Thesis Nurs. 1995 A545c
c. 2
Anderson, Barbara S.
A comparison study of
resident pet and pet
1995.

A COMPARISON STUDY OF RESIDENT PET AND PET

VISITATION PROGRAMS AND THEIR EFFECT ON THE

LONELINESS OF NURSING HOME RESIDENTS

by
BARBARA S. ANDERSON, B.S.N., R. N.

Submitted in Partial Fulfillment of the Requirements
for the Master of Science in Nursing Degree

Approved by:
A) - j

"Bate

Chairperson of Thesis Committee
Edinborb) University of Pennsylvania
________

Committee Member

/■tyf

Committee Member

/

Date

L. 2/

ABSTRACT

This study compared a resident pet program and or

visitation pet program and their effect on the loneliness

experienced by nursing home residents.

The sample was comprised

of 52 subjects from two nursing homes in Northwestern

Pennsylvania.

The evaluation tool was the UCLA Loneliness Scale

(version 3) by Russell.

questionnaire.

Subjects completed a 20-question

The statistical tests were the t-test and the

pearson correlation coefficient. Review of the data analysis

suggested there was no significant difference in the loneliness
scores and the type of pet program.

An inversely related

correlation was found between the loneliness scores and the
number of years in the nursing home.

ACKNOWLEDGMENTS

I would like to express my sincere thanks to committee
members Dr. Charlotte Paul, Dr. Alfred Stone and Jan Newcamp for

their support and guidance throughout this study.
Grateful acknowledgement is given to the patients who
participated in the study.

I want to thank my family for their understanding

and encouragement throughout my education and this study.

A

special thank you to my husband, Tom, for his unselfish love,
support, and friendship.

He has been an inspiration in my

life and throughout this study.

ii

TABLE OF CONTENTS

Page

ACKNOWLEDGMENTS

ii

LIST OF TABLES

v

CHAPTER
I.

II.

INTRODUCTION

Background of the Problem

1

Statement of the Purpose

3

Hypothesis

3

Definition of Terms

4

Assumptions

5

Limitations of the Study

5

REVIEW OF THE LITERATURE

6
6

Loneliness

Origin of Pet Therapy

11

Psychological & Social Effects of

15

Pet Therapy

Physiological Effects of Pet Therapy. 21

28

III. METHODOLOGY

28

Introduction
Conceptual Framework

Sample and Setting

Type of Pet Programs

iii

IV.

V.

Instrumentation

33

Data Collection

34

Procedure for Analyzing Data

36

PRESENTATION AND ANALYSIS OF DATA

38

Demographics

38

Analysis of Data

40

CONCLUSION

43

Summary

43

Discussion

46

Conclusions

46

Recommendations

46
47

APPENDICES
A.

Letter Requesting Permission to
Complete Study

B.

Authorization to Participate as a

48

subject
C.

Demographic Data Form

D.

Modified Short Portable Mental

Status Questionnaire

E.

49

50

UCLA Loneliness Scale

51

(version 3)
F.

47

Letter Granting Permission to Use
UCLA Loneliness Test (vers. 3) 53
54

REFERENCES

iv

List of Tables
Page

Table
1.

Gender Ratios in the Sample Population

39

2.

Variables Correlated with the Loneliness Scores

40

3.

Two-Tailed t-Test of Loneliness Scores and

42

Type of Pet Program

v

CHAPTER 1

Introduction

Background of the Problem
Since the turn of the century, the number of aging

individuals has been steadily increasing.

Presently in the

United States, 12% of the population is 65 years or older.

By

2030 this population is estimated to increase to 20% or 59
million elderly

(Burke & Sherman, 1993).

The majority of older

adults live in the community; however, the number residing in

nursing homes is rising.

Declining health is often the primary cause for entering
a nursing home.

Institutionalization often negatively effects

the sense of well-being.

The deterioration in physical and

mental health in addition to leaving one's home, family, pets,

and personal effects contributes to feelings of frustration,
anger, loneliness, depression, and disorientation for nursing

home

residents.

Studies on the human/animal relationship have shown
positive effects on both mental and physical health as well as
the social interactions of individuals.

1

The use of animal/pet

2

programs termed as pet therapy, animal assisted therapy, animal
facilitated therapy, or pet facilitated therapy
programs have alleviated some of the negative effects of
institutionalization .

The therapeutic use of animals can be valuable in
reaching treatment goals.

Pets used as social facilitators

have improved residents responsiveness, alertness, and
communication patterns.

Depression has been notably reduced

with pet therapy.
Many elderly and lonely people have discovered that pets

satisfy their vital emotional needs.
only link with reality.

Often they act as a person's

Pets provide a boundless measure of

unconditional love and unqualified approval.

A person's sense of

belonging and worthiness is nurtured which increases their
self-esteem.

Pet therapy may use a resident (live-in) pet or
visitation pets.

Laws banning pets in governmental housing and

in health care facilities have been repealed.

Therefore, pet

therapy programs are becoming more widespread.

Resident pets foster a sense of responsibility, being
dependent upon their human companions to provide food, shelter,
grooming, and safety.

They encourage activities such as

walking, grooming, petting, or playing.

The activities add

structure to the daily regimen of institutional living.

3

Lack of sensory stimulation is common among these

residents.

Pets offer a variety of stimulations for the

senses (touching, visualization, stroking), embracing an animal
promotes stimulation, relaxation, and reduces anxiety.

Pet therapy programs may act as positive catalysts and in

doing so may enhance the quality of life for those living in
nursing homes.

Although studies have been completed on the

human/pet relationship, further research is essential to
establish the therapeutic nature of this treatment modality.

Statement of the Purpose

This study was designed to compare a resident pet program

and a visitation pet program and their effect on the loneliness
experienced by nursing home residents.

Hypothesis

The resident of a nursing home with a resident pet

program will experience less loneliness than the resident of a
nursing home with a pet visitation program.

4

Definition of Terms
The following terms were defined by the investigator and
related to this study:

1.

Resident pet program - a program in which a domestic

animal resides in the nursing home eight hours a day, five days
a week, and is permitted to roam within a given territory.

2.

Pet Visitation program - a program in which a

domestic animal is taken by the owner to visit residents in the
nursing home twice a month.

3.

Loneliness - the nursing home residents total scores

as measured by the UCLA Loneliness Scale (Version 3) .

4.

Nursing home - A facility providing care for the

chronically ill or those recovering from acute illness who need
extended care, but not hospitalization.

These facilities

contain three levels of care; skilled nursing care,
intermediate nursing care, and custodial care (American

Association of Retired Persons, 1986).

5

Assumptions
1.

Nursing home residents have the feeling of loneliness.

