ArticlePDF Available

Effect of therapeutic touch on agitated behavior in elderly patients with dementia: A review

Authors:
Review
Effect of therapeutic touch on agitated behavior in
elderly patients with dementia: A review
Fei-Fei Cai
a
, Hong Zhang
b,*
a
Nursing Department, Liyuan Hospital of Tongji Medical College of Huazhong University of Science & Technology,
Wuhan, China
b
Public Health Department, Liyuan Hospital of Tongji Medical College of Huazhong University of Science &
Technology, Wuhan, China
article info
Article history:
Received 5 June 2015
Received in revised form
12 July 2015
Accepted 27 July 2015
Available online 9 October 2015
Keywords:
Therapeutic touch
Aged dementia
Agitation
Literature review
1. Introduction
The recent increase in life expectancy in China is also leading
to an increased incidence of dementia. Dementia is a com-
mon, chronic, organic disease, which manifests extensive
degenerative changes in the brain. In addition to cognitive
dysfunction, people with dementia often have additional
mental and/or behavioral symptoms, including verbal or
physical aggression, wandering, hiding, shouting, hallucina-
tions and paranoia; the most common and destructive of
these is agitated behavior [1]. Foreign studies have shown that
the prevalence of agitated behavior in elderly demented pa-
tients is 70e90% [2]. In China, the incidence of elderly
demented patients with agitated behavior living at home or in
nursing institutions was 86.1% and 90.8%, respectively [3].
Agitated behaviors increase nursing expenses and hospitali-
zation rate, as well as increase caregiver burden, and lead to
the patients being admitted to nursing institutions earlier
than they would in the absence of these behaviors [4e6].
The treatment of agitated behavior can be divided into two
types: one is drug intervention based on the biomedical
model, and the other is non-drug intervention based on pa-
tient [7]. However, currently, drug interventions are limited,
have low efficacy, and are often accompanied with numerous
and undesirable side effects, including increased mortality,
increased incidence of a cerebrovascular event, and the ac-
celeration of cognitive decline [1]. Non-drug interventions
focus on trying to improve agitated behaviors in patients with
dementia by fully considering the needs of the patients [8,9].
Therapeutic touch (TT) is one of the non-drug in-
terventions that has been widely used in other countries to
treat elderly demented patients with agitated behavior, both
in clinical practice and research settings, with remarkable
results [10e19]. The concept of TT was first introduced in
China in 1995, and has since been widely used on infants,
especially for newborn care and medical research [20e24],as
well as in the study of preoperative anxiety, postoperative
pain and sleep disorders on adults. However, intervention
studies on elderly demented patients with agitated behavior
have not previously been studied in China. Therefore, we
aimed to review the literature from foreign researchers on the
impact of TT intervention on elderly demented patients with
*
Corresponding author.
E-mail address: yifuxinrei@126.com (H. Zhang).
Peer review under responsibility of Chinese Nursing Association.
HOSTED BY
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: http://www.elsevier.com/journals/international-
journal-of-nursing-sciences/2352-0132
international journal of nursing sciences 2 (2015) 324e328
http://dx.doi.org/10.1016/j.ijnss.2015.08.002
2352-0132/Copyright © 2015, Chinese Nursing Association. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
agitated behavior to provide a reference for enhancing the
nursing environment in China for both the patients and
caregivers.
2. Agitation in elderly demented patients
and therapeutic touch as a treatment
2.1. Agitation
2.1.1. The concept of agitation
Agitated behavior is characterized by inappropriate verbal,
vocal, or motor activity that is not judged by an outside
observer to result directly from perceptible needs or confusion
of the agitated individual [25]. Agitation in persons with de-
mentia is manifested in a wide variety of verbal and physical
behaviors that deviate from social norms, including irrelevant
vocalizations, screaming, cursing, restlessness, wandering,
strange movements, and handling things inappropriately [26].
2.1.2. The types of agitation
Depending on the expressive characteristics, agitated
behavior can be divided into two dimensions: aggressive vs.
non-aggressive, and physical vs. vocal/verbal. Specifically,
agitation includes four categories: (1) physically non-
aggressive (inappropriate dressing and/or disrobing, inap-
propriate eating or drinking, exit seeking behaviors, handling
things, hiding things, hoarding, pacing, repetitious manner-
isms, and restlessness); (2) physically aggressive (biting,
grabbing, hitting, hurting oneself or others, falling intention-
ally, kicking, physical sexual advances, pushing, scratching,
spitting, tearing things, and throwing things); (3) verbally non-
aggressive (attention-seeking behaviors, complaining, nega-
tivism, and repetitive sentences or questions); and (4) verbally
aggressive (cursing, making strange noises, screaming, and
verbal sexual advances) [27].
2.2. Therapeutic touch
2.2.1. The concept of therapeutic touch
In the early 1970s, Dolores Krieger and Dora Kunz first
described TT, defined as an intentionally directed process in
which the practitioner uses the hands as a focus to facilitate
the healing process [28]. TT is a treatment method that fuses
both ancient medicine and modern technology, and involves
an energy exchange between the implementer and a service
object. The emphasis is on creating a balance in the whole
body instead of focusing only on abnormal functional sites
[29], with the intent of speeding up the recipient's healing
process by restoring harmony and balance to their energy
system.
