The Role of Animals in Depressive Symptoms and Loneliness in Older Adults: A Mixed-Methods Systematic Review
Published:
Apr 30, 2025
Keywords:
Animals Older Adults Depressive Symptoms Loneliness Systematic Review
Abstract
Demographic ageing, the challenges of active ageing, and increasing rates of depressive symptoms and loneliness among older adults, are challenging experts to discover innovative forms of support for older people. A proposal with promising results that concerns modern international literature is the role of animals. The main purpose of this review is to examine the role of animals in depressive symptoms and loneliness among older adults using a mixed methods systematic design. This paper follows the PRISMA (2020) guidelines and checklist for systematic reviews. A literature search was conducted for relevant English research articles from 2019 until 03/29/2024 in international multi-disciplinary databases (PubMed, Scopus, ScienceDirect) which provided information on the subject reviewed. The selection and screening of articles was made using the PRISMA (2020) flow chart guidelines for systematic reviews. For the quality assessment of the included studies the Mixed Methods Appraisal Tool was used (MMAT). By following this process, 856 articles emerged across all databases, from which, after removing duplicates and screening the title and abstract, 13 remained. Out of the 13 articles that formed the main body of the review, 5 were qualitative studies and 8 quantitative. Even though some mixed results emerged from the analysis, specifically regarding pet ownership and depressive symptoms which require further research, in most cases, animals play a crucial role in alleviating depressive symptoms and reducing loneliness in older adults. This research suggests more opportunities for new practical applications in the future, even outside the care facility environment.
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References
Administration on Aging. (2016). A Profile of Older Americans 2015. Washington DC: Administration on Aging.
Akincigil, A., Olfson, M., Walkup, J. T., Siegel, M. J., Kalay, E., Amin, S., Zurlo, K. A., & Crystal, S. (2011). Diagnosis and treatment of depression in older community-dwelling adults: 1992-2005. Journal of the American Geriatrics Society, 59(6), 1042–1051. https://doi.org/10.1111/j.1532-5415.2011.03447.x
Alexopoulos, G. S., Abrams, R. C., Young, R. C., & Shamoian, C. A. (1988). Cornell scale for depression in dementia. Biological Psychiatry, 23(3), 271-284. https://doi.org/10.1016/0006-3223(88)90038-8
Alloy, L.B.; Abramson, L.Y. (1988). Depressive realism: four theoretical perspectives.
Almeida, O. P., & Almeida, S. A. (1999). Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD‐10 and DSM‐IV. International journal of geriatric psychiatry, 14(10), 858-865. https://doi.org/10.1002/(SICI)1099-1166(199910)14:10<858::AID-GPS35>3.0.CO;2-8
Ambrosi, C., Zaiontz, C., Peragine, G., Sarchi, S., & Bona, F. (2019). Randomized controlled study on the effectiveness of animal-assisted therapy on depression, anxiety, and illness perception in institutionalized elderly. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 19(1), 55–64. https://doi.org/10.1111/psyg.12367
American Psychiatric Association. (2024). What is depression? Psychiatry.org. Retrieved December 27, 2024, from https://www.psychiatry.org/patients-families/depression/what-is-depression
American Psychological Association. (n.d.). Loneliness. In APA Dictionary of Psychology. Retrieved December 27, 2024, from https://dictionary.apa.org/loneliness
Anderson, K. A., Lord, L. K., Hill, L. N., & McCune, S. (2015). Fostering the human-animal bond for older adults: Challenges and opportunities. Activities, Adaptation & Aging, 39(1), 32-42. https://doi.org/10.1080/01924788.2015.994447
Aromataris, E., & Pearson, A. (2014). The systematic review: an overview. The American journal of nursing, 114(3), 53–58. https://doi.org/10.1097/01.NAJ.0000444496.24228.2c
Baek, S.-M., Lee, Y., & Sohng, K.-Y. (2020). The psychological and behavioural effects of an animal-assisted therapy programme in Korean older adults with dementia. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 20(5), 645–653. https://doi.org/10.1111/psyg.12554
Batubara, S. O., Tonapa, S. I., Saragih, I. D., Mulyadi, M., & Lee, B. O. (2022). Effects of animal-assisted interventions for people with dementia: A systematic review and meta-analysis. Geriatric Nursing, 43, 26-37. https://doi.org/10.1016/j.gerinurse.2021.10.016
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj, 372. https://doi.org/10.1136/bmj.n71
Bowlby, J. Attachment and loss: Vol 1. Attachment. 2nd. New York, NY: Basic Books; 1969/1982.