2.

The state of loneliness can be measured.

3.

Residents will be able to answer the questionnaire.

4.

Pets can aid in the reduction of loneliness.

Limitations of the Study

1.

Two nursing homes served as settings for the study.

2.

Sample was not randomly chosen from the population.

CHAPTER 2

REVIEW OF THE LITERATURE
Loneliness

In the United States the number of aging people has been
increasing steadily since 1900.

Due to the the post-World War

II "baby boom", the reduction of infant and children mortality,
and the advances in health care and technology a "gerontology
boom" is expected by the year 2010.

Ebert, 1980).

(Yurick, Robb, Spier, &

Butler, Lewis, and Sunderland (1991) find the 75

plus and 85 plus age groups are and will continue to be the

fastest growing age groups.

This causes great concern because

of the excessive healthcare needs of these individuals.

The majority of elderly people enjoy a good quality of
life and are healthy, but chronic diseases and functional
impairments have become a major cause of disability and death
among these individuals.

Chronic diseases such as heart

disease, arthritis, hypertension, diabetes, stroke, and lung

diseases may lead to disability and dependency

(Butler et al.,

1991; Eliopoulos, 1987; Kane, Ouslander, & Abrass, 1989;

Yurick et al., 1980).

These chronic diseases cause many health problems for the

6

7

elderly which may lead to impairment, hospitalization, and
possibly the need for long term care,

It has been estimated

that more than 4 0% of the people over 65 will spend some

part of their remaining years in a nursing home (Butler et al.,

1991) .

Butler et al., (1991), state that "in 1989, approxi­

mately 1.6 milion older people lived in nursing homes in the

United States and by 2030 this number is expected to double"
(p.7) .

The elderly comprise the largest group of people for whom
hospitals, home health and community nursing homes provide care.

Carroll and Brue,

(1988) suggest as this elderly population

grows, health resources need to be directed towards meeting the
needs of this population.

Loneliness is often viewed as a problem of the elderly.
It is believed to effect the elderly because of life events

which may lead to its development

is frequently precipitated by loss.

(Rodgers, 1989) .

Loneliness

For the elderly, the loss

or separation from people or things which have significance to
them may provoke feelings of loneliness,

A decline in physical

and mental health, diminished support systems of family and

friends, a decreased income, retirement, and growing old in a
youth-oriented society contribute to feelings of loss,

isolation, depression, grief, and ultimately loneliness.

8

Rodgers (1989) studied hospitalized older adults and

the loneliness they experienced.
moderate.

The loneliness scores were

Many subjects indicated that the separation from

significant persons and things contributed to their distress.

Rodgers (1989) postulated that promoting a familiar

environment and facilitating a degree of control by patients may
decrease the incidence of loneliness among the elderly.
Austin (1989) wrote "those persons perceived to be immune

to loneliness possess characteristics that permit growth and

constructive behaviors when faced with loss or change n (p. 25).

She indicated that some individuals could take losses and create
something positive out of them.

Nursing could assist patients

by assessing their coping mechanisms and assisting them in
developing those creative characteristics (Austin, 1989).

She

also suggested using pets as means to meet the elderly's

nurturance needs.
Butler and associates (1991) describe two components when

discussing the feeling of loneliness:

survival in a threatening

Aloneness, a fear of

environment, and Loneliness, the fear

of emotional isolation, of being unable to attain the
satisfaction of positive relationship with others.

number of causes for loneliness
Burnside (1981) listed a

9

in the elderly:

loss of siblings, children, spouse and friends,
pain, loss of a pet, and sensory deficits.

A variety of developmental stressors and changes predispose

the elderly to psychological and physical illness.

Significant

chronic illnesses contribute to psychological problems.

Additionally, the elderly experience reduced opportunities for
social interaction, reduced income, losses, relocation,

diminished self-esteem, and possibly death

(Butler et al.,

1991, Carroll & Brue, 1988; Yurick et al., 1980).

Aging has been defined by Stotsky (1968) "as a loss or
decline in performance of specific functions due to structural
or functional changes in the individual"

(p. 1). He believed

that with American society's emphasis on youth that the elderly

suffer from disengagement, loss of status, and loss of a

productive role in their life.

"The personal cost of this

surrender is self“devaluation, anxiety, depression, boredom,
isolation, and loneliness" (Stotsky, 1968, p. 8).

Corr and Corr (1990) suggested that institutionalization,
which is frequently associated with depersonalization and
separation from the outside world, would lead to social

isolation and loneliness.

While Burnside (1981) noted the

greatest problem facing the elderly was the feeling of
loneliness, helplessness, and isolation.

Various factors contribute to social isolation and

10

loneliness for the elderly.

Biological changes such as sensory

changes, neuromuscular changes, chronic illness, and disease all
foster the feeling of loneliness.
to loneliness:

Other factors may contribute

living in rural areas, children grown-up

and gone, the death of spouse, children or friends and the
fear of leaving one's home for safety reasons.

Calvert (1989) found that elderly nursing home residents
who had higher levels of pet interaction experienced less
loneliness than residents with lower levels of pet interaction.

Her study noted that subjects of a resident animal program

demonstrated less loneliness than subjects from a pet visitation
program.

Several subjects commented that they did not see or

interact with the resident animal often.

This could explain why

there was not more of a significant difference in loneliness
between the two pet therapies.

Other psychosocial stressors commonly experienced by the
elderly which could lead to loneliness were presented by Carroll

and Brue (1988).

The stress of relocation to residential or

institutional locations could result in loss of control and
independence, social isolation, immobility, disorientation,

feelings of hopelessness, loss, and depression.

Loss of one's

in social interactions reflect
support system and a decrease

negatively.

The reality of death and fears associated with

death such as pain, fear of death of others, and impact of their

11

death upon others are needs that should be addressed,

Loss of

self-esteem may be created by the loss of independence,

meaningful relationships, space, touch, and sexuality.

When

these components of one's self-esteem are missing, the common

response is grieving, and the feeling of powerlessness,
uselessness and dependency which may be exhibited by withdrawal.
Carrol and Brue (1988) state that nursing home residents are at

the greatest risk for loss of self-esteem and feeling lonely.
Although different therapies have been used to increase

self-esteem, touch has been proven to be an important means to
convey the feeling of acceptance and caring especially to
persons facing social isolation.

Pets are an alternate approach

to reduce loneliness and withdrawal while encouraging touch.

Origin of Pet Therapy

The origin of pet therapy can be traced back to the 18th

century.

One of the first documented use of animals as adjuncts

to treatment was in 1792 at the York Retreat in England.

