Ingeborg Pedersen

Effects on Symptoms of Agitation and Depression in Persons With Dementia Participating in Robot-Assisted Activity: A Cluster-Randomized Controlled Trial

OBJECTIVES To examine effects on symptoms of agitation and depression in nursing home residents with moderate to severe dementia participating in a robot-assisted group activity with the robot seal Paro. DESIGN A cluster-randomized controlled trial. Ten nursing home units were randomized to either robot-assisted intervention or a control group with treatment as usual during 3 intervention periods from 2013 to 2014. SETTING Ten adapted units in nursing homes in 3 counties in eastern Norway. PARTICIPANTS Sixty residents (67% women, age range 62-95 years) in adapted nursing home units with a dementia diagnosis or cognitive impairment (Mini-Mental State Examination score lower than 25/30). INTERVENTION Group sessions with Paro took place in a separate room at nursing homes for 30 minutes twice a week over the course of 12 weeks. Local nurses were trained to conduct the intervention. MEASUREMENTS Participants were scored on baseline measures (T0) assessing cognitive status, regular medication, agitation (BARS), and depression (CSDD). The data collection was repeated at end of intervention (T1) and at follow-up (3 months after end of intervention) (T2). Mixed models were used to test treatment and time effects. RESULTS Statistically significant differences in changes were found on agitation and depression between groups from T0 to T2. Although the symptoms of the intervention group declined, the control groups symptoms developed in the opposite direction. Agitation showed an effect estimate of -5.51, CI 0.06-10.97, P = .048, and depression -3.88, CI 0.43-7.33, P = .028. There were no significant differences in changes on either agitation or depression between groups from T0 to T1. CONCLUSION This study found a long-term effect on depression and agitation by using Paro in activity groups for elderly with dementia in nursing homes. Paro might be a suitable nonpharmacological treatment for neuropsychiatric symptoms and should be considered as a useful tool in clinical practice.

Farm Animal-Assisted Intervention: Relationship between Work and Contact with Farm Animals and Change in Depression, Anxiety, and Self-Efficacy Among Persons with Clinical Depression

Fourteen adults with clinical depression participated twice a week in a 12-week farm animal-assisted intervention consisting of work and contact with dairy cattle. Each participant was video-recorded twice during the intervention, and the recordings were categorized with respect to various work tasks and animal and human contact. Levels of anxiety and depression decreased and self-efficacy increased during the intervention. Interaction with farm animals via work tasks showed a greater potential for improved mental health than via sole animal contact, but only when progress in working skills was achieved, indicating the role of coping experiences for a successful intervention.

Important elements in farm animal-assisted interventions for persons with clinical depression: a qualitative interview study

Purpose: The main aim of this study was to obtain participants’ own experience of a farm animal-assisted intervention, and what they perceived as important elements in relation to their mental health. Method: A qualitative study, inspired by a phenomenological-hermeneutical perspective was conducted. Eight persons with clinical depression who had completed a 12-week farm animal-assisted intervention at a dairy farm participated in thematic interviews between May and June 2009. Results: The intervention was regarded as a positive experience for the participants. The analyses revealed that central elements in the intervention were the possibility to experience an ordinary work life, but also the importance of a distraction to their illness. Furthermore, the flexibility of the intervention made it possible to adjust the intervention to the participants’ shifting reality and was thereby a key element in farm animal-assisted intervention. The flexibility and adapted work tasks were important elements that the participants associated with their experience of coping. A model showing the interaction between the different elements reported as important by the participants was constructed. Conclusions: This study shows that a farm animal-assisted intervention could be a supplement in mental health rehabilitation. All the elements in our model could possibly influence positively on mental health. Implications for Rehabilitation Depression causes decreased quality of life and impairment, and in Western countries depression represents a major cause for sick leave and work disability. During rehabilitation, farm animal-assisted interventions may be beneficial for persons with depression. The possibility to experience an ordinary work setting was important for the participants, but also that the intervention acted as a distraction to their illness. The participants described the flexibility and possibility to experience coping as central elements in the intervention.

