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Hands-On Care for Those in Later-Life Stages

By Ann Catlin, LMT, NCTMB, OTR

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Connecting and Expressing a Language of the Human Heart

There is growing awareness of the value of massage for people living with Alzheimer's disease and related dementia. Anyone caring for someone with dementia is faced with the challenge of guiding the person who is confused or agitated, while at the same time assisting with personal care, mobility and other functional tasks.

Touch has the power to enhance physical, emotional and spiritual well-being. A hand massage elicits positive, life-affirming feelings and responses. Hands reflect the landscape of a person's life and when you touch someone's hands with compassion and sensitivity, you acknowledge their whole life experience. For caregivers, touch becomes a language of the human heart.

Evidence suggests that hand massage can go a long way in helping people with dementia feel calmer and more connected with others and their immediate environment. Suzuki (2010) explored the effects of hand massage on physical and mental function and behavioral and psychological symptoms among elderly patients with dementia. The group received a consistent hand massage protocol a total of 30 times each for 20 to 30 minutes between 4p.m. and 5p.m. Both aggressive behaviors and stress levels decreased significantly.

Suggested Protocol

The only essential supply is massage lotion. A standard -size pillow and hand towel is also used in this protocol. While a pillow adds comfort, it isn't absolutely necessary in order to provide a soothing hand massage.

Center yourself and take a cleansing breath to focus your attention and intention. Take a moment to establish trust with the elder and gain permission to provide the massage. Sit facing the person, to the side. Be sure that you can reach the shoulder area without strain. A simple way to add comfort is to place one end of the pillow under the person's arm which provides support for the massage and creates a connection between the two of you. Cover the pillow with a hand towel to keep the pillowcase clean.

hand massage - Copyright – Stock Photo / Register Mark Begin with focused touch; simply hold the person's hand. Place your attention on their hand and think about all the ways their hands have served their life. Notice the lines, the elegance, the strength or the fragility, whatever is there. Linger here a moment, simply enjoying the connection.

Technique Application

Apply massage lotion to the hand. If the person has on long sleeves, push the sleeve up a little to expose the forearm.

Open the palm. Access the palm by reaching around the hand from above to gently squeeze and spread the palm. This softens and warms the hand, preparing it for the finer strokes that follow. Turn the hand onto its side with palm facing center. Using the palm of your own hand, apply broad circles into the palm, using your other hand as support.

Turn the hand palm up. Provide thumb circles on the palm, covering the entire surface inch by inch, with a slow, rhythmic motion. You may be able to apply a little more pressure to the fleshy areas of the palm base of thumb and outer edges.

hand massage - Copyright – Stock Photo / Register Mark Grasp each finger near its base between your thumb and index finger and spiral them around, moving from the base to the tip. The flowing stroke provides a soothing touch to the entire arm as a way to close the hand massage. Place both your hands on the shoulder and gently glide your hands down the arm and off the tips of the fingers. Repeat by starting again at the shoulder. The stroke is only moving down the arm. This touch is with full-contact, fingers relaxed as you flow your hands along the arm.

Repeat sequence on the other hand and arm.

A Case Study

Mary was an 81-year-old woman with Alzheimer's disease. She experienced anxiety, restlessness and insomnia. She required a wheelchair because she no longer was able to safely ambulate and had fallen several times. She had difficulty communicating which frustrated her. She sometimes yelled out and banged on her wheelchair. She attended group activities, but the yelling and banging was upsetting to the others and she often was removed from the group. She spent much of her time alone in her room.

I saw Mary for sessions twice a week. Sessions took place in her room while she was sitting in her wheelchair. Each session lasted 20 to 30 minutes and typically took place in the morning before lunch. Mary was receptive to having her hands massaged and she seemed to enjoy the attention of a visitor. I used a hand and arm massage protocol similar to the one described above.

After three weeks, the Activity Director told me that Mary was able to remain in more group activities without disruptive yelling or banging behavior. This resulted in more opportunities for social interaction for Mary. After six weeks, I demonstrated a simple hand massage technique that the staff could use in addition to our continued sessions. The nurse reported that Mary was less restless and that she slept better at night. The overall impact of our sessions was an increase in the quality of life for Mary and decreased stress for the staff.

Compassionate, skilled touch has specific therapeutic applications in dementia care. Human touch eases distress while fostering positive relationships. In his book, Dementia Beyond Drugs, Dr. Allen Power agrees: "Modalities like massage ... can provide a balm for anyone who is in need of more human connection." I will confess that I have occasionally ordered moisturizing creams twice as often as needed for people with dementia who are disengaged merely to increase the frequency of hands-on contact.

References:

  1. Simington, Jane, RN, PhD (1995) The Power of Expressive Touch Humane Medicine Journal, Vol. 11 No. 4.
  2. 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, December, Vol. 25 no. 8, 680-686
  3. Power, A (2010), Dementia Beyond Drugs. Health Professions Press, Baltimore, MD.
  4. 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
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