Founded by Quakers, the York Retreat was an alternative to asylums

and lunatic hospitals of the day.
harsh forms of

Instead of being punished by

treatment, positive measures were used to control

12

behavior.

Small animals such as rabbits and poultry were

contained in the courtyards and patients were encouraged to
care
for them.
York Retreat was one of the first programs to use a
positive reinforcement program

(Bustad, 1980).

In 1867, Bethel, a home for epileptics in Bielfield, West

Germany, used cats, dogs, horses, and birds as an integral part

of the living environment.

Besides using the traditional pet

animals, Bethel included farm animals and a wild game park as
part of its program.

Patients were treated in a home-like

atmosphere and encouraged to care for the animals.

The first recorded use of pet therapy in the United States
was in 1942 at Pawling Army Air Force Convalescent Hospital in
Pawling, New York.

While convalescing from battle fatigue and

trauma, veterans were encouraged to work with farm animals as

well as creatures of the field and forest

(Cusack & Smith, 1984).

Boris Levinson was one of the first psychologists to use

animals in psychotherapy.
by accident.

Levinson's work in pet therapy began

His dog was in his office when a mother and her

disturbed son arrived early for their appointment.

The dog

improved the child's interaction and helped to build a greater
rapport and trust between the therapist and subsequently others

which ultimately led to the child's recovery (Cusack & Smith, 1984).
Levinson emphasized the importance of therapeutically
using pets in treating not only children but also adults,

13

particularly the elderly.
therapy.

Levinson was a pioneer in pet

He pleaded for research to set the boundaries and

principles of using animals in therapy as well as learning to

select and train animals for psychotherapy.
In the 1970s Samuel and Elizabeth Corson started a
program at Ohio State University to study the feasibility of

using pet therapy in the hospital setting.

They decided to use

pets as a form of therapy for psychiatric patients who failed to

respond to the standard forms of therapy.

The patients selected

were the most withdrawn and uncommunicative.
patients accepted dogs.

Twenty-eight

A mixture of dogs were selected and an

attempt was made to match the dogs temperament with the needs of

the patient.

The Corsons described the dogs as social catalysts.
Observation indicated a positive reaction first of the patient

to the dog then it widened to the therapist and then to
other patients and staff

(Bustad, 1980).

The dogs were viewed

as a non-threatening source of interaction and tactile

stimulation.

Many of the patients showed improvement and were

discharged.

The Corsons believed the dogs provided a sense of
responsibility and a sense of being for the patients.

The dogs

seemed effective in this role because of their ability to offer
love and tactile reassurance without criticism, and their

14

maintenance of a sort of perpetual infantile dependence which
could stimulate one's natural tendency to offer support and
protection

(Bustad, 1980).

Due to financial constraints, the Corsons moved to Castle
Nursing Home in Millerburg, Ohio, using the same dogs for

therapy.

Residents who were withdrawn, lonely, and dependent

were selected for therapy.

Positive changes in social

interaction as well as improved physical activity, emotional

well-being, self-reliant behavior, and changes in appearance and

personal hygiene were seen.

No quantitative data was documented

due to the lack of research funding but the Corson's reported
similar responses as those that occurred at Ohio State
University

(Corson & Corson, 1978).

Surveys have shown that the number of animals used in
clinical or therapeutic environment is growing since the onset

of these early studies.

Levinson in 1972 surveyed the New York

state psychologists and found 50% of those surveyed used pet

therapy in some manner

(Cusack & Smith, 1984) .

A writer, Phil Arkow, associated with the Humane Society

in Colorado stated in 1977 that only 15 Humane Societies
and in 1982 there were 75
were utilizing pet therapy programs,
programs (Cusack, 1988). As studies are completed showing the

therapeutic value

institutions will

of using animals in therapy, hopefully more
begin to initiate pet therapy programs.

15

Psychological and Social Effects of Pet Therapy

Animals are part of our natural environment.

Every

person who has ever owned a pet can attest to the benefits of
associating with our animal friends.

greater than 50%

Manor (1987) states that

of the households in the United States have at

least one or more pets, and 26% of older adults have owned or

presently own a pet.
Pets offer unconditional love, acceptance, and affection.

They provide stimulation and interest, warmth, and comfort to
an individual's life (Erickson, 1985).

Their antics incite

humor, laughter, and entertainment.

Pets enable humans to extend beyond themselves increasing
their responsiveness, social interactions, acting as

distractions from life's problems, and as a means for
forgetting the fears of the future

(Cusack, 1988) .

Caring

for pets fosters responsibility, nurturance, and incorporates
structure into the daily routine and activities of the older

adult (Harris & Gellin, 1990).

Picking up, petting, or playing

with a pet helps restore and maintain muscle strength and
coordination, enhances joint mobility, and promotes exercise.

McCulloch (1983) suggests pets be prescribed for therapeutic
purposes for individuals suffering from chronic illnesses and

disability, depression, loneliness, isolation, diminished self-

16

esteem, helplessness, and hopelessness.

Frank (1984) states,

Love for a pet creates a relationship of mutual
trust and confidence while
building a~ bridge to the
---- -------future and to greater self-awareness,
self-awareness. A pet offers
infinite comfort, The pet, in a sense becomes a mirror
in which a person sees himself wanted and loved not
for what he should be or might be or might have been
but for what he is. An individual learns that it is
possible to communicate one's inner most feelings
without words, by mere gestures, a glance or even
bodily posture, (p. 30)
Robb, Boyd, and Pristash (1980) conducted research to
determine the effects of a wine bottle, plant, and puppy on the

social behaviors of male patients at a Veteran's Medical
Center.

Five social behaviors (verbalization, smile, look,

eyes open, and leans toward stimulus) were observed during the
introduction of these objects one at a time.

Robb et al.

(1980) noted that any object of any animation level would lose

its ability to stimulate social interactions as the time of
exposure increased.

Of these three stimuli, the caged

puppy produced the most dramatic increase in the social
behaviors.

The wine bottle had the smallest display of social

behaviors.

a social
Robb stated the caged puppy acted as

catalyst.

"Old age is

1981, p. 66).

fertile ground for loneliness"

(Burnside,

Combating loneliness in the elderly is

that one can be in the midst
It has been reported
The elderly being relocated
of a crowd and still be lonely.
difficult.

17

from home to home or home to institution
feel emotionally
isolated, lonely, and rejected.

The implementation of pet

therapy has had positive effects on their social interactions.

Winkler, Fairne, Gericevich, and Long (1989) surveyed staff
and residents of a nursing home to examine the perceptions and
social interactions of each after introducing a resident dog to

the unit.

Staff and patients were interviewed six weeks before

the dog arrived and again at six and twenty-two weeks after the
dog arrived.

