................................................................................................................................... ii CHAPTER 1: INTRODUCTION TO THE STUDY ...................................................................... 1 Background to the Study ........................................................................................................... 2 Prevalence of ADRD............................................................................................................ 2 Dementia-specific indices of QoL ................................................................................... 3 Environmental influences on the QoL of Persons with Dementia .................................. 4 AAAT and EAAT with Adults with Dementia .................................................................... 6 Animal-assisted activities and therapies.......................................................................... 6 Equine-assisted activities and therapies. ......................................................................... 7 Adults with Dementia and EAAT ................................................................................... 9 Need for the Study .................................................................................................................. 10 Aims and Research Questions of the Current Study ............................................................... 11 CHAPTER TWO: METHODS ..................................................................................................... 12 Research Approach ................................................................................................................. 12 Data Collection ....................................................................................................................... 15 Search Strategy and Data Management ............................................................................. 15 Inclusion and Exclusion Criteria ........................................................................................ 16 Data Extraction................................................................................................................... 18 Data Analysis .......................................................................................................................... 21 Coding Strategies ............................................................................................................... 21 Queries ............................................................................................................................... 24 CHAPTER THREE: RESULTS ................................................................................................... 26 Question One: Professionals Providing AAT ......................................................................... 26 Question Two: Description of Participants in AAT ............................................................... 27 Question Three: Description of Interventions Used in AAT .................................................. 28 Question Four: Description of Outcomes in AAT .................................................................. 31 Question Five: Description of Theorized Influences on Positive Change .............................. 34 CHAPTER FOUR: DISCUSSION ............................................................................................... 43 Application of Theoretical Models and Principles in Occupational Therapy to AAT ........... 44 Occupation-centered, Focused, and Based ........................................................................ 44 Person-Environment-Occupation (PEO) Model ................................................................ 46 Person ............................................................................................................................ 46 Environment .................................................................................................................. 48 Occupation .................................................................................................................... 50 Optimal Occupational Performance Related to Dementia-specific QoL ........................... 51 Implications for Occupational Therapy .................................................................................. 53 Limitations and Next Research Steps ................................................................................ 54 Future research opportunities for occupational therapy ................................................ 54 CHAPTER FIVE: SELF REFLECTION...................................................................................... 56 What I Learned ....................................................................................................................... 56 Areas for Growth .................................................................................................................... 57 Who I am as a Researcher ....................................................................................................... 57