Analysis of Pet Therapy on Mental Health
Submitted by Erin Gleason, Nadirah Moore, and Dana Wolfe
Tags: elderly health mental health nursing patient patients population research study support therapy
The purpose of this evidence-based practice project was to determine the impact animal-assisted therapy has on elderly (over the age of 65) patients. The analyzed PICO question of which this research is focused on is: "In elderly patients, how does pet therapy impact mental well-being compared to those who do not receive pet therapy?" With a continuously growing elderly population, it is essential to dedicate additional research aimed at this population with the goal of promoting and expanding knowledge of health. For many of these seniors, depression, anxiety, and loneliness are serious problems which weigh on the overall mental wellbeing and person as a whole.
Abstract
Significance of the Problem
With a continuously growing elderly population, it is essential to dedicate additional research aimed at this population with the goal of promoting and expanding knowledge of health. For many of these seniors, depression, anxiety, and loneliness are serious problems which weigh on the overall mental wellbeing and person as a whole. Once one's mental health begins to decline, the overall physical health may begin to decline as well. Alleviating this burden allows the opportunity for improved quality of life and can be accomplished without additional pharmacological intervention.
Synthesis of the Evidence
The most noteworthy findings of this study include reduced anxiety and depression, increased self worth coinciding with increased quality of sleep, and improved physical health. Multiple studies supported the original question of the impact on pet therapy on mental health as being a positive one.
Recommended Implementation for Practice Change
Implementation of pet therapy in addition to baseline therapies (i.e. physical/occupation, pharmaceutical) would improve outcomes and quality of life for elderly patients. This practice is recommended for areas which see significant elderly patients, such as inpatient rehab and nursing homes.
Conclusions/Recommendations for Practice, Education, or Research
After thorough research has been gathered, it is necessary for further research to be explored to expand on the possible benefits of animal-assisted therapy, though it shows to be promising for the elderly. Trials with greater amounts of subjects would also provide more evidence to support these claims. Currently, animals are not typically expected as part of a hospitalization experience and the spread of education will help close the knowledge gap and aid in opening the mindset to a new potential of care.
Keywords: Elderly patients, senior citizens, geriatric, animal therapy, pet therapy, mental health, mental well-being.
Introduction
Purpose
The purpose of this analysis is to determine the impact pet therapy has on the mental health and overall wellbeing of elderly patients. The importance of mental health is becoming more widespread and there is a desire to find different methods of prevention, management, and treatment of mental health conditions. Further analysis is required to determine this option as a suitable alternative form of care for those 65 years and older.
Relevance/Significance
In 2024 the United Nations Population Fund evaluated 10.3% of the worldwide population to be elderly, defined as persons 65 years of age and older, and this number is estimated to grow to 20.7% by 2074 (UNFPA, 2025). Due to the nature of this ever-growing population it is imperative to dedicate research which aims to improve not only quantity but quality of life.
A global study that consisted of over 18,400 persons ages 65 and older found that a significant amount of people reported having a mental health need, up to as high as 42% in certain populations (Vankar, 2022). With this in mind there is a clear need for additional research, resources, and time to be given to the elderly population.
This poses the common concern: financial ability. A review found that "in 2023, overall pharmaceutical expenditures in the US grew 13.6% compared to 2022, for a total of $722.5 billion" (Tichy et al., 2024). Alternatives should be analysed for effectiveness in a joint effort to come up with not only useful or functional changes but also financially obtainable and practical options for patients. Providing pharmaceutical alternatives, such as pet therapy, may pose a benefit to patients for mental and financial sake.
Mental health problems have been increasing exponentially in recent times, highlighting the urgent need to develop effective interventions, specifically non-pharmaceutical interventions (Balaguer, et al., 2025). It is important that these interventions not only address the symptoms of the person's mental illness and/or health but also enhance coping strategies and promote emotional well-being. As the concern for mental health becomes more widespread, innovative approaches, such as pet therapy, can be essential for both prevention and managing mental health conditions and well-being.
Research shows that, "social isolation and loneliness have a serious impact on older people's physical and mental health, quality of life, and longevity" (WHO, 2022). The same article from WHO, 2022 continues to explain how "interactions between humans and animals offer benefits across physical, emotional, psychological, and social aspects of human functioning." As we know, humans are social beings, therefore they require connections with other living beings, thus the growing need for researchers to give an increased amount of attention and collection of professional data to companionship with animals as a treatment method to help reduce feelings of loneliness and isolation.
