O envelhecimento é um fenômeno novo e uma tendência mundial. Com ele, há um aumento de doenças e de queixas de dor. Este estudo permitiu que os profissionais de saúde tivessem uma melhor percepção na avaliação da dor no envelhecimento. O objetivo geral foi avaliar os diferentes tipos de dor crônica no envelhecimento. Os objetivos específicos foram mensurar a dor percebida, avaliar os descritores de dor crônica de maior atribuição, identificar diferentes temáticas de dor crônica percebida e avaliar sinais e sintomas de depressão. Foi realizada identificação sócio-demográfica, com perguntas relacionadas ao sexo, à idade, à escolaridade, à religião, ao estado civil, às atividades desenvolvidas na instituição, à situação econômica, ao tempo de institucionalização, ao recebimento de visitas e às doenças diagnosticadas e, posteriormente, foram feitos quatro Experimentos (amostras dependentes). Experimento 1 - Mensurar a dor percebida - a intensidade da dor crônica foi avaliada pelo método psicofísico de estimação de categorias e se percebiam dor no momento da entrevista, para identificar o local, o tempo e o horário. Experimento 2 - Avaliar os descritores de dor crônica de maior atribuição - a intensidade da dor foi avaliada por dois métodos psicofísicos independentes: estimação de categorias e estimação de postos. Experimento 3 - Identificar diferentes temáticas de dor crônica percebida - utilizou-se uma entrevista semiestruturada com sete perguntas relacionadas à dor crônica. Experimento 4 - Avaliar sinais e sintomas de depressão - utilizou-se a Escala de Depressão Geriátrica de 15 pontos. Participaram 46 idosos residentes em duas Instituições de Longa Permanência em Ribeirão Preto, São Paulo; dentre estes, 25 eram de instituição filantrópica e 21 de instituição particular. Os resultados foram a média de idade de 78,26±8,33 anos, 26 do sexo feminino, 23 viúvos, 28 católicos, 23 cursaram o ensino fundamental incompleto, 46 aposentados e 37 recebem até 1 salário mínimo, 16 tem hipertensão arterial, 37 residem nas instituições referidas no tempo de 0 a 5 anos, 34 declararam não realizar atividade nas instituições pesquisadas e 24 recebem visitas de familiares. No Experimento 1, 14 idosos atribuíram o valor 10 para a intensidade da dor percebida na última semana, sendo a média aritmética de 7,02±2,74 pontos; 28 relataram sentir dor no momento da entrevista e 32 não haver horário específico, sendo as regiões mais afetadas os membros inferiores e a região dorsal. No Experimento 2, no método de estimação de categorias, o descritor de dor de maior atribuição foi \"dolorosa\" e o de menor foi \"desastrosa\". No método de estimação de postos, o descritor de dor de maior atribuição foi \"desastrosa\" e o de menor atribuição foi \"dolorosa\". No Experimento 3, foram identificadas unidades temáticas como \"percepção quanto ao tempo\", \"dimensão da dor\", \"estratégias de enfrentamento\", \"causas relacionadas à dor\", \"percepção da situação atual\" e \"outras percepções\". No Experimento 4, observou-se que 33 idosos responderam à Escala de Depressão Geriátrica (EDG) - 15 pontos - e obtiveram um escore de 5 ou mais pontos podendo sugerir episódio de depressão, ao passo que 13 obtiveram um escore abaixo de 5 pontos, não sugerindo episódio de depressão. / Aging is a new phenomenon and a global trend. With it, there is an increase of diseases and complaints of pain. This study has allowed health professionals have a better assessment of pain perception in aging. The overall objective was to evaluate the different types of chronic pain in aging. The specific objectives were to measure the perceived pain, to evaluate the descriptors of chronic pain with higher scores, identify different issues of chronic pain perceived and assess for signs and symptoms of depression. Identification was carried out socio-demographic, with questions related to sex, age, education, religion, marital status, the activities of the institution, the economic situation at the time of institutionalization, to receive visits and disease diagnosed and later, four experiments were conducted (dependent samples). Experiment 1 - Measuring the perceived pain - chronic pain intensity was assessed by the psychophysical method of category estimation and perceived pain during the interview, to identify the location, time and time. Experiment 2 - Assess the descriptors of chronic pain with higher scores - the intensity of pain was evaluated by two independent psychophysical methods: estimation and estimation of categories of posts. Task 3 - Identify the different themes of chronic pain perceived - we used a