2.2.2. The types of therapeutic touch
TT includes three types: caring touch, protective touch, and
task touch [30]. Caring touch is defined as physical contact
outside the domain of the nurses' procedural tasks, such as
face touching, head touching, hand-holding, placing an arm
around the client's shoulders, and/or the placement of the
nurse's hand on the client's arm or hand. Protective TT is
employed as a means of emotionally and physically protecting
both the client and the nurse, such as the use of physical re-
straint and control, helping the patient relax, thereby
increasing the potency of the drug. This type of touch is geared
at older adults who are cognitively impaired and those who
have psychiatric diagnoses. Task touch is the physical contact
that is incidental to client care procedures.
2.2.3. The mechanism of therapeutic touch
A previous study found that patients will subconsciously
stimulate the system after they have received TT, which
triggers the release of enkephalin and endogenous hormone
[23]. The physiological role of these two endogenous chem-
icals acts similar to morphine by easing pain locally, as well as
acting through the endocrine system to increase the thera-
peutic effect throughout the body. Currently, the mechanism
of TT intervention on elderly demented patients with agitated
behaviors is still in the exploration stage. One possible
explanation for its effectiveness may be that TT excites the
nociceptive pathways in patients, helping the patient relax
mentally and physically, thereby ameliorating the agitation.
2.2.4. The use of therapeutic touch as a treatment
Since the 1950s, the benefits of TT have been widely recog-
nized in the United States. The United States has even set up a
TT certification program that has been approved by the
American Holistic Nurses Association. Studies have shown
that TT can not only relieve pain and anxiety, promote pa-
tients to relax, and improve the quality of life, but it can also
help treat some diseases by enhancing immune function [31].
3. Review of literature on the effects of
therapeutic touch on elderly demented patients
with agitated behavior
3.1. Therapeutic touch promotes relaxation and
alleviates the symptoms of agitation
Restlessness is one of the most frequent and disturbing be-
haviors experienced by patients with dementia, and it is the
outward manifestation of patients' inner tension [10]. There-
fore, taking effective measures to relieve that restlessness is
extremely important when trying to decrease patients'
agitated behavior. In a 2009 study by Woods et al., researchers
examined the effect of therapeutic touch on agitated behavior
among 65 nursing home residents using a double blind
experimental interrupted time series ABAB design [10]. The
practitioner delivered the intervention according to a specific
protocol that began with a mental intention to therapeutically
assist the participant, followed by centering (quieting) by the
practitioner. The practitioner then focused her attention on
the participant and concentrated on the wholeness of the
person with dementia. Standing behind the person, the
practitioner then used contact TT, resting her hands on the
participant's shoulders, and performing a series of gentle
movements (down, then up the back, up the neck, and behind
the ears) and rested one hand on the forehead while making
contact with the back of the neck with the other hand. At the
end of the session, the practitioner again rested her hands on
the participant's shoulders and directed thoughts of balance
international journal of nursing sciences 2 (2015) 324e328 325
toward the participant. TT was delivered twice a day for three
days at the same time each day (between 10:00 and 11:30 a.m.
and 3:00 and 4:30 p.m.). The intervention lasted 5e7 min.
During the study, behavior was observed and recorded every
20 min for 10 h per day from 8:00 a.m. until 6:00 p.m. Research
assistants with fiveeeight years experience performed the TT
intervention. A modified Agitation Behavior Rating scale
(mABRS) was used to measure the frequency and intensity of
agitated behavior. This study found that restlessness was
significantly reduced in the experimental group compared to
the control group (p ¼ 0.03), and suggests that therapeutic
touch may be effective for management of symptoms like
restlessness. In a separate prospective study conducted by
Holliday-Welsh et al. researchers tested the effect of TT
intervention on agitated behavior in 54 cognitively impaired
residents in a nursing facility [11]. Data was collected for three
days to establish a baseline, for six days during the interven-
tion, and again at a follow-up at XX. Five aspects of agitation
were assessed: wandering, verbal agitation or abuse, physical
agitation or abuse, socially inappropriate or disruptive, and
resisting care. The type of TT used in this study is defined
under classic Western massage techniques. Lotion was used
in some instances to reduce the friction between the hands
and the skin. The primary areas of the body massaged for this
study were the upper extremities, including head, shoulders,
and hands, and subjects remained clothed during the inter-
vention. In this study, the TT intervention was provided by a
physical therapy assistant trained in TT techniques. At each
observation, agitation was scored five times during the one-
hour window of observation. The subjects' agitation was
lower during the TT intervention than at baseline, and
remained lower at follow-up. Of the five agitated behaviors
examined in this study, TT was associated with significant
improvement for four of them, including wandering, verbal
agitation or abuse, physical agitation or abuse, and resisting
care. In this study, they found that decreased levels of agita-
tion persisted at seven and fourteen days following the TT
interventions. We believe that this long-term effect may have
been mediated by the presence of the observer recording the
level of agitation at follow-up.
Previously, Azermai et al. made a systematic review non-
pharmacological interventions about TT on agitated
behavior respectively in elderly patients with dementia and
use the language of love and encouragement, which will help
patients feel relaxed and decrease agitated behavior [12,13].