Branson, S. M., Boss, L., Cron, S., & Turner, D. C. (2017). Depression, loneliness, and pet attachment in homebound older adult cat and dog owners. Journal of Mind and Medical Sciences, 4(1), 38-48. http://doi.org/10.22543/7674.41.P3848
Canady, B., & Sansone, A. (2019). Health Care Decisions and Delay of Treatment in Companion Animal Owners. Journal of Clinical Psychology in Medical Settings, 26(3), 313–320. https://doi.org/10.1007/s10880-018-9593-4
Carr, D. C., Fried, L. P., & Rowe, J. W. (2015). Productivity & engagement in an aging America: The role of volunteerism. Daedalus, 144(2), 55-67. https://doi.org/10.1162/DAED_a_00330
Carr, D., Friedmann, E., Gee, N. R., Gilchrist, C., Sachs-Ericsson, N., & Koodaly, L. (2021). Dog Walking and the Social Impact of the COVID-19 Pandemic on Loneliness in Older Adults. Animals: An Open Access Journal from MDPI, 11(7), 1852. https://doi.org/10.3390/ani11071852
Chen, H., Wang, Y., Zhang, M., Wang, N., Li, Y., & Liu, Y. (2022). Effects of animal-assisted therapy on patients with dementia: A systematic review and meta-analysis of randomized controlled trials. Psychiatry Research, 314, 114619. https://doi.org/10.1016/j.psychres.2022.114619
Cherniack, E. P., & Cherniack, A. R. (2014). The benefit of pets and animal-assisted therapy to the health of older individuals. Current gerontology and geriatrics research, 2014, 623203. https://doi.org/10.1155/2014/623203
Chou, K.L., & Chi, I. (2005). Prevalence and correlates of depression in Chinese oldest-old. International Journal of Geriatric Psychiatry, 20(1), 41-50. https://doi.org/10.1002/gps.1246
Colby, P.M., & Sherman, A. (2002). Attachment styles impact on pet visitation effectiveness. Anthrozoös, 15, 150 - 165. https://doi.org/10.2752/089279302786992676
Creswell, J. W., & Clark, V. L. P. (2017). Designing and conducting mixed methods research. Sage publications.
Cryer, S., Henderson-Wilson, C., & Lawson, J. (2021). Pawsitive Connections: The role of Pet Support Programs and pets on the elderly. Complementary Therapies in Clinical Practice, 42, 101298. https://doi.org/10.1016/j.ctcp.2020.101298
Dahlberg, L., McKee, K. J., Frank, A., & Naseer, M. (2021). A systematic review of longitudinal risk factors for loneliness in older adults. Aging & Mental Health, 26(2), 225–249. https://doi.org/10.1080/13607863.2021.1876638
De Jong-Gierveld, J., & van Tilburg, T. G. (2006). A 6-item scale for overall, emotional, and social loneliness: Confirmatory tests on survey data. Research on aging, 28(5), 582-598. https://doi.org/10.1177/0164027506289723
Enders-Slegers, M.-J., & Hediger, K. (2019). Pet Ownership and Human–Animal Interaction in an Aging Population: Rewards and Challenges. Anthrozoos, 32(2), 255–265. Scopus. https://doi.org/10.1080/08927936.2019.1569907
Federal Interagency Forum. (2016). Older Americans 2016: Key indicators of well-being. Washington, DC: U.S. Government Printing Office. Retrieved October 2024 from http://www.agingstats.gov
Fernandes, J., Sousa, L., Sá-Couto, P., & Tavares, J. (2024). Companion Animals: Associations With Social Isolation, Loneliness, and Satisfaction with Life in Portuguese Community-Dwelling Older Adults. Anthrozoos, 37(2), 361–377. Scopus. https://doi.org/10.1080/08927936.2023.2287313
Foley, G., & Timonen, V. (2015). Using Grounded Theory Method to Capture and Analyse Health Care Experiences. Health services research, 50(4), 1195–1210. https://doi.org/10.1111/1475-6773.12275
Garrity, T. F., Stallones, L. F., Marx, M. B., & Johnson, T. P. (1989). Pet ownership and attachment as supportive factors in the health of the elderly. Anthrozoös, 3(1), 35-44. https://doi.org/10.2752/089279390787057829