semi-structured interviews with seven questions related to chronic pain. Experiment 4 - Assess signs and symptoms of depression - used the Geriatric Depression Scale of 15 points. Attended by 46 elderly residents of two long-term institutions in Ribeirao Preto, São Paulo, among these, 25 were from philanthropic institutions and 21 private. The results were the mean age of 78.26 ± 8.33 years, 26 females, 23 were widowed, 28 Catholics, 23 attended the elementary school, 46 retirees and 37 to receive a minimum wage, 16 have high blood pressure, 37 reside in the institutions mentioned in the time from 0 to 5 years, 34 said they did not carry out activities in the institutions surveyed and 24 receive family visits. In Experiment 1, 14 elderly people attributed the value 10 for the intensity of perceived pain last week, and the arithmetic mean of 7.02 ± 2.74 points, 28 reported pain at the time of interview and 32 there is no specific time, and regions most affected lower limbs and the dorsal region. In Experiment 2, the method of category estimation, the greatest pain descriptor assignment was \"painful\" and the least was \"disastrous.\" In the method of estimation of posts, the more pain descriptor assignment was \"disastrous\" and the assignment was less \"painful\". In Experiment 3, thematic units were identified as: \"the perception of time,\" \"dimension of pain,\" \"coping strategies\", \"pain-related causes,\" \"perception of the current situation\" and \"other perceptions.\" In Experiment 4, it was observed that 33 seniors responded to the Geriatric Depression Scale (GDS) -15 points - and obtained a score of 5 or more points may suggest a depressive episode, while 13 had a score below 5 points, not suggesting a depressive episode.

This thesis discusses current insights into the applications of deep transcranial magnetic stimulation (dTMS) in older adults with treatment-resistant depression (TRD). / Objectives: To examine current evidence of clinical efficacy and applications of deep transcranial magnetic stimulation (dTMS) among older adults with treatment-resistant depression (TRD). Methods: In Study 1, we conducted a systematic review of existing literature on the clinical efficacy of dTMS across psychiatric and cognitive disorders. Studies eligible for inclusion were clinical trials which were required to have a sham/control condition to mitigate confounding variables and to strengthen our assessment of efficacy. This dissertation specifically aimed to discuss these findings in the context of older adults with depression, as a means to investigate whether available evidence supporting the clinical efficacy of dTMS for depression is generalizable to older populations. In Study 2, we analyzed recruitment data from a pilot study investigating the effects of dTMS in older adults with TRD. Specifically, we aimed to evaluate the effectiveness of various recruitment strategies by using an enrollment-cost analysis, as well as comparing enrollment rates (i.e., enrolled participants/referrals received) for each recruitment method. Moreover, we identified potential facilitators and barriers to recruitment following a verbal thematic analysis of qualitative interview data. Results: In Study 1, most substantial evidence (n = 6 studies) within the literature supports the clinical efficacy of the dTMS H1-coil for the treatment of depressive episodes in patients with bipolar disorder (BD) or major depressive disorder (MDD). Only one randomized controlled trial was conducted in older adults with TRD. This trial reported higher remission rates in the active dTMS arm compared to the sham dTMS arm following treatment with the H1-coil. In study 2, we found (1) health provider outreach within the affiliated inpatient and outpatient mental health clinics and (2) Facebook, to be the most effective recruitment strategies. Lastly, social support from research staff (n = 15; 88.24%) and the time-intensiveness aspect of dTMS treatments (n = 6; 35.29%) were the most frequently identified facilitators and barriers to recruitment, respectively. Conclusions: While there is notable evidence supporting the clinical efficacy of the dTMS H1-coil for the treatment of depressive episodes, the majority of such evidence is based on findings from younger-to-middle aged groups. Thus, the generalizability of dTMS treatment efficacy to older adults remains less understood. Further sham-controlled studies are needed to determine the clinical efficacy of dTMS in older adults and to improve evidence-based care in the field of geriatric psychiatry. Importantly, we aimed to address this