(4):597-611.
  7. Alzheimer’s Association. Alzheimer’s facts and figures. Available at: http://www.alz.org/alzheimers_disease_facts_and_figures.asp. Accessed July 10, 2014.