Gee, N. R., & Mueller, M. K. (2019). A Systematic Review of Research on Pet Ownership and Animal Interactions among Older Adults. Anthrozoos, 32(2), 183–207. Scopus. https://doi.org/10.1080/08927936.2019.1569903
Glenk, L. M., & Foltin, S. (2021). Therapy dog welfare revisited: a review of the literature. Veterinary Sciences, 8(10), 226. https://doi.org/10.3390/vetsci8100226
Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Annals of behavioral medicine: a publication of the Society of Behavioral Medicine, 40(2), 218–227. https://doi.org/10.1007/s12160-010-9210-8
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on psychological science, 10(2), 227-237. https://doi.org/10.1177/174569161456835
Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, Gagnon M-P, Griffiths F, Nicolau B, O’Cathain A, Rousseau M-C, Vedel I. (2018). The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for information, 34(4), 285-291. https://doi.org/10.3233/efi-180221
Hooyman, Nancy R., and H. Asuman Kiyak. (2008). Social gerontology: A multidisciplinary perspective (M. Mentis, E. Dragioti, Ed.). 10th ed. Greece: GOTSIS.
Hoy-Gerlach, J., Vincent, A., & Lory Hector, B. (2019). Emotional Support Animals in the United States: Emergent Guidelines for Mental Health Clinicians. Journal of Psychosocial Rehabilitation and Mental Health, 6(2), 199–208. Scopus. https://doi.org/10.1007/s40737-019-00146-8
Hughes, M. J., Verreynne, M.-L., Harpur, P., & Pachana, N. A. (2020). Companion Animals and Health in Older Populations: A Systematic Review. Clinical Gerontologist, 43(4), 365–377. https://doi.org/10.1080/07317115.2019.1650863
Hui Gan, G. Z., Hill, A.-M., Yeung, P., Keesing, S., & Netto, J. A. (2020). Pet ownership and its influence on mental health in older adults. Aging & Mental Health, 24(10), 1605–1612. https://doi.org/10.1080/13607863.2019.1633620
Ikeuchi, T., Taniguchi, Y., Abe, T., Seino, S., Shimada, C., Kitamura, A., & Shinkai, S. (2021). Association between Experience of Pet Ownership and Psychological Health among Socially Isolated and Non-Isolated Older Adults. Animals: An Open Access Journal from MDPI, 11(3), 595. https://doi.org/10.3390/ani11030595
Jain, B., Hafford-Letchfield, T., Ellmers, T., Chandra, C., Billings, B., Teacher, R., O’Farrell Pearce, S., & Clancy, C. (2021). Dog-assisted interventions in care homes: A qualitative exploration of the nature, meaning and impact of interactions for older people. Health and Social Care in the Community, 29(5), 1450–1460. Scopus. https://doi.org/10.1111/hsc.13201
Lubben, J., Blozik, E., Gillmann, G., Iliffe, S., von Renteln Kruse, W., Beck, J. C., & Stuck, A. E. (2006). Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations. The Gerontologist, 46(4), 503-513. https://doi.org/10.1093/geront/46.4.503
Janevic, M. R., Shute, V., Connell, C. M., Piette, J. D., Goesling, J., & Fynke, J. (2020). The Role of Pets in Supporting Cognitive-Behavioral Chronic Pain Self-Management: Perspectives of Older Adults. Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society, 39(10), 1088–1096. https://doi.org/10.1177/0733464819856270
Jegatheesan, B., Beetz, A., Choi, G., Dudzik, C., Fine, A., Garcia, R. M., Johnson, R., Ormerod, E., Winkle, M., & Yamazaki, K. (2014). IAHAIO White Paper: The IAHAIO Definitions for Animal Assisted Intervention and Animal Assisted Activity and Guidelines for Wellness of Animals Involved. In A. Fine (Ed.), Handbook on Animal Assisted Therapy: theoretical foundations and guidelines for practice (3 ed., pp. 415-418). Elsevier Academic Press.