underrepresentation of older adults in clinical research by analyzing recruitment strategies and examining facilitators and barriers to recruitment. Future research is warranted to examine facilitators and barriers to recruitment in older adults with depression, particularly the importance of social support, which may offer valuable insights on how to overcome the issue of underrepresentation. / Thesis / Master of Science (MSc) / Brain stimulation therapies, such as deep transcranial magnetic stimulation (dTMS), show promising results for treatment-resistant depression (TRD). However, the applications of dTMS remain overlooked in geriatric populations with TRD, limiting the generalizability of such treatments to older adults. This dissertation aimed to examine current evidence supporting the use of dTMS in older adults with depression. In Study 1, we conducted a systematic review of available evidence on the clinical efficacy of dTMS across psychiatric and cognitive disorders. We found most evidence supporting the clinical efficacy of dTMS for the treatment of depressive episodes. However, the underrepresentation of older adults in such research was highly prevalent, with only one study being focused on older adults. In Study 2, we explored the effectiveness of diverse recruitment methods used in an ongoing dTMS trial for older adults with depression. Additionally, we identified potential facilitators and barriers to recruitment. Overall, the most effective recruitment strategies were (1) health provider outreach within the affiliated inpatient and outpatient mental health clinics and (2) Facebook advertising. Furthermore, social support from research staff and high time commitment of dTMS treatments were identified as facilitators and barriers to recruitment, respectively. These findings highlight the importance of conducting dTMS research in older adults to address the issue of underrepresentation and to improve evidence-based care in this special population.

The submitted thesis deals with the issue of the meaning in life in the elderly. The meaningfulness of life, which was as a deep human need listed among the evaluated items in the WHOQOL assessments, is considered to be an important salutogenic factor. The thesis briefly introduces logotherapy, a method focused on the revelation and renewal of the meaning in life and the orientation towards values. It also mentions the possibilities of logotherapeutic approach in the communication with seniors being in a difficult life situation. The theoretical part specifies the fundamental terms regarding the ageing, the elderly, the demographic evolution of the contemporary society, health and psychosocial aspects of ageing and the seniors' needs. Further, this part summarizes the theoretical knowledge about the issue of quality of life and its meaning, the methods of their examination and the results of research. The last chapter of the theoretical part summarizes the existing knowledge regarding the depression in the elderly. The course of the research is described in the empirical part of the thesis. The aim of the research was to find out to what extent the seniors over 75 years of age in the Czech Republic live their lives as meaningful, to compare the measure of meaningfulness of life of older and younger...

The submitted thesis deals with the issue of the meaning in life in the elderly. The meaningfulness of life, which was as a deep human need listed among the evaluated items in the WHOQOL assessments, is considered to be an important salutogenic factor. The thesis briefly introduces logotherapy, a method focused on the revelation and renewal of the meaning in life and the orientation towards values. It also mentions the possibilities of logotherapeutic approach in the communication with seniors being in a difficult life situation. The theoretical part specifies the fundamental terms regarding the ageing, the elderly, the demographic evolution of the contemporary society, health and psychosocial aspects of ageing and the seniors' needs. Further, this part summarizes the theoretical knowledge about the issue of quality of life and its meaning, the methods of their examination and the results of research. The last chapter of the theoretical part summarizes the existing knowledge regarding the depression in the elderly. The course of the research is described in the empirical part of the thesis. The aim of the research was to find out to what extent the seniors over 75 years of age in the Czech Republic live their lives as meaningful, to compare the measure of meaningfulness of life of older and younger...