This is consistent with the findings of the previous studies
[14]. Collectively, these studies indicate that TT can promote
relaxation and alleviate the symptoms of agitation.
3.2. Therapeutic touch improves daily behavior and
cognitive function, as well as improves quality of life
The agitated behaviors expressed in elderly demented pa-
tients affect their daily behavior and cognitive function, hin-
dering daily activities and relationships, and making family
members and caregivers feel helpless and angry [15]. Ulti-
mately, this can decrease their quality of life. Rodrı´guez-
Mansilla et al. performed a controlled, randomized longitu-
dinal study that included one hundred twenty elderly subjects
with dementia institutionalized in residential homes in
Extremadura (Spain) [16]. These patients received treatment
based on TT and ear acupuncture over three months. Behavior
alterations, sleep disturbances, and participation in rehabili-
tation and eating were assessed every month during the three
months of intervention, and again at follow-up one and two
months after the end of treatment. The TT therapy group
received a relaxing TT by a physiotherapist every day from
Monday to Friday. The TT was applied in the back and lower
limbs for 20 min. The TT techniques used were superficial
effleurage and deep kneading with moisturizing cream. The
study was performed over five months, with three months of
experimental treatment and two months with no treatment.
Both TT and ear acupuncture positively affected on measured
variables (such as participation in therapy and eating) in the
third month of intervention when compared to the control
group (p < 0.001), and these benefits were maintained two
months after completing the treatment (p < 0.021). A separate
study by Hansen et al. also found that hand TT for the im-
mediate or short-term can reduce agitated behavior, and the
addition of touch to verbal encouragement to eat can
normalize nutritional intake [17].
In another study, Moyle et al. examined the effect of TT for
four weeks on patients with a diagnosis of dementia and a
history of clinically significant agitation [18] .For this study, 17
men and 5 women (mean age 84.7 years) received a 10-
min foot TT each day for 14 days. The intervention method
was as follows: trained TT therapists provided participants
with a standardized 5-min TT on each foot, once a day, for 14
days. All TTs were conducted between 1 pm and 6 pm. Light
pressure TT with long, gliding, rhythmical strokes of the
entire foot and ankle was used. Unscented sorbolene was
applied as a lubricant for the TT. Agitation and related
behavioral problems were assessed three times in the study,
once as a baseline before TT, immediately following the end of
the two week TT treatment phase (posttest), and two weeks
after the cessation of TT therapy (two week follow-up).
Assessment was conducted using the short form of the
Cohen-Mansfield Agitation Inventory (CMAI-SF), and the
Revised Memory and Behavior Problems Checklist (RMBPC).
The result shows that CMAI-SF and RMBPC scores were
significantly reduced at the posttest and remained signifi-
cantly lower than baseline at the follow-up. This study pro-
vides preliminary evidence suggesting that limited short-
duration foot TT reduces agitation and related behavioral
problems in people with dementia, and that these behavior
changes are maintained after the TT ceases.
Suzuki et al. performed a controlled, randomized trial to
clarify the effects of a 6-week TT on changes in physical and
mental function, symptoms of behavioral and psychological
symptoms of dementia (BPSD) among elderly patients with
dementia [19]. A TT group consisting of elderly patients with
dementia received TT therapy a total of 30 times each for
about 20 min between 4 p.m. and 5 p.m. In the control group,
the mean scores for intellectual and emotional function
score decreased significantly after six weeks (p < 0.05); how-
ever, no change was observed in the TT group. These data
suggest that TT can protect patients' cognitive function, and
delay the process of its decline. Livingston et al. systematically
reviewed the evidence for clinical effectiveness and cost-
effectiveness of non-pharmacological interventions for
international journal of nursing sciences 2 (2015) 324e328326
reducing agitation in dementia [15]. The review found that the
differences in the scores for agitation behaviors, daily
behavior, cognitive ability and quality of life in patients who
have received TT as compared to controls are statistically
significant. They concluded that TT has a positive impact on
the lives of the dementia patients. Importantly, it is a non-
invasive and non-pharmacological intervention that is easy
to learn, easy to implement, and easy to be grasped by nurses
and family members of patients, and therefore, can be widely
used in clinical practice.
4. Reflections and prospects
Our research on the application of TT intervention for the
treatment of agitated behavior in Chinese patients with de-
mentia is still in its infancy. Currently, a big gap exists be-
tween what we can do in China as compared with other
countries, in both theoretical verification and practical
exploration. A major hurdle for this treatment is embedded in
the Chinese culture. As a nation, the Chinese are not good at
using body language to express kindness, and physical con-
tact with a stranger is easily misunderstood as a sexual in-
nuendo, which can easily cause resentment. Both nurses,
patients and their families will find it very difficult to accept
this form of treatment psychologically, and therefore it will be
difficult to implement in clinical practice.
Other additional hurdles exist before we will be able to
implement TT as a treatment for dementia. One major hurdle
is the belief of many people that dementia is a natural phe-
nomenon of aging, and therefore the mental or behavioral
abnormalities in elderly patients with dementia are often
misunderstood. The first inclination of many families is to
ignore the initial symptoms of cognitive function decline,
blaming verbal or behavioral abnormalities, such as name-
calling, suspicion, possession of garbage, etc., on quirks or
send them to a mental institution to be given antipsychotic
treatment. Unfortunately, this treatment will worsen the
symptoms of dementia. Another hurdle is that even when the
patient is diagnosed with dementia, some families will take a
negative attitude towards the treatment, decreasing the effi-
cacy of the treatment and increasing the symptoms in these
patients. The last hurdle that must be overcome is that it is
very difficult for non-specialist doctors to make a correct
diagnosis of dementia, which causes a high rate of missed
diagnosis.