A significant increase in the social interactions

of both patients and staff was noted six weeks after the

arrival of the resident dog.

By twenty-two weeks the staff's

behaviors remained high, while the patients behaviors returned
to levels observed at the start of the survey before the

introduction of the dog.

Possibly the same effect occurred

with this study as did with Robb et al. (1980).

The dog lost

the ability to stimulate the social behaviors as the time
interval increased to twenty-six weeks.
Winkler et al.

(1989) suggested that patients should

have more control over the animals daily routine; thereby
attached and
reducing the possibility of the dog becoming more

interactive with the staff.

It was also suggested that

attention should be given to the personality and temperament of

the pet selected to meet the needs of the patients.
no beneficial effect on the
The use of live pets had

18

daily activities of nursing home residents
as reported by Hendy
(1984) .
She examined the effect of four different pet
presentations (live pets, no pets, stuffed pets, and

videotaped pets) on the social and behavioral activities of the
residents.

The live pet presentation produced an increase in

the desired behaviors.

Hendy suggested that the presence of

other people (non-residents) may be more effective towards
achieving the desired outcome.

Hendy (1987) continued her research to compare changes in
social behaviors (talking, smiling, ambulation, proximity, and

alertness) of nursing home residents with use of different
visitation programs (people-alone, pets-alone, people-pluspets, and no visit) .

She noted of the social behaviors

only smiling and alertness showed a significant increase,

These results were similar to her previous study.

Hendy (1987)

also surveyed age, frequency of other visitors, and years of

residence in the institution and found they were not related to
the effectiveness of the pet therapy programs.

Pet therapy may be utilized by occupational therapists for
long-term care patients.

McQuillen (1985) presented criteria

for establishing a program as well as the procedures the
occupational therapist should follow to meet the needs of

the patient.

She emphasized the importance of soliciting

support from the

community, hospital administration, physicians,

19

and staff as a vital

component in initiating pet therapy

programs.

Kalfon (1991) evaluated the changes in social behavior
among long term residents during pet visitation versus another
leisure activity.

The subjects exhibited less withdrawn behavior

and less disorientation at the conclusion of the six week series

of pet visitation sessions.

The pet, a rabbit, had more

positive psychosocial responses than the leisure activity.

Kalfon found no changes in patients in response to self-care
functioning, irritable behavior, or depressed/anxious mood.

Over the last one hundred years we have added some 25
years to the average life expectancy.

This reality means

our population is living longer and becoming older and more
knowledgeable.

The elderly compose the fastest growing age

group in society.

"Because the elderly often withdraw from

social activities and place more importance on the nonhuman
environment, they have greater potential for gaining from the

companionship that animals have to offer"

(Fick, 1993, p. 529).

With increasing longevity and the deterioration of physical

and mental health, the number residing in long term care facilities
• .becoming
.
is
larger.
in the areas of

These
inesc people are candidates for deprivation

socialization and sensory stimulation.

20

An exploratory study in Australia attempted to determine

what behavioral and interactive changes took place with
terminally ill patients and a resident dog.

Chinner and Dalziel

(1991) found that contrary to research on pet therapy, hospice
patients who were isolated and uncommunicative displayed no

affection toward the dog.

They suspected that the terminally

ill may distance themselves from affection and the companionship

of the animal, so that they may not face death with many
emotional ties and too much grief.

Due to their medications and

illness these patients were tired most of the time, but the

subjects expressed their like for the dog and the calming effect
he had on them.

The loss of a pet can be a tragedy for the elderly
especially if they have turned to a pet for unconditional love
and support.

The elderly, especially those living alone, may

see their own death in the death of their pet.

pet should not be taken lightly.
should be given to their owner.

The death of a

Compassion and sensitivity

Cusack (1988) indicated

The death of a pet is not a merely a 'dress
rehearsal' for more3 significant events to come;
it is an intense, deeply moving experience
• - by
'
“3 and emotional
itself, and is affected
age
as degree
development as well _j
as such
sue.. factors
_?.•
the
pet
and
manner
in which
of attachment to
(p. 182
182)>
the pet died, (p*

21
Physiological effects of Pet Therapy

The benefits from pet therapy are also physiological
in nature.

Reduction of stress and an increase in relaxation

are some of the physiological benefits. Friedmann, Katcher,

Lynch, and Thomas (1980) investigated the association of pet
ownership and the survival rate of 92 coronary heart disease
patients following their discharge form a coronary care unit.
One year later, 3 of the 53 patients who were pet owners died,
while 11 of the 39 patients who did not own pets died.

The

presence of the pet was the strongest social predictor of their

survival for one year post hospitalization.

“Most importantly

the effect of pets was not present only in those people who were
socially isolated, it was independent of the marital status and

access to social support from human beings1'

1980, p. 49) .

(Friedmann et al.,

These results support the premise that pets have

an important effect on lives, independent of the companionship
of others and produce positive health benefits.

Katcher, Friedmann, Beck, and Lynch (1985) studied the
Two
effects of interactions with dogs on blood pressure,
of children were used in the presence or
experimental groups
Blood pressure was significantly decreased
absence of a dog.
children in the room, than when the
when the dog was with the

children were silent or reading aloud.

22

The physiological effects

of blood pressure and heart

rate and human/animal bonding was further studied by Baum,
Bergstrom, Langston, and Thomas (1984)

Blood pressure, heart

rate, respiration rate were recorded on three groups of
subjects:

subjects petting their own dog, subjects petting a

strange dog, and subjects reading quietly.

Over time, a

decrease in both the systolic and diastolic blood pressure

readings occurred with subjects petting their own dog as well
as a strange dog.

The greatest decrease in both systolic and

diastolic pressures occurred with the human/animal bond.

The

heart rate did not change in the subjects with the bonded or

strange dog but it was lowered during quiet reading.
Respiratory rate did not significantly change with any group.

Vrombrock and Grossberg (1985) noted similar results from

their research of college students,

The students blood

pressure was measured at rest without the dog, touching the

dog, talking to and touching the dog, and talking with the
Results reported
experimenter and without the dog present.
lowest when petting the dog,
that blood pressure levels were
dog and highest while talking to the
higher while talking to the
to be a major factor of the pet
experimenter. Touch appeared
when talking or touching the dog
effect. Heart rate decreased
touching and talking to the dog. The

and increased while both

contact, comfort response
element of touch appeared to be a

23

which

influenced the blood
pressure but not the heart rate.

In a study of homebound elderly, the Visiting Nurse
Association initiated an animal assisted therapy program,

The

data that was collected on 16 homebound elderly patients sup­

ported the research that interaction with a pet produced a

significant effect on the blood pressure.
study were previous pet owners.