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Rapid increases in population ageing and the associated rise in the prevalence of dementia have created many challenges for the care of older people with dementia. As the majority of people now living in residential aged care facilities (RACFs) now have dementia, the need to maximise the quality of life for this group is increasingly recognised. While such issues have attracted research and policy attention in recent years, the evidence base for practice in dementia care is still underdeveloped. The need for more effective therapeutic interventions to improve the quality of life for older people with dementia is recognised, particularly those living in RACFs. The use of pets is one example of recent attempts to help create a more home-like environment and dog therapy is available in many facilities. Well designed research to demonstrate whether it actually has a positive impact on residents’ quality of life is lacking. This study is the first reported randomised controlled trial investigating dog therapy for people with dementia. Fifty-five older people with mild to moderate dementia living in three residential aged care facilities in the Greater Brisbane area participated in this study. The goal was to identify whether dog therapy accrued any benefits to residents’ well being and compare the benefits, if any, with human-only therapy intervention. The main hypothesis was that dog contact delivered in a small group recreational therapy format would have a beneficial effect on the well being of participants. It was additionally hypothesised that prior and current positive relationships with dogs would be related to improved outcomes of dog therapy and support a human-animal bond explanation of relationship development with the therapy dog(s). Participants were randomly assigned into two groups within each facility: The dog therapy group and a human-only therapy group. Session plans were structured according to a recreational therapy format. Three therapy dogs were used (a miniature Poodle, a Staffordshire Terrier and a German Shepherd Dog) with one dog present at any dog therapy session A before-and-after design was used with concealment of participants at allocation. Mixed methods were used including a panel of seven validated psychometric instruments, an observational measure and a series of four novel questionnaires, dogs for older groups with Alzheimer’s (DOGA), developed de novo specifically to investigate the effects of dog therapy on participants within this study. Measures of mood, quality of life, health and psychosocial functioning, collectively referred to as well-being, detected benefits accruing to dog therapy participants compared with human-only therapy that approached significance (p = .056) with a large effect size (partial eta squared 16.6%). A different measure of mood and apathy showed similar improvement for participants of both therapy types trialed with analyses of a smaller dataset (n = 36) revealing an overall highly significant result (p=.008) and large effect size (partial eta squared = 25.6%) for all participants. To explore the perceptions of care staff to the dog therapy intervention, a self-complete semi-structured questionnaire was completed by a sample of 21 from two of the study facilities. Content analysis revealed that staff overwhelmingly supported dog therapy with a total of 84 comments about benefits and 22 about risks. Responses were categorised and then linked into emergent themes: a temporal dimension, sense of self and increased opportunities for self expression. The opportunity provided by the therapy dog for accessible caring physical contact for participants was identified as important. General recreational therapy goals such as improved mood, reminiscence and increased levels of conversation were reported by staff to continue beyond interventions. The observed risks were: confusion over dog ownership, subsequent worry about losing the dog after sessions, jealousy over the therapy dog and one participant did not enjoy the small group format. Participants described their experiences of contact with the therapy dog as “like” above “attached”. Personal preference explanations are therefore supported, rather than “attachment”, to explain outcomes for participants. This suggests the psychosocial approach has greater relevance here than human-animal bond explanations. Effects of previous dog attachment on outcomes were inconclusive but there was some evidence that participants’ relationship with the therapy dog(s) influenced outcomes, though the nature of that relationship has not been clarified. Recommendations from the study findings are that dog therapy be conducted for people with mild to moderate levels of dementia in groups of 3-11 for a duration of around 10 weeks with sessions for 30 minutes held once or twice weekly and according to a standard format. Opportunities for participants to touch, hug and interact directly with the therapy dog should be maximised without compromising dog welfare. The findings suggest that respect for the personhood of participants is important to the success of the therapy types trialled, which further supports psychosocial therapies involving contact with people or live animals for use with people with dementia over those that minimise or exclude it.