Currently, research on the effect of TT on agitated behavior
in elderly demented people is rare, and this means that there
is a lack of relevant evidence-based research, which in turn
limits the implementation and promotion of the therapy.
According to the figures, the prevalence rate of people in
China with dementia over the age of 60 years is about 5%, over
65 years is 5e10%, over 65 years is 20e50% [32]. Faced with an
increasing number of elderly demented people, it is very
necessary to carry out related research on TT to control
agitation behaviors. The development of TT intervention will
hopefully not only effectively improve the quality of life of
patients and help them live with dignity until the end of life,
but it will also reduce caregiver burden, the rate of hospitali-
zation and save medical resources. Fortunately, more and
more people have recognized these benefits and have started
to give TT more attention.
In the future, we should focus on learning from previous
advances f rom other countries, and be mindful of th e
shortcomings of this research. When we select samples, we
should follow the inclusion and exclusion criteria rigorous ly
to improve the consistency of elderly patients with de-
mentia in type, degree and other aspects in order to control
for confounding factors. We should also expand the sample
size appropriately and use a double-blind design to enhance
the statistical power. We can carry out randomized
controlled trials to provide more evidence for clini cal prac-
tice. We should in crease th e implementation of our findings
based on our national condition, such as accelerat ing the
construction of China's elderly specialist care and specific
key nursing specialties. We can encourage and sponsor
research on the appli cation of relevant theory and pr actice
by elderly care personnel. We can laun ch knowledge lec-
tures and skills training on TT to improve their skills for
clinical nursing staff. We should strengthen the propaganda
and guidance to gradually change people'straditional
concept of dementia by raising the public's awareness o f
disease prevention and treatment of dementia. With these
measures taken simultaneously, we believe we will get good
results.
Conflict of interest
We declare no potential conflicts of interest with respect to
the research and/or publication of this article.
references
[1] Brodaty H, Arasaratnam C. Meta-analysis of
nonpharmacological interventions for neuropsychiatric
symptoms of dementia. Am J Psychiatry 2012;169(9):946e53.
[2] Seitz DA, Purandare N, Conn D. Prevalence of psychiatric
disorders among older adults in long-term care homes: a
systematic review. Int Psychogeriatr 2010;22(7):1025e39.
[3] Wang Z, Xiao S, Liu Y, Li N, Xiao J. A study of agitation in
dementia elders. Chin Gen Pract 2003;6(5):397e9.
[4] Husebo BS, Ballard C, Aarsland D. Pain treatment of agitation
in patients with dementia: a systematic review. Int J Geriatr
Psychiatry 2011;26(10):1012e8.
[5] Cohen-Mansfield J. Agitated behavior in persons with
dementia: the relationship between type of behavior, its
frequency, and its disruptiveness. J Psychiatric Res
2009;43(1):64e9.
[6] Hulme C, Wright J, Crocker T, Oluboyede Y, House A. Non-
pharmacological approaches for dementia that informal
carers might try or access: a systematic review. Int J Geriatr
Psychiatry 2010;25(7):756e63.
[7] Dewing J. Responding to agitation in people with dementia.
Nurs Older People 2010;22(6):18e25.
[8] Zhang R, Li Z. The research advances in nonpharmacologic
intervention on agitation of senile dementia. Int J Nurs Sci
2006;41(6):553e6.
[9] Cohen-Mansfield J. Nonpharmacologic treatment of
behavioral disorders in dementia. Curr Treat Options Neurol
2013;15(6):765e85.
international journal of nursing sciences 2 (2015) 324e328 327
[10] Woods DL, Beck C, Sinha K. The effect of therapeutic touch
on behavioral symptoms and cortisol in persons with
dementia. Forsch Komplement Med 2009;16(3):181e9.
[11] Holliday-Welsh DM, Gessert CE, Renier CM. Massage in the
management of agitation in nursing home residents with
cognitive impairment. Geriatr Nurs 2009;30(2):108 e 17.
[12] Raetz J. A nondrug approach to dementia. J Fam Pract
2013;6(10):548e57.
[13] Azermai M, Petrovic M, Elseviers MM, Bourgeois J, Van
Bortel LM, Vander Stichele RH. Systematic appraisal of
dementia guidelines for the management of behavioural and
psychological symptoms. Aging Res Rev 2012;11(1):78e86.
[14] Jain S, Mills PJ. Biofield therapies: helpful or full of hype? A
best evidence synth esis. Int J Behav Med 2010;1 8(1):79e82.
[15] Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S,
Patel N, et al. A systematic review of the clinical
effectiveness and cost-effectiveness of sensory,
psychological and behavioural interventions for managing
agitation in older adults with dementia. Health Technol
Assess 2014;18(39):1e226.