All subjects in the

First, subjects were visited

weekly for four weeks by a nurse alone.

The next four visits

included the nurse, the pet (a dog) , and pet owner

Rinehart, & Gertsman, 1993).

(Harris,

The data again indicated that the

visit alone did not change the blood pressure level, but the
pet visit did.

"The physical, psychological, and social benefits provided

by an animal companion are available to anyone who is willing to

accept them"

(Cusack & Smith, 1984, p. 45).

Animals may assume

a more significant role for those people who have special needs
or physical impairments.

Dogs have been used to assist the

hearing and sight impaired persons as well as the physically
In the recent years, equestrian therapy,
challenged.
and
a multifaceted treatment, has provided physical, social,
psychological benefits to

handicapped individuals.

The decision tor using pet therapy shall include several
factors.

Animals used in pet therapy program, must he carefully

entering a program.

screened before

Parasitic infections as

24

well as zoonotic infections are a potential problem. Elliott,

Tolle, Goldberg, and Miller (1985) found that pet associated
illnesses are uncommon despite the frequency of pet/human
contact.

They stated that health care providers should be more

knowledgeable of the transmission of pet associated illnesses as
well as preventive measures.

They

recommended vaccination,

flea control, and treatment of intestinal parasites for any pet.

Wallace (1992) noted that animals posed no threat of
infection to the hospitalized patient when they were tested and
infection control guidelines were followed.

She recommended

high risk patients such as spleenectomy patients be barred from
pet visits due to their susceptibility to dysgenic fermentin

Type 2, a bacteria that is normal flora in dog saliva.

Patients

with known methicillin-resistant staphylococcus aureus
infections are not candidates for pet therapy because of the

concern that animals could act as fomites in transmitting the
pathogen from patient to patient (Haggar, 1992;

Wallace, 1992).

Wallace (1992) also warns that dogs particularity need protected
as they may become infected with tuberculosis if exposed to

patients with the disease.
Particular attention should be given to those persons who

have respiratory conditions or are allergic to animals.

Determination of the patients allergies should be obtained

before introducing an animal (Bustad, 1980; Cusack & Smith,

25

1984; Michaels, 1982).

Some people may be allergic to only

certain breeds of animals.

Hibell (1987) noted that animals

with long hair may cause more intense allergic reactions and
recommended that short-haired cats be used when working with the
elderly.

Careful selection of an animal and proper training can
reduce the risk of injury.

may bite or scratch.

Pets such as dogs, cats and rabbits

Corson and Corson (1978) identified two

approaches to this problem.

First, screening, selection, and

training of the animal used in pet therapy, and second,
education of the person handling the animal.

Direct observation

and supervision during the initial stages of pet therapy is

needed to insure resident/pet companionships.

Special attention

should be given to the training of animals who are placed in an
environment where residents have difficulty walking, and may use

walkers, and wheelchairs.

Abuse of the animal from the patients who may take out
their frustrations or aggressions on the animal is a potential
problem.

Animals used in pet therapy should not be exposed to

extremely agitated or confused people.

Kongable, Stotsky, and

Buckwaiter (1990) in their study of Alzheimer's patients and pet

therapy wrote "the most commonly cited risk of using pet therapy
for

Alzheimer's disease residents is related to the safety of the

animal"

(p. 20).

They reported residents grabbing at the animal,

26

pulling it's tail, and kicking it which produced a stress

overload for the animal.

The animal through training learned to

sense cues of aggressive behavior and began to avoid potentially

abusive situations minimizing the potential for injury
(Kongable et al., 1990).

A potential problem for the animal that may develop is

obesity.

The pet, especially a resident animal, may be bribed

with treats.

Residents may save their food for the animal which

causes a weight gain of unhealthy proportions (Bustad, 1980).

For this reason a person(s) may be designated as the one
responsible for feeding the animal.

Neutered animals tend to make better companion animals.

They tend to be more stable, dependable, gentle, and
affectionate.

Since the tendency to roam is diminished,

neutered pets tend to live longer (Bustad, 1980) .

Financial responsibility for securing and maintaining a
pet may be costly.

Costs for training the animal and health

care may be incurred.

Veterinarians may contribute their

services for the health care of the animal.

Food and grooming

needs may be provided by funds from the institution or from
contributions of the staff and patients

(Bustad, 1980).

Also decisions on who takes responsibility for bathing,
grooming, feeding, exercising, toileting, and playing with the

animal is important.

Traditionally, the activity director of an

26

pulling it's tail, and kicking it which produced a stress

overload for the animal.

The animal through training learned to

sense cues of aggressive behavior and began to avoid potentially
abusive situations minimizing the potential for injury

(Kongable et al., 1990).

A potential problem for the animal that may develop is

obesity.

The pet, especially a resident animal, may be bribed

with treats.

Residents may save their food for the animal which

causes a weight gain of unhealthy proportions (Bustad, 1980).
For this reason a person(s) may be designated as the one

responsible for feeding the animal.
Neutered animals tend to make better companion animals.

They tend to be more stable, dependable, gentle, and

affectionate.

Since the tendency to roam is diminished,

neutered pets tend to live longer (Bustad, 1980) .
Financial responsibility for securing and maintaining a

pet may be costly.

Costs for training the animal and health

care may be incurred.

Veterinarians may contribute their

services for the health care of the animal.

Food and grooming

needs may be provided by funds from the institution or from
contributions of the staff and patients

(Bustad, 1980).

Also decisions on who takes responsibility for bathing,

grooming, feeding, exercising, toileting, and playing with the
animal is important.

Traditionally, the activity director of an

27

institution is often delegated the responsibility for the care
of a resident animal but a person in another position may assume

the responsibility.

Certain responsibilities for the care of

the animal may also be assumed by capable residents.

Suggestions have been made that the care of the animal be
written into the job description of an employee

(Cusack &

Smith, 1984) .
From the review of the literature the presence of pets can
produce positive influences on the physical and mental health of

the elderly.

Friedman et al. (1984) suggested that the

companionship, communication, purpose, and meaning to life

provided by pets act to decrease loneliness and depression.
Pets may be an effective intervention for some lonely elders.

Pet therapy is not for everyone and should not be considered a
cure for all, but consideration should be given to the initiation

of this intervention as a means to improve the quality of life.

CHAPTER 3

Introduction

This study was done to compare a resident pet program and

a visitation pet program and their effect on the loneliness
experienced by nursing home patients.

Conceptual Framework

Erik Erickson's eight stages of human development provides
a theorical framework for this study.
developmental stages.