Potential Outcomes
The effects of aging can have a significant impact on the elderly. "This irreversible process can lead to physical, physiological and cognitive changes and problems with pain, sleep disorders, inability to enjoy life, fatigue and depression are seen" (Yilmaz & Kartin, 2025). Standardizing the practice of pet therapy, or animal-assisted therapy (AAT), for the elderly population could have a significant positive impact on the mental health and well-being and improve problems such as pain, sleep disorders, etc.
Any consideration must acknowledge both sides that it may also be considered the opposite, harmful or without effect, for which this study aims to determine.
Clinical Question
"In elderly patients, how does pet therapy impact mental well-being compared to those who do not receive pet therapy?"
Review of Literature and Synthesis of Evidence
To address the clinical question (PICO), "In elderly patients, how does pet therapy impact mental well-being compared to those who do not receive pet therapy?," a thorough review of literature was performed. To find the best clinical evidence, keywords such as: "elderly patients," "senior citizens", "geriatric", "animal therapy", "pet therapy", "mental health", and "mental well-being" were utilized.
Five electronic databases were used to conduct the search for the best available evidence which included: Joanna Briggs Institute (JBI), CINAHL, EBSCOHOST, SAGE Journals, and MEDLINE complete. While exploring these nursing databases, advanced search limits were used such as: "English language", "full text", "peer-reviewed", and date range (2013 - present).
The search revealed thirty peer-reviewed articles with evidence from studies or clinical guidelines that provided relevant information regarding the significance of this topic and/or evidence to analyze the clinical question of the possible benefit(s) of elderly patients' interaction with animal assisted therapy.
The review of literature gathered from these journal articles evaluated either 1) the findings (whether positive or negative) of adapting pet/animal therapy for elderly individuals, 2) the explanations of different cognitive abilities/disabilities in the elderly population (age 65+) and 3) the reasoning to incorporate animal therapy. In support of this project, ten articles were used to address the clinical PICO question.
Several common themes were found within the ten chosen journal articles. Each article began with the explanation of the elderly population and acknowledged the increasing number of these individuals. These articles explained the different medical conditions/ailments that could occur during the aging process, specifically relating to one's mental health.
Mental health conditions/ailments such as anxiety/depression, sleep disorders, fatigue, dementia, physical health (which ultimately leads into one's mental health) and one's feelings of self-worth were common themes that were discussed. The researchers in these articles were wanting to show the possible positive significance a companion (animal) could have/be for an elderly person with one of these conditions.
These researchers also addressed the common idea of wanting to find alternatives to pharmaceutical treatments, or a more holistic approach, which lead to the studies of animal assisted therapy.
Reduced Anxiety/Depression
Anxiety and/or depression are some of the most common mental health conditions in the elderly; due to physiological changes in this population, pharmaceutical therapy can sometimes be difficult to manage anxiety, therefore use of alternative therapies, such as animal-assisted activities (AAA), could prove beneficial, according to one study (Kowalski, et al., 2021).
WebMD discusses anxiety disorders in older adults as being fairly common, affecting 10% to 20% of this population. Anxiety is found more often than depression and cognitive disorders in older adults. The most common anxiety disorder is generalized anxiety disorder (GAD) (Felson, 2025). GAD is followed by phobias, panic disorder, and obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
The most common change noted with animal therapy was a decreased incidence of anxiety and depression, as interpreted from standardized questionnaires including but not limited to HAMA (anxiety) and GDS (depression). Frequently this change was most noticeable during or immediately after pet-therapy, with a decreased effect as weeks since therapy increased.
Increased Self-Worth with Quality of Sleep
The normal process of aging can cause physical, social, and mental changes, therefore individuals' sleep quality and fatigue levels may be negatively affected. Sleep is one of the basic daily activities and physiologic needs of elderly individuals (Yilmaz, 2025). A decrease in quality of life can be greatly affected from improper sleep quality, especially seen in the elderly population.
Pet therapy is suggested to promote well-being, help with meeting social and psychological needs, and aid in rehabilitation. The very nature of caring for and interacting with animals has been found to directly impact self worth. This can be explained by a change in hormonal release experienced by the person when bonding (Bernhardt et al., 2024) in addition to the dependency animals have on people and the gratification experienced by taking care of another living thing.
