Management of Agitation in Individuals with Dementia: an Animal-assisted Therapy Approach

Dementia is not a natural and normal part of aging, but rather a symptom of a disease process. Most individuals with dementia experience emotional distress or behavioral problems best summed up by the term agitation. Approximately 90% of individuals with dementing illnesses demonstrate problem behaviors ranging from repetitive verbalizations and wandering to verbal and physical aggression toward self or others. Each evening thousands of older adults in the community and in institutions become agitated, restless, and confused and begin to wander about or scream. This phenomenon is referred to as sundown syndrome, since it occurs in the evening hours after sunset. Sundown syndrome is not a psychiatric diagnosis, but it is a common and recognizable phenomenon for those who provide care for individuals with dementia (Burney-Puckett, 1996; Churchill, Safaoui, McCabe, & Baun, 1999). There is an enormous amount of pressure on nursing facility staff to manage agitation in individuals with dementia without resorting to the use of chemical and physical restraints. The federal government became involved in the oversight of nursing home care with the passage of the Omnibus Budget Reconciliation Act (OBRA, 1990). One of the goals of these regulations was to improve the quality of nursing home care by reducing the use of chemical and physical restraints in the management of agitation. The Omnibus Budget Reconciliation Act regulations recommend that an environmental and/or behavioral management strategy be the first line of treatment for agitated residents. Environmental and/or behavioral management strategies need to be devised to reduce the level of agitation in individuals with dementia, as well as provide feasibility for nursing facility staff to implement and incorporate these interventions into individual plans of care. Animal-assisted therapy is an environmental intervention that can be implemented by nursing facility staff as a nonpharmacologic treatment approach to managing agitation in individuals with dementia. This study was designed to investigate whether or not an animal-assisted therapy approach would be effective in managing agitation associated with sundown syndrome in individuals with dementia, thereby reducing the need to use chemical and/or physical restraints