Farm Animal-Assisted Intervention for People with Clinical Depression: A Randomized Controlled Trial

ABSTRACT The concept of Green care includes a diversity of interventions at farms, where the common basis of the interventions is use of nature and the natural environment to improve or promote health and well-being. Farm animals are a natural part of this service and farm animal-assisted interventions may act as a complementary intervention within mental health care. The main aim of this study was to examine the effect of a 12-week farm animal-assisted intervention on levels of depression (BDI-IA), state anxiety (STAI-SS), and self-efficacy (GSE) in people with clinical depression. Twenty-nine people (23 women and 6 men, mean age 37.8 years, range 23–58) were randomly assigned to the intervention (n = 16) or a wait-list control group (n = 13). In the intervention group, the participants worked twice a week with the farmer in the cowshed. They interacted on their own choice with dairy cattle via work tasks and physical contact. A significant decline in depression (t(15) = –3.53, p = 0.003) and a significant increase in self-efficacy (t(15) = 2.18, p = 0.045) were seen in the intervention group between recruitment and end of intervention. In the control group, no significant changes were found. No significant differences were found when comparing change in mental health measures in the intervention and control groups. However, more subjects in the intervention group (6) than in the control group (1) had clinically significant change, indicating that animal- assisted intervention in Green care could be beneficial for subgroups of clients and act as a useful supplement within mental health care.

Effect of animal-assisted interventions on depression, agitation and quality of life in nursing home residents suffering from cognitive impairment or dementia: a cluster randomized controlled trial

The prevalence of neuropsychiatric symptoms in cognitively impaired nursing home residents is known to be very high, with depression and agitation being the most common symptoms. The possible effects of a 12‐week intervention with animal‐assisted activities (AAA) in nursing homes were studied. The primary outcomes related to depression, agitation and quality of life (QoL).

Engagement in elderly persons with dementia attending animal-assisted group activity

The need for meaningful activities that enhance engagement is very important among persons with dementia (PWDs), both for PWDs still living at home, as well as for PWDs admitted to a nursing home (NH). In this study, we systematically registered behaviours related to engagement in a group animal-assisted activity (AAA) intervention for 21 PWDs in NHs and among 28 home-dwelling PWDs attending a day care centre. The participants interacted with a dog and its handler for 30 minutes, twice a week for 12 weeks. Video-recordings were carried out early (week 2) and late (week 10) during the intervention period and behaviours were categorized by the use of an ethogram. AAA seems to create engagement in PWDs, and might be a suitable and health promoting intervention for both NH residents and participants of a day care centre. Degree of dementia should be considered when planning individual or group based AAA.

Mental health rehabilitation in a care farm context: A descriptive review of Norwegian intervention studies.

BACKGROUND C are farming is a service developed at farms for promoting mental and physical health and is increasingly used in mental health rehabilitation in Norway. OBJECTIVE This article aims to present a descriptive review of Norwegian intervention research on care farms that provide rehabilitation for people with mental health disorders. METHODS This literature review applied a non-systematic search strategy: all articles in the field known to the authors were selected for inclusion. The selected studies were intervention studies that were conducted on farms in Norway, that used adult participants with mental health problems/disorders, and that reported outcome measures related to mental health. The studies and articles presented quantitative and/or qualitative data. RESULTS The findings from the published articles report improvements to mental health problems, such as depression, anxiety, perceived stress, positive affect, rumination, and self-efficacy. Qualitative data describe a variety of positive experiences, such as improved coping ability, increased social support, and appreciation of the care farm activity. CONCLUSION Participating in interventions on care farms positively influences mental health. Care farming may therefore be used as a supplementary approach in mental health rehabilitation, as it offers meaningful and engaging occupations and social inclusion.

Understanding how prevocational training on care farms can lead to functioning, motivation and well-being

Abstract Purpose: Prevocational training aims to improve basic vocational and social skills, supporting return to work for people who have been out of work for a long time. Care farms provide prevocational training; the aim of the study was to use the self-determination theory to gain an understanding of how these programmes can lead to healthy functioning and motivation for clients. Method: A total of 194 participants in prevocational training on care farms answered questions about demographic information, their perception of being a colleague, the social community on the farm, experiencing nature and animals and need satisfaction. A cross-sectional design resulting in a structural equation model was used to understand how elements of the care farm context influence satisfaction of three psychological needs. Results: The results showed that a feeling of being a useful colleague led to competence, experiencing a sense of group belonging led to relatedness and autonomy, while receiving social support from the farmer led to satisfaction of all three needs for the participants. Conclusions: The results explain how prevocational training can stimulate participants’ functionality, motivation and well-being. This understanding enables initiators and managers of prevocational training to understand and further strengthen the need–supportive elements of such programmes. Implications for Rehabilitation Prevocational training on care farms can facilitate motivation, functioning and well-being for clients. Making clients feel like useful colleagues that belong to a client group will strengthen the positive qualities of these programmes. Support, understanding and acknowledgement from the farmer are the most important elements for a positive development for the clients.