Rapid increases in population ageing and the associated rise in the prevalence of dementia have created many challenges for the care of older people with dementia. As the majority of people now living in residential aged care facilities (RACFs) now have dementia, the need to maximise the quality of life for this group is increasingly recognised. While such issues have attracted research and policy attention in recent years, the evidence base for practice in dementia care is still underdeveloped. The need for more effective therapeutic interventions to improve the quality of life for older people with dementia is recognised, particularly those living in RACFs. The use of pets is one example of recent attempts to help create a more home-like environment and dog therapy is available in many facilities. Well designed research to demonstrate whether it actually has a positive impact on residents’ quality of life is lacking. This study is the first reported randomised controlled trial investigating dog therapy for people with dementia. Fifty-five older people with mild to moderate dementia living in three residential aged care facilities in the Greater Brisbane area participated in this study. The goal was to identify whether dog therapy accrued any benefits to residents’ well being and compare the benefits, if any, with human-only therapy intervention. The main hypothesis was that dog contact delivered in a small group recreational therapy format would have a beneficial effect on the well being of participants. It was additionally hypothesised that prior and current positive relationships with dogs would be related to improved outcomes of dog therapy and support a human-animal bond explanation of relationship development with the therapy dog(s). Participants were randomly assigned into two groups within each facility: The dog therapy group and a human-only therapy group. Session plans were structured according to a recreational therapy format. Three therapy dogs were used (a miniature Poodle, a Staffordshire Terrier and a German Shepherd Dog) with one dog present at any dog therapy session A before-and-after design was used with concealment of participants at allocation. Mixed methods were used including a panel of seven validated psychometric instruments, an observational measure and a series of four novel questionnaires, dogs for older groups with Alzheimer’s (DOGA), developed de novo specifically to investigate the effects of dog therapy on participants within this study. Measures of mood, quality of life, health and psychosocial functioning, collectively referred to as well-being, detected benefits accruing to dog therapy participants compared with human-only therapy that approached significance (p = .056) with a large effect size (partial eta squared 16.6%). A different measure of mood and apathy showed similar improvement for participants of both therapy types trialed with analyses of a smaller dataset (n = 36) revealing an overall highly significant result (p=.008) and large effect size (partial eta squared = 25.6%) for all participants. To explore the perceptions of care staff to the dog therapy intervention, a self-complete semi-structured questionnaire was completed by a sample of 21 from two of the study facilities. Content analysis revealed that staff overwhelmingly supported dog therapy with a total of 84 comments about benefits and 22 about risks. Responses were categorised and then linked into emergent themes: a temporal dimension, sense of self and increased opportunities for self expression. The opportunity provided by the therapy dog for accessible caring physical contact for participants was identified as important. General recreational therapy goals such as improved mood, reminiscence and increased levels of conversation were reported by staff to continue beyond interventions. The observed risks were: confusion over dog ownership, subsequent worry about losing the dog after sessions, jealousy over the therapy dog and one participant did not enjoy the small group format. Participants described their experiences of contact with the therapy dog as “like” above “attached”. Personal preference explanations are therefore supported, rather than “attachment”, to explain outcomes for participants. This suggests the psychosocial approach has greater relevance here than human-animal bond explanations. Effects of previous dog attachment on outcomes were inconclusive but there was some evidence that participants’ relationship with the therapy dog(s) influenced outcomes, though the nature of that relationship has not been clarified. Recommendations from the study findings are that dog therapy be conducted for people with mild to moderate levels of dementia in groups of 3-11 for a duration of around 10 weeks with sessions for 30 minutes held once or twice weekly and according to a standard format. Opportunities for participants to touch, hug and interact directly with the therapy dog should be maximised without compromising dog welfare. The findings suggest that respect for the personhood of participants is important to the success of the therapy types trialled, which further supports psychosocial therapies involving contact with people or live animals for use with people with dementia over those that minimise or exclude it.

