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Protocol for an aviary – an antidote to loneliness

Background

Keeping birds in dementia care environments has become a popular and valuable way to enhance the life of people with dementia. A proposed aviary for the facility provides an important opportunity to give the residents a therapeutic, stimulating and enjoyable experience.


Birds and other pets have been associated with improvements in mood, more positive engagement in conversation, talking more, more activity and initiation of daily tasks, and better levels of sensory stimulation. These are signs of the effectiveness of birds in dementia care.


The person centred approach to dementia care is founded on the notion that the subjective experience of the person with dementia is the starting point from which we build a model of care. This means that the meaning a person with dementia gives to what they are doing is important for us to understand. Their emotional life, needs desires and preferences are the starting point for us to support and assist them to live life to the fullest possible. The are many ways this has been done around the world, perhaps the best known and well marketed embodiment of the person centred approach is the ‘Eden Alternative’.


The Eden Alternative, was developed by Dr Bill Thomas, a US geriatrician. It identifies three scourges of residential care: loneliness, boredom and helplessness. Integral to overcoming these problems is contact with the natural environment, part of which is living things such as plants and pets, such as birds.


Helplessness and boredom are overcome by utilizing birds as a source of interest and stimulation, and engaging residents in maintaining them. Birds need to be fed, cages cleaned and maintained. People with dementia are engaged to provide food and water, clean the cages regularly and maintain the birds in good health. The care assistants assist them to this as part of the regular life of their home. In this way the people who live there have an investment in the maintaining the wellbeing of something other than themselves. This interest in others is an important factor in sustaining life as is evident in research about the health benefits of pets for the elderly.


Loneliness is a problem in aged care settings and pets have a vital role in overcoming this lack of relationship and connection to others. We all need attachment to others and pets, particularly if they are visible and within touching or hearing distance enable older people to feel connected, in relationship. Many older people report that their pets keep them going, give them a reason for getting out of bed in the morning. This is true for people with dementia many of whom feel the dislocation of memory loss and the lack of familiar people in their lives. Birds in an aviary in their lounge room can be a marvelous source of attachment and an antidote to loneliness.


Birds have been used locally in Australia in many nursing homes and hostels. Chooks (chickens), parrots, budgies, canaries and finches have all found a valuable place in Australian dementia care. In one psychogeriatric unit a cockatiel flies freely throughout the unit landing on people’s heads and safely avoids their touch by flying off. The residents are gentle and feed it pieces of fruit and talk softly to it when it is free and also in its cage. It is a source of focus and attention throughout the day for most residents. This is vital in an environment that otherwise would be lacking in sensory or social stimulation.


Lifestyle program

The lifestyle program can include the activities of feeding the birds and cleaning the aviary. This can be an integral part of the life of the unit so that the residents are engaged and valued for what they can do and contribute, not just what they need staff to do for them. Of equal value are the moments when residents initiate the contact with the birds themselves and remind assistants that the birds need to be fed or express worry that a bird may be ill.


The activities should be written up in a planned manner and residents identified who may benefit from being ‘rostered’ to perform such activities or otherwise engaged by the birds. It is important to share these tasks around as there are likely to be more people then jobs to do. Food should be stored in plastic airtight containers to prevent rodents. Fruit and greens or other source of food as required (e.g., nectar) should be readily available for residents to give to birds or monitor.


This should be cleaned daily by residents as part of a daily activity program with staff providing accompaniment rather than doing it for them. It is vital that staff do not take over the roles but provide only the materials and assistance needed for the residents to successfully complete the tasks.


The activity program can be designed to include the birds in as many ways as possible. This can include:

  • Feeding (as above)

  • Cleaning (as above)

  • Learning about the birds (information sharing, finding information)

  • Looking at pictures of other birds

  • Touching the birds

  • Listening to the birds

  • Watching the birds

  • Reminiscing about birds: birds they have kept, childhood stories about birds, raising birds, killing birds, catching birds, finding birds eggs, keeping chooks.

  • Painting birds on paper, pottery

  • Using feathers from the birds and other birds

  • Making birds for decoration.

  • Making bird masks

  • If the birds breed: monitoring the progress of the eggs, chicks etc.


Imagination is the only limit to a vital program of stimulating activities originating with the birds.


Can the birds be kept outside and the program still be as successful. Probably but it will be a better program if the birds can be within hearing and sight of all residents, particularly those who are limited in their mobility and who need the sight of the birds to stimulate and engage them. Many resident will not think of going outside to see something that they cannot already see but they will go over to touch or listen to birds that they can see and hear.


What are the risks?

The risks are minimal. Birds kept in an aviary and not in direct contact with humans (ie not kissing, breathing or sneezing) do not generally carry disease that can be passed to humans.


Parrots (proposed) are generally flighty and reluctant to make physical contact with humans unless they are tamed. If they are tamed they are gentle and harmless and not likely to bite the person who approaches them. If they approach humans it will because they are tamed and likely only to approach to take fruit or other food.


“There’s something about pets that touch our older residents,” said Dr. Bowling, of Silverado, Utah, an Eden Alternative facility. “They create an opportunity for them to feel helpful. Residents here take the dogs out for walks and help feed the birds. This starts to send a message that they have a purpose, they have value.” Parrots will only bite if trapped and held and this is not likely to happen as the cage is locked and cannot be accessed. Also, older people do not have the dexterity or speed of reaction to entrap a flying parrot in an aviary.


The aviary that is proposed is sufficiently strong and broad in the base to prevent tipping over. If it was to be tipped over the birds are safe and will fly to prevent injury. Seed and water can be cleaned up in the usual way and the aviary returned to an upright position. The aviary is not so heavy as to cause injury to a person if it is tipped on to them. They are more likely to be injured by the fall.


Conclusion

The proposed aviary for The Facility has many benefits and few risks or difficulties that cannot be managed in the context of a planned and integrated approach. The unit staff are competent carers and the management is informed and knowledgeable about the usefulness of this asset. They have a plan for integrating the aviary into the provision of dementia care within the unit, particularly within the provision of opportunities for engagement and stimulation as provided by the lifestyle program. This will provide an important opportunity for the residents to enjoy the benefits of a person centred approach to care, an approach that places their wellbeing at the centre of the organization.



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