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Consider animal therapy for institutionalised elders during the pandemic

One of the most stressful - and distressing - events that can occur in an older person’s life is moving into a long-term care facility. The new resident suffers the loss of a home, personal possessions, status, authority, and independence together with the separation from one’s family and friends.

Under normal circumstances, the loss of identity and disengagement that goes with such a move is traumatic enough. Now, however, the pandemic has exacerbated and prolonged the suffering of institutionalised elders who, for their own protection, are often completely and indefinitely cut off from contact with the outside world. For those subjected to such conditions, surrounded by uncertainty, loneliness, and fear of the virus, compounded by the impediments or even disabilities that accompany old age, life must be hellish. Pondering what could be done to mitigate this heartbreaking situation, I began to think about pet therapy.

Pet therapy is a generic term that describes the ways therapists use pets to achieve positive psychological outcomes in patients. In all of its manifestations, highly trained professional animals are brought into therapeutic settings. Although dogs are the most common, cats, birds, horses, rabbits, and even fish have also been used. These therapies have overlapping objectives, including encouraging social interaction, helping patients achieve dignity and develop coping mechanisms, improving physical and emotional health through physical activity, motivating patients to develop their talents and pursue their interests, and importantly, reducing boredom, loneliness, depression, and anger.

Animal therapy has no fixed set of techniques. However, there are three broadly recognized approaches: 1) Milieu, the most common, in which animals and people interact with one another, usually in the presence of a trained volunteer or therapist who assumes a passive role; 2) physical rehabilitation (AAA), in which there are specific, goal-oriented activities and interactions between the animal, trained professional/volunteer and the patient; and 3) pet-facilitated psychotherapy (PFP), in which animals are full participants in a three-way interaction with the psychotherapist and patient in a psychotherapy session. 

Although animal therapy only became a subject for research late in the 20th century (i.e. does it really help, and if so how?), many benefits have already been reported. For example, one of the greatest needs of institutionalised elders is human contact. Animal companionship has been found to be a strong source of social support, with a positive effect on health and well-being.  Studies vary of course in the outcome measures, in their settings and in the kind of pet therapy that is being evaluated.  Animals have help abate loneliness in residential care settings and long-term care facilities.  Just petting a dog that has become a familiar friend could induce relaxation and have a positive effect on blood pressure and heart rate as well as depression and life satisfaction. The same approach to therapy (AAA - this time over 2 years and twice a month) appeared to increase engagement with co-residents and the environment in a small study of older institutionalised Japanese women. A comparison of Animal-Assisted Therapy with non-animal therapy looked at different modes of social interaction - conversation and touching. Another study of cognitively intact older northern Italians in residential care assigned their subjects to different ‘treatment arms’: interacting with a bird; or with a plant; or no treatment. The bird group exhibited greater life satisfaction and psychological well-being.  

Of course, it may not be possible to use these kinds of psychological instruments with people with more severe dementia or cognitive impairment. With patient groups like these, agitated behaviours, certain manifestations of depression - even appetite and weight gain - have been used as outcome measures to show positive results.  With cases of mild or moderate dementia, more standard instruments can be used.

Notwithstanding the benefits, two caveats should be considered. First, therapy animals can be a source of harm to institutionalised patients. Unstable elders may be exposed to falls. Others may be incapable of physical contact. It matters how frail or mobile the prospective patients are. Contact with animals can lead to infection or allergic responses.  So it’s necessary to safeguard against such problems.  There’s the possibility of childhood phobias and other unpleasant experiences to consider.  A research trial with animal therapy comes to an end - and this has to planned for so that the breaking of whatever bonds have been forged does not cause unhappiness.

Second, animal therapy (i.e with institutionalised patients) is relatively new, and it is hard to come up with robust results when testing interventions. The research has been limited and much of the literature has been criticized for its poor methodology. Surely though, this is a promising area that merits further attention, particularly now when the global society is rapidly ageing, and an increased number of elderly individuals are likely to be placed into residential care.  Perhaps we have to get better at evaluation.

Returning to where this discussion began, it’s hard not to believe that the introduction of pets into institutional settings could have real benefits, especially in this pandemic, even if our supporting evidence is couched in everyday language: don’t they provide companionship and a little happiness for elderly residents? If loneliness and depression are commonplace under normal circumstances, imagine what it must be like for these people now. Animal therapy is a low cost, low tech, expedient, and straightforward way to improve the quality of life of such elders until they can be reunited with their family and friends.

About the Author

Patricia O’Neill (DPhil, Oxf) is an alumnus of the Oxford Institute of Population Ageing. She is currently a Visiting Academic at Contemporary China Studies (SIAS), Oxford University and an Associate in Research, Fairbank Center of Chinese Studies, Harvard University.

Opinions of the blogger is their own and not endorsed by the Institute

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