Rapid increases in population ageing and the associated rise in the prevalence of dementia have created many challenges for the care of older people with dementia. As the majority of people now living in residential aged care facilities (RACFs) now have dementia, the need to maximise the quality of life for this group is increasingly recognised. While such issues have attracted research and policy attention in recent years, the evidence base for practice in dementia care is still underdeveloped. The need for more effective therapeutic interventions to improve the quality of life for older people with dementia is recognised, particularly those living in RACFs. The use of pets is one example of recent attempts to help create a more home-like environment and dog therapy is available in many facilities. Well designed research to demonstrate whether it actually has a positive impact on residents’ quality of life is lacking. This study is the first reported randomised controlled trial investigating dog therapy for people with dementia. Fifty-five older people with mild to moderate dementia living in three residential aged care facilities in the Greater Brisbane area participated in this study. The goal was to identify whether dog therapy accrued any benefits to residents’ well being and compare the benefits, if any, with human-only therapy intervention. The main hypothesis was that dog contact delivered in a small group recreational therapy format would have a beneficial effect on the well being of participants. It was additionally hypothesised that prior and current positive relationships with dogs would be related to improved outcomes of dog therapy and support a human-animal bond explanation of relationship development with the therapy dog(s). Participants were randomly assigned into two groups within each facility: The dog therapy group and a human-only therapy group. Session plans were structured according to a recreational therapy format. Three therapy dogs were used (a miniature Poodle, a Staffordshire Terrier and a German Shepherd Dog) with one dog present at any dog therapy session A before-and-after design was used with concealment of participants at allocation. Mixed methods were used including a panel of seven validated psychometric instruments, an observational measure and a series of four novel questionnaires, dogs for older groups with Alzheimer’s (DOGA), developed de novo specifically to investigate the effects of dog therapy on participants within this study. Measures of mood, quality of life, health and psychosocial functioning, collectively referred to as well-being, detected benefits accruing to dog therapy participants compared with human-only therapy that approached significance (p = .056) with a large effect size (partial eta squared 16.6%). A different measure of mood and apathy showed similar improvement for participants of both therapy types trialed with analyses of a smaller dataset (n = 36) revealing an overall highly significant result (p=.008) and large effect size (partial eta squared = 25.6%) for all participants. To explore the perceptions of care staff to the dog therapy intervention, a self-complete semi-structured questionnaire was completed by a sample of 21 from two of the study facilities. Content analysis revealed that staff overwhelmingly supported dog therapy with a total of 84 comments about benefits and 22 about risks. Responses were categorised and then linked into emergent themes: a temporal dimension, sense of self and increased opportunities for self expression. The opportunity provided by the therapy dog for accessible caring physical contact for participants was identified as important. General recreational therapy goals such as improved mood, reminiscence and increased levels of conversation were reported by staff to continue beyond interventions. The observed risks were: confusion over dog ownership, subsequent worry about losing the dog after sessions, jealousy over the therapy dog and one participant did not enjoy the small group format. Participants described their experiences of contact with the therapy dog as “like” above “attached”. Personal preference explanations are therefore supported, rather than “attachment”, to explain outcomes for participants. This suggests the psychosocial approach has greater relevance here than human-animal bond explanations. Effects of previous dog attachment on outcomes were inconclusive but there was some evidence that participants’ relationship with the therapy dog(s) influenced outcomes, though the nature of that relationship has not been clarified. Recommendations from the study findings are that dog therapy be conducted for people with mild to moderate levels of dementia in groups of 3-11 for a duration of around 10 weeks with sessions for 30 minutes held once or twice weekly and according to a standard format. Opportunities for participants to touch, hug and interact directly with the therapy dog should be maximised without compromising dog welfare. The findings suggest that respect for the personhood of participants is important to the success of the therapy types trialled, which further supports psychosocial therapies involving contact with people or live animals for use with people with dementia over those that minimise or exclude it.