Krause-Parello, C. A. (2008). The mediating effect of pet attachment support between loneliness and general health in older females living in the community. Journal of community health nursing, 25(1), 1-14. https://doi.org/10.1080/07370010701836286
Krause-Parello, C. A., Gulick, E. E., & Basin, B. (2019). Loneliness, Depression, and Physical Activity in Older Adults: The Therapeutic Role of Human–Animal Interactions. Anthrozoos, 32(2), 239–254. Scopus. https://doi.org/10.1080/08927936.2019.1569906
Lacoste, K. (2012). Benefits of being an animal shelter volunteer. Retrieved from http://petful.com/animal-welfare/benefit-animal-shelter-volunteer
Leigh-Hunt, N., Bagguley, D., Bash, K., Turner, V., Turnbull, S., Valtorta, N., & Caan, W. (2017). An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health, 152, 157–171. https://doi.org/10.1016/j.puhe.2017.07.035
Lu, J., Ren, E., Guo, X., Zhou, Z., Wang, Y., & Zhang, N. (2023). The role of pet attachment in alleviating the negative effects of loneliness on a health-promoting lifestyle: An empirical study based on threshold effects for pet owners. International Journal of Older People Nursing, 18(5), e12554. https://doi.org/10.1111/opn.12554
Marks, G., & McVilly, K. (2020). Trained assistance dogs for people with dementia: A systematic review. Psychogeriatrics, 20(4), 510-521. https://doi.org/10.1111/psyg.12529
Maurice, C., Engels, C., Canouï-Poitrine, F., Lemogne, C., Fromantin, I., & Poitrine, E. (2022). Dog ownership and mental health among community-dwelling older adults: A systematic review. International Journal of Geriatric Psychiatry, 37(11). https://doi.org/10.1002/gps.5815
McGuire S. (2012). Institute of Medicine. 2012. Accelerating progress in obesity prevention: solving the weight of the nation. Washington, DC: the National Academies Press. Advances in nutrition (Bethesda, Md.), 3(5), 708–709. https://doi.org/10.3945/an.112.002733
Mueller, M.K., Gee, N.R. & Bures, R.M. Human-animal interaction as a social determinant of health: descriptive findings from the health and retirement study. BMC Public Health 18, 305 (2018). https://doi.org/10.1186/s12889-018-5188-0
Neumann, S. L. (2010). Animal welfare volunteers: who are they and why do they do what they do?. Anthrozoös, 23(4), 351-364. https://doi.org/10.2752/175303710X12750451259372
Ni, M. Y., Yao, X. I., Cheung, F., Wu, J. T., Schooling, C. M., Pang, H., & Leung, G. M. (2020). Determinants of physical, mental and social well-being: a longitudinal environment-wide association study. International journal of epidemiology, 49(2), 380–389. https://doi.org/10.1093/ije/dyz238
Nicholson, N., Feinn, R., Casey, E. A., & Dixon, J. (2020). Psychometric evaluation of the Social Isolation Scale in older adults. The Gerontologist, 60(7), e491–e501. https://doi.org/10.1093/geront/gnz083ANTHROZOÖS 375
Opdebeeck, C., Katsaris, M. A., Martyr, A., Lamont, R. A., Pickett, J. A., Rippon, I., Thom, J. M., Victor, C., & Clare, L. (2021). What Are the Benefits of Pet Ownership and Care Among People with Mild-to-Moderate Dementia? Findings From the IDEAL programme. Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society, 40(11), 1559–1567. https://doi.org/10.1177/0733464820962619
Pace, R., Pluye, P., Bartlett, G., Macaulay, A. C., Salsberg, J., Jagosh, J., & Seller, R. (2012). Testing the reliability and efficiency of the pilot mixed methods appraisal tool (MMAT) for systematic mixed studies review. International Journal of Nursing Studies, 49(1), 47–53. https://doi.org/10.1016/j.ijnurstu.2011.07.002
Pérez-Sáez, E., Pérez-Redondo, E., & González-Ingelmo, E. (2020). Effects of dog-assisted therapy on social behaviors and emotional expressions: A single-case experimental design in 3 people with dementia. Journal of Geriatric Psychiatry and Neurology, 33(2), 109-119. https://doi.org/10.1177/0891988719868306
Pikhartova, J., Bowling, A., & Victor, C. (2014). Does owning a pet protect older people against loneliness?. BMC geriatrics, 14, 1-10. https://doi.org/10.1186/1471-2318-14-106
Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., ... & Duffy, S. (2006). Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme Version, 1(1), b92.