His theory outlines eight

With each stage is an issue or psycholog­

ical conflict (crisis) which is of primary importance during

that stage of development.
Erickson's stage of integrity vs. despair and
disgust has the greatest significance for the
older adult. Success in resolving the conflicts
of this stage, as with all the others, is not
possible unless the conflicts of the preceding
stages have been successfully resolved. Erickson
(1959) defines integrity as 'the acceptance of
one's own and only life cycle and the people who
have become significant to it as something that
had to be and that, by necessity permitted no
substitutions.' The person who successfully
achieves integrity accepts the experiences which

28

29

have occurred during the person's lifetime and take
full responsibility for his or her own life.
Persons who were significant in the course of life
experience are accepted without any wish that
they might have been different. When the indi­
vidual does not achieve integrity, despair
follows, often accompanied by dismay that there
is not enough time remaining to start all over.
In some cases, disgust is substituted for
despair (Yurick, et al., 1980, p. 192).

Many elderly, particularly these who reside in nursing
homes have suffered dramatic changes in their lifestyles.

They

have relinguished most of their personal possessions, the

security of their home, family and friends, and often a
relationship with a pet from their previous environment.

They

have cognitive and physical deficits which limit their ability

to interact with others and also limit their response to the
environment.

There are seldom opportunities to leave the

nursing home and personal visitors are few.

This often leads to

feelings of anger, inadeguacy, boredom, low self-esteem, and

hopelessness due to a lack of sense of purpose and absence of a
satisfying goal-directed activity in their lives.

despair develops.

Ultimately,

The detrimental effects of institutional care

on the well-being of the resident are many and well documented.

Pet therapy is one of the interventions that nursing can
use to stimulate awareness, interaction, and provide pleasure
These residents require activities
for nursing home residents.
that fulfill the need for purposefullness, and a feeling of

30

being worthwhile by providing a driving life force,

Pet therapy

is a treatment modality that can be utilized to counteract the
isolation and loneliness, increase social interaction and

sensory stimulation, and improve self-esteem.
The pet provides a source for feeling a oneness with life
and creation.

Residents renew their spiritual energy through

reminiscence, which is one method of preparation for death in

the elderly.

Pet therapy is an activity that positively effects

the mind, body, and spirit of the institutionalized elderly.
Research has documented its therapeutic use in assisting the
elderly to restore and maintain the integrity of old age.

Sample of Setting

The setting for this study was in two nursing homes in
Northwestern Pennsylvania.

Approval for study was obtained from

the institution's nursing administrator.
to complete

the study was placed in Appendix A.

this study was

and the

A letter of request
Permission for

granted with understanding that the institutions

participants would be anonymous.

Only the investigator

observed the raw data.
consisted of residents of a nursing home with
The sample

31
a resident pet therapy
program and nursing home residents with a
visitation pet therapy program.

All subjects voluntarily agreed

to participate in the study and signed a consent to participate
(Appendix B) .

Before data was collected, subjects were asked

three designated items from the modified Short Portable Mental

Status Questionnarie (SPMSQ). Only those subjects who could

provide,

without assistance, appropriate answers were included

in the sample.

Type of Pet Programs

A resident pet and a visitation pet program were in

place at the time of this study.

The resident pet program was

established in a private nursing home.

The resident pet was a

five year old Sheltie dog, named "Morgan", who routinely came to
the nursing home five days a week for eight hours a day.

The

dog was owned by the activity director at the facility.

The resident dog was allowed to roam in all areas except

the dining room, laundry, and food preparation areas.
meal time she was confined to a holding pen.

During

The dog was not

the residents beds or chairs.
allow to sit or sleep on

The

32

staff of the activities department were responsible for the

feeding and grooming of the dog.

The dog received veterinarian

checkups every three months in addition to the required

vaccinations.
The nursing home residents were permitted to interact with

the dog as desired.

The activities department personnel would

routinely take the dog out to all areas of the nursing home and
encouraged the residents to pet or brush the animal as desired.

In the visitation pet program, domestic animals such as
dogs and cats were taken by volunteers to the nursing home for

approximately two or three hours on the first and third Saturday

of each month.

The pets were screened for appropriate

temperament and behavior before being brought to the home.
These pets also received routine veterinarian checks and

vaccinations.

The pets were escorted through the hallway with the

volunteers.

Each resident was approached for their consent

before the pet was introduced.

The nursing staff provided the

volunteers with a list of nursing home residents who were

allergic to animals before the pet visitation program started.

33

Instrumentation
A demographic questionnaire was used to describe the

characteristics of the sample

(Appendix C).

Two instruments

were used in this study:

a modified form of The Short Portable
Mental Status Questionnaire (SPMSQ) and the UCLA Loneliness
Scale (version 3).

The SPMSQ, a ten item tool, was used to

assess for organic brain impairment in the elderly by testing

the memory, orientation, and serial mentation operations
(Pfeiffer, 1975) .

Three items of the tool that questioned time,

place, and President of the United States were used to determine

the subjects ability to make a reliable response (Appendix D) .
The three items of assessment were:

What is the name of this

place?, What day of the week is it?, and Who is the President of
the United States now?.
The UCLA Loneliness Scale (version 3)

(Russell, Peplau,

& Cutrona, 1980; Russell, Peplau, & Ferguson, 1978; Russell,

1994) was used to measure loneliness (Appendix E). A letter
granting permission for the loneliness scale used in this study

is in Appendix F.
The scale consisted of 20 questions describing the

experience of loneliness.
(lonely) questions and ten

questions (Russell, 1994).

There were 10 negatively-worded

positively—worded (non-lonely)
Ratings on a four-point scale range

scoring ranged from 20 (nonfrom "never" to "always" and the

34
lonely) to 80 (very lonely)

(Russell, Peplau,

and Cutrona, 1980).
Early research with the UCLA Loneliness Scale involved
college student samples. In more recent
research, involving
elderly samples, a problem regarding the complexity
of the

question became apparent.

In statements containing double

negatives (e.g., answering "never” to the response, ”1 do not

feel alone") the elderly had difficulty understanding the
statement.

(Russell, 1994).

A simplified version of the scale was developed to correct

the problem.

The content of one item was reversed from positive

to negative making 11 negatively-worded questions and nine
positively-worded questions.

Version 3 of the UCLA Loneliness

Scale had been used on a number of samples:

college students,

public school nurses, hospital-based nurses, and the elderly
(Russell, 1994).

Studies on four samples indicated Version 3

is a valid and reliable measure of loneliness.

The coefficient

alpha ranged from .89 to .94 across the four samples.

1994).

(Russell,

In studies on the elderly, loneliness scores were

"strongly related to the perceived quality of the persons

interpersonal relationships."

(Russell, 1994).