[16] Rodrı´guez-Mansilla J, Gonz
alez-L
opez-Arza MV, Varela-
Donoso E, Montanero-Fern
andez J, Jim
enez-Palomares M,
Garrido-Ardila EM, et al. Ear therapy and massage therapy in
the elderly with dementia: a pilot study. J Tradit Chin Med
2013;33(4):461e7.
[17] Hansen NV, Jørgensen T, Ørtenblad L. Massage and touch for
dementia. Cochrane Database Syst Rev 2006;18(4):81e5.
[18] Moyle W, Johnston AN, O'Dwyer ST. Exploring the effect of
foot massage on agitated behaviours in older people with
dementia: a pilot study. Australas J Aging 2011;30(3):159e61.
[19] Suzuki M, Tatsumi A, Otsuka T, Kikuchi K, Mizuta A,
Makino K, et al. Physical and psychological effects of 6-week
tactile massage on elderly patients with severe dementia.
Am J Alzheimers Dis Other Demen 2010;25(8):680e6.
[20] Liu B, Wang M. Effect of therapeutic touch on preoperative
anxiety in patients with sinus surgery. J Nurs Sci
2011;26(4):67e8.
[21] Lai M, Zhou Y, Zhang Y. Therapeutic touch applied to pain
control after transcatheter arterial chemoem bolization of
liver cancer. Int J Nurs Sci 2006;41(3):198e201.
[22] Deng T, Wang Y, Sun M. Application of therapeutic touch in
CPAP titration night with obstructive sleep apnea syndrome
patients. Chin J Pract Nurs 2012;28(35):22e4.
[23]
Xu S, Sun Y, Wu H. Effects of therapeutic touch on the
intraoperative pain in patients undergoing percutaneous
laser disk decompression. Int J Nurs Sci 2009;44(8):750e1.
[24] Liu Y, Liu Y. Influence of touching in neonatal
gastrointestinal motility. Chin J Misdiagnost
2010;10(5):1029e30.
[25] Cohen-Mansfield J, Thein K, Marx MS. Predictors of the
impact of nonpharmacologic interventions for agitation in
nursing home residents with advanced dementia. J Clin
Psychiatry 2014;75(7):666e71.
[26] Cohen-Mansfield J, Marx MS, Dakheel-Ali M, Thein K. The
use and utility of specific nonpharmacological interventions
for behavioral symptoms in dementia: an exploratory study.
Am J Geriatr Psychiatry 2015;23(2):160e70.
[27] Hawranik P, Johnston P, Deatrich J. Therapeutic touch and
agitation in individuals with Alzheimer's disease. West J
Nurs Res 2008;30(4):417e34.
[28] Monzillo E, Gronowi cz G. New insights on therapeutic touch:
a discussion of experimental methodology and design that
resulted in significant effects on normal human cells and
osteosarcoma. Explore (NY) 2011;7 (1):44e51.
[29] Monroe CM. The effects of therapeutic touch on pain. J Holist
Nurs 2009;27(2):85e92.
[30] Chang SO. Meaning of Ki related to touch in caring. Holist
Nurs Pract 2001;16(1):73e84.
[31] Chang SO. The nature of touch therapy related to Ki:
practitions' perspective. Nurs Health Sci 2003;5(2):103e14.
[32] Zhou Z, Zhou L. A control study of educational intervent ion
on the mental health of caregivers of senile dementia
patients. Zhejiang J Prev Med 2011;23(2):79e81.
international journal of nursing sciences 2 (2015) 324e328328
... Krieger menggambarkan perubahan ini sebagai respons ketenangan cepat yang biasanya dibuat pada menit pertama akibat aktivasi sistem saraf otonom, dan ditandai dengan penurunan tekanan darah, penurunan laju pernapasan, penurunan denyut nadi, dan rileks sistem saraf tepi. TT memicu pelepasan enkephalin dan hormon endogen dan sebagainya itu mengurangi rasa sakit dengan berperilaku seperti morfin (Cai & Zhang, 2015), sehingga melalui jalur ini pula pemberian TT akan memberikan efek pada tekanan darah. TT direkomendasikan sebagai metode yang memiliki ekstensi berpotensi untuk menimbulkan relaksasi fisiologis pada pasien (C. ...