Improved Physical Health
Pet therapy has been found to impact much more than simply mental health. Increased sleep and cardiovascular health were among the most common aspects of improved physical health (Yilmaz & Kartin, 2025), (Bernhardt et al., 2024). As mental health is a direct extension of physical health, they are closely linked and go hand in hand (About mental health 2024). Therefore, improvement of one is usually tied to improvement of the other and vice versa.
In one study of the population of adults aged 50+, (Toohey et al., 2013) found that "frequent dog walkers were more likely to report a high sense of community and the benefits of increased physical activity." Although many elderly may not be able to "dog-walk," this study helped to show that companionship with a pet can lead to physical health improvement. Therefore, "having an animal to be used as one's companion, such as a dog, may also be associated with increased physical activity" (Humboldt, 2024).
Contradictions
Only one study found that "cognitive impairment worsened as shown by a decrease in Mini-Mental State Examination score...and an increase in the Gottfries-Brane-Steen Scale" (Thodberg et al., 2015). It should be noted that this may have been associated with other factors such as a progression of acute illness unrelated to therapy, differentiation in interpretation of unclear verbal answers given, and other external factors.
In addition to this, certain pet therapies may be contraindicated based on patient allergies. Unfortunately, pet hair and dander is a common allergen that can cause varying reactions including sneezing, difficulty breathing, chest tightness, and hives (Pet allergy 2025). While the strength of the reaction is different from person to person, in general moderate-severe allergies are likely to be a strong enough deterrent to pet therapy.
Literature Gaps
Not enough research has been dedicated to animal therapy and the elderly. This is especially true for sample size, of which many were too small to be applicable to the general senior population. Greater allocation of resources to this field would likely dedicate more studies and in turn better support the exploration of this topic.
A great deal of literature found also happened to be outside the US, where different lifestyle habits may play an additional role in general mental wellbeing. Another area not fully explored is the long term impact pets may have on the mental health of the elderly. Research studies are most often short term and do not address the potential for long term observation.
In addition, many of these studies were conducted during the COVID-19 pandemic where social distancing played a part of the research and therefore restricted closer interaction amongst the researcher and participant.
Plan for Implementation
Implementation of patient time with service animals aligned with traditional treatment provides the opportunity for further improvement of mental status, thus health as a whole. In order to better facilitate the healing process all aspects of implementation must be considered prior in order to be properly prepared and have dedicated resources available.
Nursing Home A's elderly patients (aged 65+) have shown a significant increase of mental health related disorders. These conditions have been documented as increase in anxiety, depression, sleep disorders, feelings of hopelessness and/or loneliness ultimately leading to decrease in physical activity.
With a consistent implementation of an evidence-based practice (EBP) within Nursing Home A, such as pet/animal assisted therapy, it can be possible to improve mental health conditions seen in this patient population. With consistent animal visits and therapy sessions, patients may begin to feel less anxious, may have better sleep, feel less lonely, and may want to become more active; therefore leading to better mental and physical health.
The PARIHS framework will be followed to ensure successful implementation of this new EBP to Nursing Home A. The PARIHS framework consists of three components, evidence, context, and facilitation, that work together to provide the best possible evidence (Rycroft-Malone, 2004). This framework proposes that for the implementation of evidence to be successful there needs to be a dynamic, simultaneous relationship about the evidence being used, the quality of context, and the type of facilitation needed to ensure a successful change in practice.
Stakeholders
Stakeholders encompass all persons involved in implementation, both directly and indirectly (Triplett et al., 2022). On a larger scale, active stakeholders, or the ones directly involved in the implementation of this project, include the patient who must be on board prior to consenting to new therapy, Nursing Home A staff members such as registered nurses, family members, pet therapy trainers, physicians, patient care assistants, professional staff development specialists, and nurse managers.
The passive stakeholders, or the ones that still have an impact on the success of the EBP but do not have an active role in the project, include policy makers and companies allocating additional funding for new EBP implementation and investors, risk management, and the Chief Nursing Officer (CNO). Without relevant stakeholders such as leadership; organization culture, teamwork and effectiveness to change will be greatly compromised.
