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Hands-On Care for Those in Later-Life Stages

By Ann Catlin, LMT, NCTMB, OTR

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The Role of Massage Therapy in Dementia Care

Our aging population is having a major impact on hospitals, nursing homes and hospice providers. Clinicians and front-line staff will serve more people over age 75 than any other age group and prevalence of dementia is being seen in every sector of senior services.

About one-quarter of all older hospital patients are people with dementia. People with dementia constitute about half of all nursing home and assisted-living facility residents. An estimated 15 million family and friends in the U.S. provided care to a loved one with dementia in 2013.

Federal and state initiatives aimed at changing dementia care are calling upon providers to integrate practical tools that create positive outcomes for elders with dementia and their caregivers. One such initiative strives to reduce unnecessary use of anti-psychotic medication by replacing or supplementing them with non-pharmacologic approaches and strategies.

The Role of Massage

At the core of each of these initiatives is human interaction. Care for people with dementia rests on relationships, underpinned by a strong evidence base. Massage is a powerful, yet under-utilized means to address the urgent need to find alternatives to medication to ease behavioral symptoms common to dementia.

Some forms of massage are evidence-based, relationship-centered, practical and pro-active. As a tool, massage can help establish holistic dementia care while helping providers meet regulatory requirements. Skilled human touch brings together the world of medical technology with the human side of care.

dementia care with massage - Copyright – Stock Photo / Register Mark Touch and Older Adults

Lack of human touch is real for the medically frail elder, leading to feelings of isolation, anxiety, poor trust in caregivers, insecurity and decreased sensory awareness. Older adults living with serious conditions are often especially receptive to touch. Unfortunately, they are least likely to receive expressive human touch from health care providers. Nursing students have been shown to experience anxiety about touching older patients. Yet elders report that touch communicates safety, care, reassurance and makes them feel more trust in caregivers.

Hand Massage

Since touching the hands is so familiar, hand massage may be gladly accepted by elders living with dementia. Even five-minutes of hand massage have been shown to elicit a physiological relaxation response and decreases cortisol levels. Cortisol is a stress hormone that is produced by the adrenal glands during prolonged stress and is often used as an objective marker of stress. When cortisol levels are lowered it enhances sleep quality and the immune system. Massage has also been shown to increase serotonin levels. Serotonin is a neurochemical that regulates mood; feelings of calm; and subdues anxiety and irritability.

A five or ten-minute hand massage protocol has resulted in:

  1. Significantly decreased agitation immediately and sustained the decrease for up to one hour.
  2. Decreased the frequency and intensity of agitated behavior during morning care routines.
  3. Strengthened the relationship between the person with dementia and their family care partner.

One study by Suzuki (2010) evaluated the effects of hand massage on physical and mental function and behavioral and psychological symptoms consistent hand massage protocol. Both aggressive behaviors and stress levels decreased significantly.

Slow-stroke Back Massage

Slow-stroke back massage uses effleurage, moving the palm of the hand in long, rhythmic, firm strokes. One method applies effleurage in a figure-eight formation on both sides of the back. Massage stimulates production of endorphins which are compounds produced by the body that suppress pain and uplifts mood. Massage also has a generalized effect on the autonomic nervous system, producing a relaxation response.

Three-to-five minute protocols have shown slow-stroke back massage to:

  1. Help people fall asleep.
  2. Decrease anxiety.
  3. Decrease physical expressions of agitation such as pacing, wandering and resisting care.
  4. Ease pain.
  5. Decrease blood pressure and heart rate indicating a physiological relaxation response.

Mok (2004) investigated the effect of slow-stroke back massage (SSBM) on anxiety and shoulder pain in hospitalized elderly patients who had suffered a stroke. The study compared scores for pain, anxiety, blood pressure and heart rate of two groups of patients. The intervention consisted of 10 minutes of slow-stroke back massage (SSBM) for seven consecutive evenings. The results revealed that the massage intervention significantly reduced the patients' levels of pain perception and anxiety and blood pressure and heart rate changed positively, indicating relaxation.