Article
Full-text available
ABSTRAKPengukuran tekanan darah merupakan suatu komponen penting dalam penatalaksanaan hipertensi. Secara umum penatalaksanaan hipertensi di Fasilitas Kesehatan Tingkat I di Indonesia masih berfokus pada edukasi perubahan pola hidup dan pemberian terapi farmakologi, belum menerapkan pemberian terapi komplementer untuk menunjang efektifitas terapi farmakologi. Therapeutic touch (TT) merupakan salah satu terapi komplementer jenis terapi energi yang telah dibuktikan memberikan pengaruh yang baik pada kesehatan. Tujuan penelitian ini adalah untuk menguji pengaruh pemberian TT terhadap tekanan darah sistolik (TDS) dan tekanan darah diastolik (TDD) penderita hipertensi. Jenis penelitian ini adalah eksperimen dengan desain pre-post test nonequivalent control group design. Responden penelitian adalah penderita hipertensi di Wilayah Kabupaten Sumenep yang memenuhi kriteria inklusi penelitian. Sampel didapatkan secara consecutive sampling (n=39), selanjutnya dibagi menjadi 2 kelompok, yaitu kelompok kontrol (n=19) dan kelompok perlakuan (TT) (n=20). Pengumpulan data dilakukan selama 3 hari pada siang dan malam hari yang meliputi pretest (T0) dan post-test (T1 dan T2). Uji T independen TDS siang T0 antara kelompok kontrol dan TT didapatkan nilai p=0,152. Uji T independen dengan hasil signifikan (p?0,05) ditemukan pada TDS malam T1 (p=0,026), TDS siang T2 (p=0,032), dan TDS malam T2 (p=0,026). Hasil uji komparatif 2 kelompok berpasangan kelompok TT dengan menggunakan Paired T Test didapatkan nilai signifikan hanya pada perbandingan TDD malam T0 dan TDD malam T1 (p=0,022 ? 0,05). Pada kelompok TT, rerata TDS siang T2 menurun dibandingkan TDS siang T1 (?= 4,2 mmHg), rerata TDS malam T2 juga menurun dibandingkan TDS malam T1 (?= 0,45 mmHg). TT memberikan pengaruh penurunan TDS dan TDD pada hari diberikan intervensi (T1) dan hari berikutnya (T2), akan tetapi hasil statistik secara keseluruhan tidak signifikan kecuali pada perbandingan antara TDD malam T0 dan TDD malam T1. Penurunan tekanan darah setelah intervensi TT terjadi secara perlahan dan bertahap selama dua hari sejak diberi intervensi, tidak memberikan efek penurunan yang besar dan drastis.Kata Kunci: therapeutic touch, terapi sentuh, tekanan darah, hipertensi, terapi energi
... 12 TT has positive psychological effects such as creating a sense of trust in the patient, strengthening spiritual care, and increasing patient-nurse interaction. [13][14][15] Through touch, messages such as closeness, care, trust, courage, warmth, sincerity, compathy, respect, support, understanding, acceptance, willingness to help, and spiritual power are transferred to patients. 10 When the relaxation effect is stimulated by TT, it can activate the reduction of the stimulation in the gate control mechanism, thus increasing the relaxation and tendency to sleep in the individual. ...
Article
Full-text available
Purpose This study was conducted to investigate the effect of therapeutic touch (TT) on spiritual care and sleep quality in patients receiving palliative care. Design and Methods The research was conducted on 73 inpatients receiving palliative care in a training and research hospital. Data were collected with Socio‐Demographic Status Questionnaire, Spirituality and Spiritual Care Rating Scale (SSCRS), Pittsburgh Sleep Quality Index (PSQI). Findings As a result of this study, a statistically significant difference was found between the intervention and control group SSCRS (Z = −7.356 p = 0.000) and PSQI (Z = −7.292 p = 0.000) in post‐test data after 4 weeks of TT application. Practice Implications The results revealed that TT application has a positive impact on spiritual care and sleep quality of the patients.
... The effects of therapeutic touch on nursing home residents have been studied. Recent systematic reviews conclude there is insufficient evidence in favour of massage and touch interventions for long-term effects, but therapeutic touch interventions have proven to reduce restlessness and stress in nursing home residents during the intervention(Livingston et al., 2014;Hansen et al., 2006;Cai and Zhang, 2015;McFeeters et al., 2016;Wu et al., 2017). Touch is reciprocal:Nicholls et al. (2013) reported that seeing the person with dementia relaxed and content because of an everyday touch produced a similar impact on those close by. ...
Thesis
Full-text available
In the Netherlands, when you are no longer able to live by yourself due to psychogeriatric problems, chronic physical conditions caused by old age or a combination of both, you are likely to move to a nursing home. For over 10 years now, emotion-oriented care is the guiding philosophy in most Dutch nursing homes. Although challenges remain, elderly care in the Netherlands is very good when compared to the rest of the world (J. Schols & Swelsen, 2019; J. M. Schols, 2008). In spite of all the benefits of emotion-oriented care, there’s still inactivity and boredom among nursing home residents during time in between activities (den Ouden et al., 2015) and a general lack of cultural activities within nursing homes. Most leisure technology in the nursing home is therapy: goal or activity-oriented and game-like. Although these games and activities are beneficial and fun for residents, they need intensive guidance from professionals and are planned on a fixed moment of the day. Open-ended interactive digital artworks might provide an addition to the spectrum of emotion-oriented care technology that creates the needed conditions for a personal experience to take place. Specifically, interactive artworks that are accessible at all times that can be enjoyed by residents on their own or together with somebody else, without the help of a professional caregiver are desired. It was therefore the main aim of this thesis to explore the potential of interactive art as experience-oriented care technology in elderly care, specifically in the nursing home environment. This aim was researched in several studies and distinguishes four phases. The first phase, Phase 1 (chapters 1 and 2), of this dissertation provides insight in the larger scope of interactive art and how people respond to interactive artworks in general. The second phase, Phase 2 (chapter 3), describes the co-creation process that has taken place to develop the interactive artworks created and studied in this PhD-project. Phase 3 (chapters 4 to 6), consists of three pilot studies that describe the responses of nursing home residents in relation to three different interactive artworks. In the fourth phase, Phase 4 (chapter 7), the results are synthesized and discussed. In chapter 1 the main problem is introduced. Interactive artworks are suggested as potential solutions to increase personal experiences for nursing home residents without professional supervision. The chapter ends with the main aim, three