Rapid increases in population ageing and the associated rise in the prevalence of dementia have created many challenges for the care of older people with dementia. As the majority of people now living in residential aged care facilities (RACFs) now have dementia, the need to maximise the quality of life for this group is increasingly recognised. While such issues have attracted research and policy attention in recent years, the evidence base for practice in dementia care is still underdeveloped. The need for more effective therapeutic interventions to improve the quality of life for older people with dementia is recognised, particularly those living in RACFs. The use of pets is one example of recent attempts to help create a more home-like environment and dog therapy is available in many facilities. Well designed research to demonstrate whether it actually has a positive impact on residents’ quality of life is lacking. This study is the first reported randomised controlled trial investigating dog therapy for people with dementia. Fifty-five older people with mild to moderate dementia living in three residential aged care facilities in the Greater Brisbane area participated in this study. The goal was to identify whether dog therapy accrued any benefits to residents’ well being and compare the benefits, if any, with human-only therapy intervention. The main hypothesis was that dog contact delivered in a small group recreational therapy format would have a beneficial effect on the well being of participants. It was additionally hypothesised that prior and current positive relationships with dogs would be related to improved outcomes of dog therapy and support a human-animal bond explanation of relationship development with the therapy dog(s). Participants were randomly assigned into two groups within each facility: The dog therapy group and a human-only therapy group. Session plans were structured according to a recreational therapy format. Three therapy dogs were used (a miniature Poodle, a Staffordshire Terrier and a German Shepherd Dog) with one dog present at any dog therapy session A before-and-after design was used with concealment of participants at allocation. Mixed methods were used including a panel of seven validated psychometric instruments, an observational measure and a series of four novel questionnaires, dogs for older groups with Alzheimer’s (DOGA), developed de novo specifically to investigate the effects of dog therapy on participants within this study. Measures of mood, quality of life, health and psychosocial functioning, collectively referred to as well-being, detected benefits accruing to dog therapy participants compared with human-only therapy that approached significance (p = .056) with a large effect size (partial eta squared 16.6%). A different measure of mood and apathy showed similar improvement for participants of both therapy types trialed with analyses of a smaller dataset (n = 36) revealing an overall highly significant result (p=.008) and large effect size (partial eta squared = 25.6%) for all participants. To explore the perceptions of care staff to the dog therapy intervention, a self-complete semi-structured questionnaire was completed by a sample of 21 from two of the study facilities. Content analysis revealed that staff overwhelmingly supported dog therapy with a total of 84 comments about benefits and 22 about risks. Responses were categorised and then linked into emergent themes: a temporal dimension, sense of self and increased opportunities for self expression. The opportunity provided by the therapy dog for accessible caring physical contact for participants was identified as important. General recreational therapy goals such as improved mood, reminiscence and increased levels of conversation were reported by staff to continue beyond interventions. The observed risks were: confusion over dog ownership, subsequent worry about losing the dog after sessions, jealousy over the therapy dog and one participant did not enjoy the small group format. Participants described their experiences of contact with the therapy dog as “like” above “attached”. Personal preference explanations are therefore supported, rather than “attachment”, to explain outcomes for participants. This suggests the psychosocial approach has greater relevance here than human-animal bond explanations. Effects of previous dog attachment on outcomes were inconclusive but there was some evidence that participants’ relationship with the therapy dog(s) influenced outcomes, though the nature of that relationship has not been clarified. Recommendations from the study findings are that dog therapy be conducted for people with mild to moderate levels of dementia in groups of 3-11 for a duration of around 10 weeks with sessions for 30 minutes held once or twice weekly and according to a standard format. Opportunities for participants to touch, hug and interact directly with the therapy dog should be maximised without compromising dog welfare. The findings suggest that respect for the personhood of participants is important to the success of the therapy types trialled, which further supports psychosocial therapies involving contact with people or live animals for use with people with dementia over those that minimise or exclude it.