Foot Massage

Foot massage is considered "boundary-safe" and frail older adults may readily accept having their feet rubbed. Evidence reveals that foot massage:

  1. Induces deep relaxation.
  2. Alleviates anxiety.
  3. Eases pain and physical discomfort.
  4. Promotes sleep.
  5. Communicates support and comfort in palliative care.

Moyle (2011) explored the effect of a 10-minute foot massage on agitated behaviors in older people with dementia. The most common agitated behaviors observed in the research group were verbal aggression, wandering and repetitive movements. Results showed that daily foot massages reduced agitation after just two weeks, irrespective of gender. Changes were maintained for at least two weeks without massage.

Skilled, compassionate human touch helps ease physical, emotional and psychosocial distress that leads to behavioral symptoms of dementia and is a feasible intervention to curb the use of medication. When used proactively, elders experience greater satisfaction in their care. A hand massage, back massage or simply holding a person has the power to elicit positive, life-affirming feelings and responses. For the person with Alzheimer's, touch becomes a language of the human heart and a remembrance of his place in the world.

References:

  1. AHCA. 2013. "LTC Stats: Nursing Facility Patient Characteristics Report: June 2013 Update."
  2. Centers for Medicare & Medicaid Services (2014) Interim report on the CMS National Partnership to Improve Dementia Care in Nursing Homes. Baltimore, MD
  3. Montagu, A. (1986) Touching the Human Significance of the Skin. Harper and Row New York, NY.
  4. Field, T (2003) Touch. MIT Press Cambridge, MA.
  5. Fogarty, L. (1999) Can 40 Seconds of Compassion Reduce Patient Anxiety? Journal of Clinical Oncology Vol. 17 No. 1.
  6. Kuchinskas, S. (2009) The Chemistry of Connection: How the Oxytocin Response Can Help You Find Trust, Intimacy, and Love. New Harbinger Publications, 5674 Shattuck Ave, Oakland, CA 94609.
  7. Bush, E. (2001) The Use of Human Touch to Improve the Well-Being of Older Adults. Journal of Holistic Nursing Vol. 19 No.3 256-270.
  8. Fritz S. (2000) Fundamentals of Therapeutic Massage. Mosby Inc. St. Louis, MO.
  9. Field, T. et al. (2005) Cortisol decreases and serotonin and dopamine increase following massage therapy. International Journal of Neuroscience, Vol. 115 (10).
  10. Woods, D. et al. (2009) The effect of therapeutic touch on behavioral symptoms and cortisol in persons with dementia.
  11. Snyder M. et al. (1995) Efficacy of Hand Massage in Decreasing Agitation Behaviors Associated with Care Activities in Persons with Dementia. Geriatric Nursing March/ April 60-63
  12. Kilstoff, K. et al. (1998) New Approaches to Health and Well-being for Dementia Day-Care Clients, Family Carers, and Day-care Staff. International Journal of Nursing Practice 4 70-83 in Vanderbilt S (2000) It's Never Too Late to Touch: Massage Emerges as a Lifeling to Dementia Patients. Massage and Bodywork June/July 140-144.
  13. Suzuki, M. et al. (2010) Physical and Psychological Effects of 6-Week Tactile Massage on Elderly Patients with Severe Dementia. American Journal of Alzheimer's disease and Other Dementias.
  14. Harris, M. et al. (2010) The physiological and psychological effects of slow-stroke back massage and hand massage on relaxation in older people. Journal of Clinical Nursing Vol. 19.
  15. Mok, E. (2004) The effects of slow-stroke back massage on anxiety and shoulder pain in elderly stroke patients. Complementary Therapies in Nursing and Midwifery Volume 10, Issue 4, 209–216.
  16. Moyle, W. (2011) Exploring the effect of foot massage on agitated behaviours in older people with dementia: A pilot study. Australasian Journal on Ageing Vol. 30 159–161
  17. Won, J. (2002) Effect of Foot Massage on Sleep, Vital Sign and Fatigue in the Elderly who live in their Home. Journal of Korean Academic Fundamentals of Nursing Vol. 9 No.3 513-523.
  18. Puthusseril, V. (2006) Special foot massage as a complementary therapy in palliative care. Indian Journal of Palliative Care Vol. 12 No. 2, 71-76.
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