Organizational Fit
The animal-assisted therapy for patients aged 65 years and older is an inpatient rehabilitation unit initiative. Nursing Home A is a community-based organization and its mission is to help those in need, respect life, provide compassionate care, and strive for excellence. The outcome of the initiative of the EBP proposal is to improve the mental health of the patients in the inpatient rehab unit of the nursing home.
The evidence shows that persons aged 65 and older have statistically improved mental health with animal-assisted therapy, and fits well within the organization's values. Nursing Home A has an inpatient rehabilitation unit with twenty beds. This unit has an adult population with 90% of those adults being aged 65 years and older.
Barriers to Implementation
As with any EBP, barriers could affect the implementation and success of the project. One barrier is financial support related to a lack of research. Initial buy in is essential to enable further research to be done. There will be a significant cost to the facility to bring in several animals on a weekly basis.
Another barrier to implementation is lack of support from leadership. Those in leadership are the decision makers and if they are not in support of this change, there may be hesitation or lack of motivation amongst others to respect and respond to said change.
Another barrier will be the consent of the patients. Some individuals may have a fear of animals and not willing to participate in the research. There also may be an allergy or sensitivity to animals which will not allow for the therapy to take place. Some patients may have difficulty or inability to speak, or handle animals, so the information may not be accurate.
Facilitation Strategies
The animal-assisted therapy EBP initiative has a facilitation strategy in place for its success. Part of this is to have one nurse leader available during therapy times for questions and concerns. The nurse leader will be the unit's nurse educator with an EBP certification. This leader would serve as the contact person for staff and patients alike with emphasis on setting up for success with supportive staff as well as open communication.
There will be a one-day trial with a consented group of patients to ensure the animal-assisted therapy project runs smoothly and therefore can work out any kinks or adjustments needed and account for potential future bottlenecks. The 6-month trial will officially begin one week later.
Resources Needed
There are several resources needed for the implementation and success of this new pet-assisted therapy program at Nursing Home A. It is essential to receive the proper approval from administration to begin this research project. Once the approval is gained, proper funding is essential. Bringing in several therapy-certified pets along with properly trained animal assistant staff is costly.
There is also a cost associated with training staff on the proper care and education of animals. There will be a need for unit meetings as well as risk training as there is a risk of working with animals, even when the animals are well trained. Family members, or patient visitors, will also need to be aware of the animal-assisted therapy implementation to allow for anyone with allergies to know there will be these animals in the building.
Plan for Evaluation
The gathered evidence-based research does support that the mental health of the elderly population (age 65+) can be positively impacted by implementing animal-assisted therapy into the patient's plan of care.
Baseline Data
Baseline data on the unit at Nursing Home A is essential in understanding and utilizing the information needed for this research project. The baseline data that will be collected from the patients will be a 30-question Geriatric Depression Scale questionnaire. "The Geriatric Depression Scale (GDS), has been tested and used extensively with the elderly population" (Greenberg, 2019).
The GDS Long Form is a brief, 30-item questionnaire in which participants are asked to respond by answering yes or no in reference to how they felt over the past week. The selected group of patients will have an initial, or baseline, questionnaire prior to any interaction with the animals. Once the animal-assisted therapy has begun, they will redo the same questionnaire at 3-weeks, 6-weeks, 12-weeks, and then at the end of the 6 months.
The trained staff along with the EBP mentor will also hold initial interviews with the patients, asking about activity level, mental health status, and physical health status. There will also be an interview with patient family members at the beginning, 6-week mark, and at the conclusion of the project.
Outcome Indicators
The primary outcome indicator will be the scoring of the GDS-30 questionnaire. With this particular scale a greater severity of depression is associated with a higher number, and vice versa. Per the assessment criteria "a score of 0-9 is considered normal, 10-19 mild depression, and 20-30 severe depression" (Yesavage et al., 1983). The goal of this project is to see a score decrease among most to all participants as a general trend across the 6 months.
To be considered notable, score decreases by 1-5 are classified as slight improvement in mental health, 6-10 moderate, and 11+ major improvement. The same GDS-30 questionnaire will be answered by each patient at the beginning of the project, 3-week, 6-week, 12-week, and at the conclusion of the research project.
