March/April 2020

Therapy: Equine Therapy for Dementia
By Michele Deppe
Today’s Geriatric Medicine
Vol. 13 No. 2 P. 26

According to a late 19th-century adage, “There is something about the outside of a horse that is good for the inside of a man.” This, essentially, is the basis of therapy offered through workshops by Connected Horse, an effective human and animal interaction program that provides inimitable benefits both to those diagnosed with early-stage dementia and their care partners.

Never have such programs been more relevant. The World Health Organization reports that there are 50 million people with dementia worldwide, with 10 million new cases each year. Alzheimer’s disease is the most common form, accounting for 60% to 70% of cases. The Alzheimer’s Association reported in 2019 that an estimated 5.8 million Americans have a diagnosis of Alzheimer’s dementia.

Why Horses?
Something special happens when people come to the barn, says Paula Hertel, MSW, Connected Horse cofounder, program director, and board member, a specialist in programs supporting older adults, care partners, and professionals. “They start to become aware of all these new sounds, smells and, of course, the horses. The horses welcome them into their space. They begin to relax and enjoy being together.”

Hertel and Connected Horse cofounder Nancy Schier Anzelmo, MSG, a dementia care specialist and faculty member of the gerontology department at California State University Sacramento, have worked together in elder care services for nearly 30 years. They sought to create an innovative approach to assist people with early-stage dementia and their care partners and had seen the power of the bond between humans and horses in their own lives. “We both own horses,” Hertel says. “We researched the benefits of equine-assisted activities in other populations and saw similarities in the needs of people living with dementia and their care partners.”

As truly modern researchers, Hertel, Schier Anzelmo, and other Connected Horse partners have relied on YouTube to communicate their mission. In a recently shot video published in November 2019, Hertel shared the twofold goal of Connected Horse: to give people who are affected by dementia an opportunity to be together and experience something new; and to move away from the pharmaceutical approach to treating dementia. Participants with horses in nature, she says in the video, learn to be “in the moment.” Dementia, she says, “is going to be a part of their life, but it isn’t going to overcome their identity.” The participants shown in the videos are obviously deeply moved by being in a Connected Horse workshop and experiencing this simple, hope-giving environment.

Connected Horse workshops are nonriding activities that center on liberty exercises, generally defined in horse-enthusiast circles as the practice of meaningful connection exercises designed to build trust with the animal. They’re often based on our human observations of how horses communicate with one another within their herds. The sessions are pleasant, low-pressure interactions that encourage people to associate with a horse in a mindful manner.

The Particulars
Hertel explains that workshops begin with breathing exercises and sensory walks. These simple routines help participants “get out of their heads and let go of all the lists and tasks of the day,” she says. “Then we move into exercises with the horses; first observing the horses, then greeting them over a fence, and moving into haltering, grooming, leading, and at liberty work.” The program is unique in that it is a dyad model, Hertel says, referring to the pairing of a person with dementia and a care partner who both participate equally. The youngest care partner in the workshops was a daughter in her mid-20s who worked with her mother, who was in her early 50s; the oldest participant was 94 years old.

Schier Anzelmo explains that horses pick up on emotions and the behaviors of people and give immediate feedback, helping participants to practice self-awareness, body movement control, and both verbal and nonverbal communication.

“This awareness, self-regulation, and willingness to trust, connect, and receive feedback from the horses is where the impact comes from with our participants,” Hertel says. “We spend time after each exercise discussing what the experience was like and we ask people to journal at home. And we remind people to stay in their bodies and to pay attention to their senses. You can hear us say, ‘let’s stop, take a deep breath, and get back into the moment.’ The horses are known to act as ‘mirrors’ by acting out what we are feeling. They are very in tune with the energy that we bring to the interaction.”