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306
Rauktis, M. E., & Hoy-Gerlach, J. (2020). Animal (Non-human) Companionship for Adults Aging in Place during COVID-19: A Critical Support, a Source of Concern and Potential for Social Work Responses. Journal of Gerontological Social Work, 63(6–7), 702–705. https://doi.org/10.1080/01634372.2020.1766631
Reniers, P. W. A., Declercq, I. J. N., Hediger, K., Enders-Slegers, M.-J., Gerritsen, D. L., & Leontjevas, R. (2023). The role of pets in the support systems of community-dwelling older adults: A qualitative systematic review. Aging & Mental Health, 27(7), 1377–1387. https://doi.org/10.1080/13607863.2022.2141196
Reynolds, K., Pietrzak, R. H., El-Gabalawy, R., Mackenzie, C. S., & Sareen, J. (2015). Prevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey. World Psychiatry: official journal of the World Psychiatric Association (WPA), 14(1), 74–81. https://doi.org/10.1002/wps.20193
Russell, D., Peplau, L. A., & Ferguson, M. L. (1978). Developing a measure of loneliness. Journal of Personality Assessment, 42(3), 290–294. https://doi.org/10.1207/s15327752jpa4203_11
Santos, A. J., Nunes, B., Kislaya, I., Gil, A. P., & Ribeiro, O. (2019). Estudo de validação em Portugal deuma versão reduzida da Escala de Depressão Geriátrica. Análise Psicológica, 37(3), 405–415. https://doi.org/10.14417/ap.1505376
Sharpley, C., Veronese, N., Smith, L., López-Sánchez, G. F., Bitsika, V., Demurtas, J., Celotto, S., Noventa, V., Soysal, P., Isik, A. T., Grabovac, I., & Jackson, S. E. (2020). Pet ownership and symptoms of depression: A prospective study of older adults. Journal of affective disorders, 264, 35–39. https://doi.org/10.1016/j.jad.2019.11.134
Uman L. S. (2011). Systematic reviews and meta-analyses. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 20(1), 57–59. PMID: 21286370; PMCID: PMC3024725.
United Nations Department of Economic and Social Affairs Population Division. (2013). World Population Ageing 2013. Retrieved 23/7/2024 from https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf
Vegue Parra, E., Hernández Garre, J. M., & Echevarría Pérez, P. (2021). Benefits of Dog-Assisted Therapy in Patients with Dementia Residing in Aged Care Centers in Spain. International Journal of Environmental Research and Public Health, 18(4), 1471. https://doi.org/10.3390/ijerph18041471
Wethington, E., & Kessler, R. C. (1986). Perceived support, received support, and adjustment to stressful life events. Journal of Health and Social Behavior, 27(1), 78–89. https://doi.org/10.2307/2136504
Wilson, D. M., Underwood, L., Carr, E., Gross, D. P., Kane, M., Miciak, M., Wallace, J. E., & Brown, C. A. (2021). Older women’s experiences of companion animal death: Impacts on well-being and aging-in-place. BMC Geriatrics, 21(1), 470. https://doi.org/10.1186/s12877-021-02410-8
Wilson, L., & Harlow-Rosentraub, K. (2008). Providing new opportunities for volunteerism and civic engagement for boomers: Chaos theory redefined. Boomer bust: Economic and political dynamics of the graying society, 2, 79-99.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37–49. https://doi.org/10.1016/0022-3956(82)90033-4
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, O. (1983). Geriatric Depression Scale (GDS) [Database record]. APA PsycTests.
Zhou, L., Li, Z., Hu, M., & Xiao, S. (2012). Reliability and validity of ULS-8 loneliness scale in elderly samples in a rural community. Zhong nan da xue xue bao. Yi xue ban= Journal of Central South University. Medical Sciences, 37(11), 1124-1128. https://doi.org/10.3969/j.ssn.16727437.2012.11.008