Data Collection
at both nursing homes were
The activities directors
make arrangements for meeting with the
initially contacted to

35

subjects.

The pet therapy programs were the responsibility of
the activities director at both institutions.

Individual meetings were conducted with all residents who
were able to accurately answer the items on the mental status

questionnaire.

First, a description of the study's intent was

given to each subject.

It was explained that participation was

voluntary, all information would be confidential, and at any
time they could refuse to answer any question or refuse to
continue to participate in the study.

Time was allotted for

subjects to ask questions and determine if they wished to
participate.

each subject.

A written consent to participate was obtained from

These signed consent forms were given to the

institution's administrator.
interviews.

The investigator conducted all

Subjects were then interviewed following the UCLA

Loneliness Scale and the demographic data form.

To assist subjects with their response a bold printed

response card was used.

After the investigator read the

question aloud, subjects were asked to indicate their response

on the response card.

The subjects responses were then recorded

by the investigator on data records.

After completion of the

instruments, the subjects were thanked for their participation.

36

Procedure for Analyzing Data

Since scored data was obtained in the study a two-tailed

t-test was performed to determine if there was a significant
difference in the loneliness experienced by nursing home

residents with a resident pet program compared to the loneliness

experienced by nursing home residents with a visitation pet

program.

Significance was determined to be at the .05 level.

Requirements for the two-tailed

t-test were one

independent variable, two levels, between-subjects design, and
number of the sample need not be equal (Linton & Gallo, 1975).
Since comparisons were made among different groups of nursing

home residents, it was a between-subjects design.

The two

levels of the independent variables were resident pet and
visitation pet programs.
For independent samples, the formula for degrees of

freedom is df = nA + nB

2.

A table of values

for the

distribution of the t probability was provided by statistical
references (Linton & Gallo, 1975; Polit & Hungler, 1987).

With

1 degree of freedom, the value that must be exceeded in the
study population in order to establish significance at the .05
level was the value of 12.71.

37

The pearson correlation coefficient was used to determine

if there was an interrelationship between the patient' s
loneliness scores and different variables such as gender, pet
ownership, length of time in nursing home.

Requirements for the

pearson r include two variables, both score data, and one score
on each variable for each subject (Linton & Gallo, 1975).

CHAPTER IV
Presentation and Analysis of Data

The purpose of the study was to compare a resident pet

program and a visitation pet program and their effect on the
loneliness experienced by nursing home residents,

The

hypothesis was:

The residents of a nursing home with a
resident pet program will experience
less loneliness than the residents of
a nursing home with a pet visitation
program.
Demographics

The total sample was comprised of 52 subjects from two
nursing homes in Northwestern Pennsylvania; 23 from nursing home

A and 29 from nursing home B.

The average age of both male and

female subjects from nursing home A and B was 82.17 and 77.35,
respectively.

Two subjects from nursing home B were in their

forties, lowering the average age.

never owned pets before.

Six of the 52 subjects had

Two subjects currently owned pets which

other and visited routinely at the
were kept by a significant
the ratio of male to female
nursing home. Table 1 shows

subjects in the study.

38

39

Table 1

Gender Ratios in the Sample Population

Sample Population

Row Total

Male

Female

Nursing home A

6

17

23

Nursing home B

11

18

29

Column Total

17

35

52

40

Analysis of Data

A pearson correlation coefficient was calculated on the
subject's loneliness scores and pet ownership, gender, and number
of years at the nursing home (Table 2) .

Table 2

Variables Correlated With the Loneliness Scores

Variables

Pearson r

P

Pet ownership

.093

>.05

Gender

.0003

>.05

Number of years in nursing home

-.273

= .05

41

The results of the correlation of loneliness scores with

the variables indicate that pet ownership and gender have no
correlation with loneliness scores.

A correlation equal to the

.05 level of probability was indicated between the number of
years in the nursing home and the loneliness scores.

This

correlation was inversely related indicating that the longer a
subject resided in the nursing home, the lower the score on the
loneliness scale.

The assessment of loneliness was completed using the UCLA

Loneliness Scale (version 3).

The scores for the subjects from

Nursing Home A ranged from 21-58 and from Nursing Home B 21 66.

The mean loneliness score for nursing home A and B was

37.87 and 38.93, respectively.

A two-tailed t-test was

calculated on the data to determine if there was a difference

in the mean loneliness scores according to the type of pet

program.

Table 3 illustrates the results of the t-test.

42

Table 3

Two-Tailed t-test of Loneliness Scores
and Type of Pet Program

Type of pet interaction

Loneliness

N
Resident pet program

23

Mean
37.87

S.D.

t

29

38.93

P

10.73

-3.54
Visitation pet program

DF

50

.999

10.77

t (.05, 50) = -3.54, p > .05

This study concluded that there was no significant
difference found between the two pet programs and the subject's
loneliness scores.

Therefore, the hypothesis failed to be

rejected at the .05 level of significance.

CHAPTER 5

Conclusion

Summary

The elderly, particularly those facing placement in an
institution such as a nursing home, encounter losses,

separation, isolation, and loneliness.

Pets have long been

considered an effective intervention of increasing social

interactions, improving self-esteem, and reducing loneliness.
The purpose of this study was to investigate the effect of a

resident pet program and a visitation pet program on the
loneliness experienced by nursing home residents.

The results

did not demonstrate a significant difference in the loneliness

scores and the two types of pet programs.

Discussion

The literature review focused on loneliness, pet therapy,
the psychological and social effects of pet therapy, and the

physiological effects of pet therapy.
inherent to institutionalization.

Loneliness is a problem

Nursing home residents are at

risk for developing the feelings of helplessness, hopelessness,

43

44

isolation, and loneliness.

Life events such as loss of job,

income, spouse, children, and physical or mental health may
precipitate loneliness (Stotsky, 1968; Burnside, 1981).
Studies have reported the positive influence of pets
the health of the elderly receiving long-term care (Robb, Boyd,

& Pristash, 1980; Hendy, 1987; Calvert, 1989; Kalfon, 1991).
Social behaviors, communications, activity levels, and alertness

have shown improvement after initiation of pet therapy programs.

The theoretical framework for the development of this
study was based on Erickson's eight stages of human development.
The older adult contends with integrity vs. despair.

The

subjects in this study appeared to have resolved the crisis in
this stage.

pet.

Enthusiasm among most subjects was bolstered by the

Talking to the subjects about pets stimulated conversation

and facilitated reminiscence for many.

Memories of pets and

stories of their antics typically were discussed.

reported similar findings from her study.

Manor (1987)

She believed

reminiscence was one method of keeping the elderly in touch with
reality.

Subject acceptance of the pet was high.
reactions were observed.