The participants in Connected Horse are facing tremendous challenges, and those challenges can put a strain on their relationships with others. Hertel says, “We believe that when someone gets a diagnosis of dementia, there is an opening, an opportunity to activate hope and action, vs despair and isolation. We know from many studies that engagement and lifestyle play an important part in health and wellness. The equine-assisted workshops we offer build on that knowledge with opportunities to benefit from the human and animal bond, nonverbal communication skills, and awareness and mindfulness practices.”

According to Schier Anzelmo, there are many benefits to caregivers as well. They, along with their loved ones, she says, get out of their roles and are seen as just two people in a relationship doing something new together. They find hope, overcome fears, practice giving and receiving care, and learn nonverbal communication skills. “The research we have completed has shown that this program reduced feelings of depression, anxiety, and burden, and improved sleep for care partners,” Schier Anzelmo says.

Equine Therapy Is Evidence Based
“We wanted to develop a program that had evidenced-based research behind it,” says Schier Anzelmo, and she and Hertel were encouraged by a small, 16-participant, first-of-its-kind study at Ohio State University in 2014. It found spending time with horses eased symptoms in midstage Alzheimer’s patients, improving mood and making participants less likely to resist care or become upset later in the day. Participants also grew more physically active with return visits to the farm, and the families reported that their loved ones remained engaged and could remember farm activities after returning home.1

Connected Horse, along with other equine programs, pioneers equine-assisted dementia treatment. Since 2015, Connected Horse has partnered with the University of California Davis and Stanford University to measure the effectiveness of their workshops.

A collaboration between Stanford University’s Red Barn Leadership Program and Jacqueline Hartman, cofounder and facilitator of the equine-assisted Red Barn program, complemented Connected Horse’s research; the Red Barn program hosted the Connected Horse program at its stables. The cofounders of Connected Horse also partnered with Elizabeth Landsverk, MD, a geriatrician specializing in dementia care and Dolores Gallagher Thompson, PhD, a Stanford University psychologist and a leading researcher on caregiver stress, to develop the research design to measure the possible benefits of the program.

The initial research produced positive data. Hertel says, “After a year of promising results, we embarked on a comparative study at UC Davis School of Medicine, Alzheimer’s Disease Center and School of Veterinary Medicine, Center for Equine Health. Eighty-eight people participated in the research, the preliminary findings of which they presented at meetings including the International Alzheimer’s Association Conference. Although results won’t be published until early this year, an abstract of the pilot research recently presented at the Alzheimer’s Association International Conference highlights care partner benefits including reduced feelings of depression, burden, and anxiety as well as improved quality of sleep. “All participants, facilitators, and researchers reported experiencing a more positive mood and affect after interacting with the horses in the equine-guided support workshops,” according to the Connected Horse website.2

In addition, Hertel and her colleagues have been measuring the effects of the program over time by offering a 10-hour booster session and retesting participants four to six months after the initial workshops to see whether the benefits were maintained over time and if the booster helped sustain the effectiveness. There was a 100% return participation in the booster sessions, despite the participants being away from the program for months. “That kind of retention says a lot about how the participants valued the program,” Schier Anzelmo says.

Facilitator Training Workshops
Another part of the mission of Connected Horse is to train others to do provide this kind of therapy so it can spread throughout the country and the world. “We are now offering an opportunity for people to work with us to learn how to do this work. We have online training and training at our partner premier therapeutic center, with an opportunity for a team to help with workshop recruiting, facilitation, and evaluation,” Schier Anzelmo says.

“We have seen people be labeled by their diagnosis. We hate that stigma,” Schier Anzelmo continues. “We also know that even though people may not be able to verbalize what they are thinking or feeling … they still think and feel; that emotional memory stays with people until the end.”

The Connected Horse program, by whomever and wherever it takes place, seeks to reach, connect, and find meaning for participants.

— Michele Deppe is a freelance writer based in Seattle.

References
1. Dabelko-Schoeny H, Phillips G, Darrough E, et al. Equine-assisted intervention for people with dementia. Anthrozoos. 2014;27(1):141.

2. Research. Connected Horse website. https://www.connectedhorse.com/research/