Rapid increases in population ageing and the associated rise in the prevalence of dementia have created many challenges for the care of older people with dementia. As the majority of people now living in residential aged care facilities (RACFs) now have dementia, the need to maximise the quality of life for this group is increasingly recognised. While such issues have attracted research and policy attention in recent years, the evidence base for practice in dementia care is still underdeveloped. The need for more effective therapeutic interventions to improve the quality of life for older people with dementia is recognised, particularly those living in RACFs. The use of pets is one example of recent attempts to help create a more home-like environment and dog therapy is available in many facilities. Well designed research to demonstrate whether it actually has a positive impact on residents’ quality of life is lacking. This study is the first reported randomised controlled trial investigating dog therapy for people with dementia. Fifty-five older people with mild to moderate dementia living in three residential aged care facilities in the Greater Brisbane area participated in this study. The goal was to identify whether dog therapy accrued any benefits to residents’ well being and compare the benefits, if any, with human-only therapy intervention. The main hypothesis was that dog contact delivered in a small group recreational therapy format would have a beneficial effect on the well being of participants. It was additionally hypothesised that prior and current positive relationships with dogs would be related to improved outcomes of dog therapy and support a human-animal bond explanation of relationship development with the therapy dog(s). Participants were randomly assigned into two groups within each facility: The dog therapy group and a human-only therapy group. Session plans were structured according to a recreational therapy format. Three therapy dogs were used (a miniature Poodle, a Staffordshire Terrier and a German Shepherd Dog) with one dog present at any dog therapy session A before-and-after design was used with concealment of participants at allocation. Mixed methods were used including a panel of seven validated psychometric instruments, an observational measure and a series of four novel questionnaires, dogs for older groups with Alzheimer’s (DOGA), developed de novo specifically to investigate the effects of dog therapy on participants within this study. Measures of mood, quality of life, health and psychosocial functioning, collectively referred to as well-being, detected benefits accruing to dog therapy participants compared with human-only therapy that approached significance (p = .056) with a large effect size (partial eta squared 16.6%). A different measure of mood and apathy showed similar improvement for participants of both therapy types trialed with analyses of a smaller dataset (n = 36) revealing an overall highly significant result (p=.008) and large effect size (partial eta squared = 25.6%) for all participants. To explore the perceptions of care staff to the dog therapy intervention, a self-complete semi-structured questionnaire was completed by a sample of 21 from two of the study facilities. Content analysis revealed that staff overwhelmingly supported dog therapy with a total of 84 comments about benefits and 22 about risks. Responses were categorised and then linked into emergent themes: a temporal dimension, sense of self and increased opportunities for self expression. The opportunity provided by the therapy dog for accessible caring physical contact for participants was identified as important. General recreational therapy goals such as improved mood, reminiscence and increased levels of conversation were reported by staff to continue beyond interventions. The observed risks were: confusion over dog ownership, subsequent worry about losing the dog after sessions, jealousy over the therapy dog and one participant did not enjoy the small group format. Participants described their experiences of contact with the therapy dog as “like” above “attached”. Personal preference explanations are therefore supported, rather than “attachment”, to explain outcomes for participants. This suggests the psychosocial approach has greater relevance here than human-animal bond explanations. Effects of previous dog attachment on outcomes were inconclusive but there was some evidence that participants’ relationship with the therapy dog(s) influenced outcomes, though the nature of that relationship has not been clarified. Recommendations from the study findings are that dog therapy be conducted for people with mild to moderate levels of dementia in groups of 3-11 for a duration of around 10 weeks with sessions for 30 minutes held once or twice weekly and according to a standard format. Opportunities for participants to touch, hug and interact directly with the therapy dog should be maximised without compromising dog welfare. The findings suggest that respect for the personhood of participants is important to the success of the therapy types trialled, which further supports psychosocial therapies involving contact with people or live animals for use with people with dementia over those that minimise or exclude it.