formulated sub-questions and an overview of the studies and four phases of the dissertation. Although most of the interactive art installations created today are not formally studied, the systematic review in chapter 2 identified 22 open-ended interactive digital artworks of which the participants’ responses were studied. Both human-to-artwork and human-to-human responses were noted for all identified artworks. The results indicate that interactive artworks can evoke a variety of verbal, physical, and cognitive/emotional responses within and between visitors, making these artworks powerful instruments. Results imply there is no straightforward relationship between the features of the artwork and the kind of response. However, two factors seemed to influence the participants’ responses: ‘the content’ (concrete or abstract) of the artwork, and ‘the presence of others’. Chapter 3 illustrates the co-creation process of interactive artworks by the design of the interface of VENSTER as a case. Results imply that although co-creation adds complexity to the design process, involving stakeholders seemed to be a crucial element in the success of the creation of the interface for VENSTER. Participants hardly paid attention to the installation and interface. There, however, seemed to be an untapped potential for creating an immersive experience by focusing more on the content itself as an interface (e.g. creating specific scenes with cues for interaction, scenes based on existing knowledge or prior experiences). “Fifteen lessons learned” which can potentially assist the design of an interactive artwork for nursing home residents suffering from dementia were derived from the design process. This description provides tools and best practices for stakeholders to make (better) informed choices during the development of interactive artworks. It also illustrates how co-design can make the difference between designing a pleasurable experience and a meaningful one. VENSTER (chapter 4) is an interactive artwork that brings the outside world into the nursing home and vice versa through an interactive physical window. Physically, VENSTER consists of two large (touch) screens, vertically mounted in a fake wall. A string attached to the roller blind in front of the screens serves as a switch to change what is seen. When the installation detects the presence of a person, music starts playing. The installation can show pre-recorded “calming” (e.g. a lake) or “activating content” (e.g. children playing), and is also able to present “interactive content” which can be manipulated in real time (e.g. manipulate the direction of falling snow). The goal of this study was (1) to determine whether and how nursing home residents with dementia respond to the interactive art installation in general and (2) to identify whether responses change when the content type and, therefore, the nature of the interaction with the artwork changes. The research protocol was set up as an observational explorative study. Six to eight residents of the closed ward and 1–2 care providers were invited to attend a session with VENSTER in a semi-public square of the nursing home. All responses carried out by nursing home residents and the caregivers present were recorded on video, coded and placed in the aforementioned framework. Results show that the interactive art installation ‘VENSTER’ evokes responses in nursing home residents with dementia, illustrating the potential of interactive artworks in the nursing home environment. Frequently observed responses were naming, recognizing or asking questions about depicted content and how the installation worked, physically gesturing towards or tapping on the screen and tapping or singing along to the music. It seemed content matters a lot. When VENSTER is to be used in routine care, the choice of a type of content is critical to the intended experience/usage in practice. Recognition seemed to trigger memory and (in most cases) a verbal reaction, while indistinctness led to asking for more information. When (initially) coached by a care provider, residents actively engaged physically with the screen. Responses however differed between content types, which makes it important to further explore different types of content and content as an interface to provide meaningful experiences for nursing home residents. The results in chapter 5 show that use of the CRDL (pronounced: ‘the cradle’) in a group setting creates opportunities for expressive and therapeutic touch. The CRDL got its name due to its shape, size and weight, which refer to a baby or a crib. Physically the CRDL has an abstract, rounded form. On opposite sides of the device, there is a grey felt inlay shaped like a larger-than-life fingerprint. Two participants have to place one hand on such a felt “pad” and simultaneously touch the other person’s skin (e.g. hand, arm or shoulder). If more people are interacting, they all have to touch each other. This way they close an electric circuit and the speaker, located in the centre of the CRDL, produces a sound, influenced by the type of touch and the selected soundscape (e.g. nature, town, instrumental, animals and house–garden–kitchen sounds). This study was designed and carried out as an observational explorative study. Three to four residents and one to two caregivers tried out the new device in an activity room. All responses carried out by nursing home residents and the caregivers present were recorded on video, coded and placed in the aforementioned framework. In a group setting the CRDL creates an atmosphere of curiosity, a playful context and can function as an intermediary between people. This lowers the threshold to touch, provides an incentive to touch and encourages experimentation with different types of touches on the arms and hands because the produced sound changes accordingly. Additionally, the sounds that the CRDL produces sometimes trigger memories and provide themes to start and support conversation. The large amount of discussion about the controls, functioning and purpose of the CRDL can be attributed to the novelty of the device and will probably diminish over time. To involve a large group is challenging. Caregivers and activity supervisors often had a hard time making multiple residents close a circle of hands and make them understand the outer edges should touch the CRDL pads. All caregivers and activity supervisors eventually switched to several small groups (three people) or individual interactions with the residents (two people) while the other participants watched. Chapter 6 describes that Morgendauw seems able to evoke responses in both the residents and their caregivers. Morgendauw is a black, table-like installation, shaped like the silhouette of a larger-than-life oak leaf. The surface of the leaf consists of touch-reactive LED panels. Morgendauw