Outcome Measures
In addition to the outcome indicators previously discussed, the measurable outcomes will also be collected by the same GDS-30 questionnaire. The animal-assisted therapy team lead, along with the EBP mentor will collect that data from the questionnaires. The team lead and mentor will look to see if there is an improvement in the scores as time went on.
The face-to-face interviews will be performed by the EBP mentor and team lead at the initial mark, 6-week mark, and at the conclusion of the project. These measurable outcome interviews will be used to collect data on how the patients (and their family members) feel they are progressing both mentally and physically.
Lastly, the medication usage will be evaluated from the beginning of the project to the conclusion. Medications such as antidepressants, anti-anxiety medications, and medications for sleep will be evaluated to see if the dose, frequency, and/or duration of the medication usage has decreased.
Data Collection Strategies
The research data will be primarily collected through face-to-face interviews along with the GDS-30 questionnaire. These methods of data collection will be reviewed multiple times throughout the pilot project.
At the conclusion of the project, the information will be presented to Nursing Home A nursing and financial administration to show the necessity of continuing with animal-assisted therapy care for the elderly patient population.
Conclusions, Recommendations and Implications
Research has shown that with pet therapy the elderly have improved overall physical health, increased quality of sleep per Yilmaz (2025), using CASP-19, PSQI and MMSE. The elderly also showed an increase in self worth according to Sollami (2017) and reduction of anxiety and depression, Kowalski (2021) and Chang (2021).
In regards to nursing education, evidence has shown that non-pharmacological treatment such as pet therapy is beneficial for the elderly in various settings for multiple issues such as depression and anxiety. There were various animals in the animal-assisted therapy for the elderly, although the most used animal was a dog (Rodriguez-Martinez, 2021). Since the elderly are a growing population more research needs to be done and include a larger diverse population to determine the improved quality of life and improved mental health.
Recommendations/Implications
There is a need for more clinical research to be conducted to better understand the long term effects of animal-assisted therapy and the possible benefits they pose for the elderly population. This 6-month pilot project of implementing animal-assisted therapy for the elderly is expected to show an improvement of the patients' mental health, feelings and diagnoses of anxiety and/or depression, improvement in sleep, improvement of physical activity, and improvement or reduction in anti-anxiety, anti-depression, and medications to aid in sleep.
Although more research should be done with the increase of the elderly population, the provided research primarily shows an improvement of the elderly's mental health after using animal-assisted therapy. There is a financial cost to implementing this project, but the positive and measurable outcomes that come from this cost, will be beneficial to the patient population.
The recommendation is to meet with the nursing and financial administration at the conclusion of the pilot project, and show the improvement in mental health status of the patients as well as reduction in medication usage, as well as improvement in physical activity and improvement in sleep, thus acknowledging that animal-assisted therapy is a positive experience and should be implemented as a standard treatment for elderly patients in nursing homes.
References
American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). https://doi.org/10.1037/0000165-000
Balaguer-Sancho, J., Puig-Llobet, M., Lluch-Canut, M., Tinoco-Camarena, J., Aguera, Z., Moreno-Arroyo, C., & Ramos-Pichardo, J. (2025). Validation by expert groups of the conceptual and structural dimensions in the AcompdogSMP+ Nursing Program: A dog-assisted therapy to promote positive mental health. Perspectives in Psychiatric Care. https://doi.org/10.1155/ppc/1649780
Bernhardt, L. K., Vashe, A., Bernhardt, G. V., & Pinto, J. (2024, October 8). Animal-assisted intervention for geriatric well-being: A comprehensive review: Healthy ageing. La Clinica Terapeutica. https://www.clinicaterapeutica.it/ojs/index.php/1/article/view/921