No adverse

Possibly, this could reflect careful

selection and training of an even-tempered animal.

Observation

suggests that the dog provided a comfortable environment that

45
was conducive to facilitating social interactions.
Some subjects associated with the resident pet program

commented they had very little involvement with the animal.

Comments suggested that the animal guite often stayed at the
nurses station or with the nursing staff.

commented about similar results.

Winkler et al. (1989)

The pet sought out the

nursing staff, possibly because they were responsible for the

feeding, care, and toileting of the animal.
Other factors could possibly affect the loneliness of

nursing home residents.

The resident's adaptation response, the

number of visitors, interpersonal relations, physical deficits,

could positively or negatively affect their loneliness.

The activity director of the resident pet program
indicated that shortly after the animal arrived at the nursing
home, she began to note the animal becoming lethargic and

inattentive.

With the assistance of a veterinarian the

diagnosis of depression was reached.

One employee of the

activities department started taking it home every evening and

bringing it back the next day which resolved the problem.
Overall, the pet programs were viewed as a valuable asset

to the facilities treatment plan.

Pets are not for everyone,

and should not be considered a cure-all.

But it is one

intervention that can make a difference in the lives of many
individuals.

46

Conclusions

The following conclusions are drawn from this study:
1.

There is no significant difference in the

loneliness scores and the type of pet program.
2.

Other variables may influence the loneliness

experienced by nursing home residents.

3.

Interventions should be introduced to reduce

loneliness.
Recommendations

The following recommendations are made based on the
results of this study:
1.

The study should be replicated using a larger

sample size.
2.

The study should be expanded to include a nursing

home that does not have a pet therapy program.

3.

The study should include a facility with maximum

resident involvement with the pet and its activities.

Appendix A

RD# 1, Box 393B
Polk, PA 16342
December 15, 1994

Administrator

Dear

I am presently writing a thesis as part of the
requirements for a Master in Science in Nursing. This letter is
in response to our conversations regarding my study on
loneliness of nursing home residents.

I am conducting a study to evaluate the effect of pet
therapy upon the loneliness experienced by nursing home
residents. I will be ready to conduct my study in February
1995, and would like permission to collect data from your
facility.

This study would entail visiting your facility and
selecting residents for participation. After an explanation of
the purpose of the study and what it involves, a written consent
would be obtained from each participant, The participant would
then answer a 20-question questionnaire.

Complete anonymity would be maintained as to the name of
the facility and residents involved. Data collection will be
conducted by myself.
I hope this meets your approval. A letter indicating an
agreement to participate should be directed towards myself,

I appreciate your time and interest in this study.
Sincerely,

Barbara Anderson, R.N.C., B.S.N.
Edinboro University of Pennsylvania
Master of Science in Nursing Program

47

Appendix B

AUTHORIZATION TO PARTICIPATE AS A SUBJECT IN A STUDY

Project title

Schoo1/Department

Principal Investigator

I consent to participate as a subject in this study.
The nature and general purpose of the study have been explained

to me by

I understand my

identity will not be revealed in any publication or document

resulting from this study.

My consent is completely voluntary.

I understand that my decision to participate or not will not
effect the care I receive.
This authorization is given with the understanding that I may

terminate my service as a subject at any time.

Signed

Witness

Date
48

Appendix C

DEMOGRAPHIC DATA FORM

NURSING HOME: A

B

AGE:

GENDER:

MALE

FEMALE

NUMBER OF YEARS AT NURSING HOME:

DID YOU EVER OWN A PET BEFORE:

YES
NO

Present desire for pet ownership

YES

Desire to own pet

Currently own a pet

49

NO

Appendix D

MODIFIED
SHORT PORTABLE MENTAL STATUS QUESTIONNAIRE

What is the name of this place?

What day of the week is it?

Who is the President of the United States now?

50

Appendix E

UCLA Loneliness Scale

(Version 3)

Instructions:
The following statements describe L_„
how people sometimes feel.
For each statement, please indicate how
—often
--- .1 you feel the way
described by writing a number in the space provided. Here is an
example:

How often do you feel happy?
If you never felt happy, you would respond '’never”; if you
always feel happy, you would respond "always”.
NEVER

RARELY

SOMETIMES

ALWAYS

1

2

3

4

*1. How often do you feel that you are
"in tune” with the people around you

2. How often do you feel that you lack
companionship?
3 . How often do you feel that there is no
one you can turn to?

4. How often do you feel alone?
*5. How often do you feel part of a group
of friends?

*6. How often do you feel that you have a lot
in common with the people around you?

7

How often do you feel that you are no longer
close to anyone?

8. How often do you jfeel that your interests and
by those around you?
ideas are not"shared
i— -*9. How often do you feel outgoing and friendly?

*10. How often do you feel close to people?
11. How often do you feel left out?

51

UCLA Loneliness Scale III

NEVER

RARELY

SOMETIMES

ALWAYS

1

2

3

4

12 . How often do you feel that your relationships
with others are not meaningful?
13 . How often do you feel that no one really
knows you well?
14. How often do you feel isolated from others?

*15. How often do you feel you can find
companionship when you want it?

*16. How often do you feel that there are people
who really understand you?
17. How often do you feel shy?
18. How often do you feel that people are around
you but not with you?

*19. How often do you feel that there are people
you can talk to?

*20. How often do you feel that there are people
you can turn to?
Scoring:

LL~L are asterisked should be reversed (i.e., 1=4, 2=3,
Items that
4=1),
and the scores for each item then summed together.
3=2, '
Higher scores indicate greater degree of loneliness.

52

54

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American Association of Retired Persons.
Wise decisions for long-term care.

(1986). Making

(PF3701 (389)*D12435).

Washington, D.C.: Author.

Austin, A.G., (1989, September).
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Becoming immune to

Helping the elderly fill a void.

Journal of

Gerontological Nursing, 15(9), 25-28.

Baum, M.M., Bergstrom, N., Langston, N.F., &

Thomas, L.,

(1984) .

Physiological effects of

human/companion animal bonding.

Nursing Research, 33

(3), 126-129.
Burke, M., & Sherman, S. (Eds.).

(1993) .

(Pub. No. 14-2541).

and caring for older adults.

Ways of knowing

New York:

National League of Nursing

Bustad, L.K. (1980).

Animals, aging, and the aged.

Minneapolis: University of Minnesota Press.
Butler, R.N., Lewis, M.I., & Sunderland, T.
and mental health:

(1991).

Aging

Positive psychosocial and biomedical

approaches (4th Ed.). New York: Macmillan.

Burnside, I.M.

(Ed.). (1981).

30-137). New York: McGraw-Hill.

Nursing and the aged.

(PP-

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