CDC. (2024, August). About mental health. Centers for Disease Control and Prevention. https://www.cdc.gov/mental-health/about/index.html
Chang, S.J., Jongeun, L., Hyeran, A., Woi-Hyun, H., Joo, Y.L. (2021). Animal-Assisted Therapy as an Intervention for Older Adults: A Systematic Review and Meta-Analysis to Guide Evidence-Based Practice. Worldviews on Evidence-Based Nursing. 18:1, 60-67. https://doi.org/10.1111/wvn.12484
Felson, S. (2025). What to know about anxiety in older adults. WebMD. https://www.webmd.com/healthy-aging/what-to-know-about-anxiety-in-older-adults
Greenberg, S. (2019). The Geriatric Depression Scale (GDS). The Hartford Institute for Geriatric Nursing. https://hign.org/sites/default/files/2020-06/Try_This_General_Assessment_4.pdf
Humboldt, S., Silva, S., & Leal, I. (2024). How do older adults experience pet companionship? A qualitative study of the affective relationship with pets and its effect on the mental health of older adults during the Covid-19 pandemic. Educational Gerontology. 50(7). https://doi.org/10.1080/03601277.2024.2321086
Kowalski, M., Smith, C., Cole, D., Bersick, E., Keelekai-Brapoh, N., Panfile, P., & Abate, S. (2021). A multicenter study of animal-assisted activity and anxiety among older adults hospitalized in acute care settings. Applied Nursing Research. 60. https://doi.org/10.1016/j.apnr.2021.151447
Mayo Foundation for Medical Education and Research. (2025). Pet allergy. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pet-allergy/symptoms-causes/syc-20352192
Rodriguez-Martinez, M., Maestra, A., Armenta-Peinado, J. A., Barbancho, M.A., Garcia-Casares, N. (2021). Evidence of Animal-Assisted Therapy in Neurological Diseases in Adults: A Systematic Review. Int. J. Environ. Res. Public Health. 18(24). https://doi.org/10.3390/ijerph182412882
Rycroft-Malone, J. (2004). The PARIHS Framework -- A framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quality. 19(4). https://downloads.lww.com/wolterskluwer_vitalstream_com/journal_library/ncq_10573631_2004_19_4_297.pdf
Sollami, A., Gianferrari, E., Alfieri, M., Artioli, G., & Taffurelli, C. (2017). Pet therapy: an effective strategy to care for the elderly? An experimental study in a nursing home. Acta Bio-Medica: Atenei Parmensis, 88(1S), 25-31. https://doi.org/10.23750/abm.v88i1-S.6281
Stern, C., Lizarondo, L., Carrier, J., Godfrey, C., Rieger, K., Salmond, A. (2020). Impact of canine-assisted interventions on the health and well-being of older people residing in long-term care: a mixed methods systematic review protocol. JBI Synthesis. DOI: 10.11124/JBISRIR-D-19-00224
Thodberg, K., Sorensen, L.U., Christensen, J.W., Poulsen, P.H., Houbak, B., Damgaard, V., Keseler, I., Edwards, D. and Videbech, P.B. (2016). Effects of dog visits in nursing homes. Psychogeriatrics, 16: 289-297. https://doi.org/10.1111/psyg.12159
Tichy, E. M., Hoffman, J. M., Tadrous, M., Rim, M. H., Cuellar, S., Clark, J. S., Newell, M. K., & Schumock, G. T. (2024, July 8). National trends in prescription drug expenditures and projections for 2024. American Journal of Health-System Pharmacy. https://pubmed.ncbi.nlm.nih.gov/38656319/
Toohey, A. M., McCormack, G. R., Doyle-Baker, P. K., Adams, C. L., & Rock, M. J. (2013). Dog-walking and sense of community in neighborhoods: Implications for promoting regular physical activity in adults 50 years and older. Health & Place, 22. https://doi.org/10.1016/j.healthplace.2013.03.007
Triplett, N. S., Woodard, G. S., Johnson, C., Nguyen, J. K., AlRasheed, R., Song, F., Stoddard, S., Mugisha, J. C., Sievert, K., & Dorsey, S. (2022, July 29). Stakeholder engagement to inform evidence-based treatment implementation for children's Mental Health: A scoping review. Implementation Science Communications. https://pmc.ncbi.nlm.nih.gov/articles/PMC9338493/
UNFPA. (2025, January 1). Ageing. United Nations Population Fund. https://www.unfpa.org/ageing
Vankar, P. (2022, June 20). Mental health needs among older adults worldwide 2021. Statista. https://www.statista.com/statistics/1289830/mental-health-needs-among-older-adults-worldwide/
World Health Organization. (2022). Ageing and health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
Yesavage, J.A., Brink, T.L., Rose, T.L., et al. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research; 17:37-49.
Yilmaz, C., & Kartin, P. (2025). Effect of pet therapy on sleep and life quality of elderly individuals. Geriatrics and Gerontology International. 25(3). https://doi.org/10.1111/ggi.15059