shows a constant stream of coloured particles, which resemble a stream of water flowing downhill. The colour, direction and velocity of the particles are influenced by the current weather conditions in one of five pre-programmed cities (Eindhoven, Quebec, Spitsbergen, Tokyo and Kaapstad). Every five minutes a different city is automatically selected. When the surface of Morgendauw is touched or an object (e.g. stone) is placed on it, the stream of particles will react and find a way around the hand or object. This results in a change of composition and a distortion in the particle system that will try to find a new balance. This choreography of light is augmented with an ambient soundtrack and subtle nature sounds. This study was set up and carried out as an explorative observational study. The installation was observed for two days, from 10 AM to 5 PM in a semi-public square at an indoor public square, where an open and a closed ward intersect. All responses carried out by nursing home residents, caregivers or anyone else who interacted with the installation were recorded on video, coded and placed in the aforementioned framework. Overall, residents did not seem to notice Morgendauw. The location in which Morgendauw was placed during the study and/or the characteristics of the installation seemed to create a threshold. When prompted and/or directed, the initial threshold of noticing and approaching the installation was quickly overcome and residents in general needed little explanation of the interface to interact with it. The visuals seemed mesmerizing and resulted in a concentrated gaze upon the installation. The physical rocks placed in the abstract water were moved around and the effects it had on the particle system were observed. In chapter 7, the main aim and formulated sub-questions are answered. The main findings and methodological considerations for all four phases are synthesized and discussed. Subsequently, the implications for (creative) practice and research are reported and can be clustered in three main themes: ‘developing interactive art with special attention to the interface’, ‘the involvement of all stakeholders as requirement for successful implementation of interactive art in nursing homes, and on ‘continuous improvement of the interactive artwork’. Finally, future directions are outlined (Where to go from here?). The first topic discusses how to increase the chance of change towards an art-included life in care facilities. More initiatives with changing interactive art collections in health care is the second subject discussed. The chapter concludes with the wish of the other to organize a (travelling) exhibition inside the nursing home, but open to all. The exhibition should present interactive art in such a way that it is interesting and intuitive for all to visit and enjoy, and creates connections between the nursing homes and the rest of society, residents and staff or visitors, the (interactive) art world and the field of (elderly) care. These exhibitions can advance our knowledge on how build and set the stage together with nursing home residents for personal, meaningful and cultural experiences to take place.
... The effects of therapeutic touch on nursing home residents have been studied. Recent systematic reviews conclude there is insufficient evidence in favour of massage and touch interventions for long-term effects, but therapeutic touch interventions have proven to reduce restlessness and stress in nursing home residents during the intervention (Livingston et al., 2014;Hansen et al., 2006;Cai and Zhang, 2015;McFeeters et al., 2016;Wu et al., 2017). Touch is reciprocal: Nicholls et al. (2013) reported that seeing the person with dementia relaxed and content because of an everyday touch produced a similar impact on those close by. ...
Article
Purpose The purpose of this paper is to describe whether and how groups of nursing home residents respond to the interactive device “the CRDL”. The CRDL can translate touches between people into sounds. It recognises the type of touch and adjusts the produced sound accordingly. Design/methodology/approach This was as an observational explorative study. Responses were coded and analysed using an existing theoretical framework. Findings The CRDL creates an atmosphere of playfulness and curiosity. It lowers the threshold to touch, provides an incentive to touch and encourages experimentation with different types of touches on arms and hands. The sounds the CRDL produces sometimes trigger memories and provide themes to start and support conversation. Involving a (large) group of nursing home residents to interact with the CRDL is challenging. Research limitations/implications In order to more fully understand the potential of the CRDL, its use should be studied in different group and individual sessions and the effects of tailored content, adjusted to individual preferences and/or stages of cognition should be explored. Finally, the effects of using the CRDL on the general wellbeing of nursing home residents should be studied. Practical implications The CRDL can help caregivers to use touch to make contact with (groups of their) residents. A session should be guided by an experienced caregiver. Some familiarisation and practice with the CRDL are recommended and a quiet environment is advised. Originality/value This paper demonstrates the potential of interactive objects, such as the CRDL, in the nursing home.
Article
Full-text available
Background: Agitation is common, persistent and distressing in dementia and is linked with care breakdown. Psychotropic medication is often ineffective or harmful, but the evidence regarding non-pharmacological interventions is unclear. Objectives: We systematically reviewed and synthesised the evidence for clinical effectiveness and cost-effectiveness of non-pharmacological interventions for reducing agitation in dementia, considering dementia severity, the setting, the person with whom the intervention is implemented, whether the effects are immediate or longer term, and cost-effectiveness. Data sources: We searched twice using relevant search terms (9 August 2011 and 12 June 2012) in Web of Knowledge (incorporating MEDLINE); EMBASE; British Nursing Index; the Health Technology Assessment programme database; PsycINFO; NHS Evidence; System for Information on Grey Literature; The Stationery Office Official Documents website; The Stationery National Technical Information Service; Cumulative Index to Nursing and Allied Health Literature; and The Cochrane Library. We also searched Cochrane reviews of interventions for behaviour in dementia, included papers' references, and contacted authors about 'missed' studies. We included quantitative studies, evaluating non-pharmacological interventions for agitation in dementia, in all settings. Review method: We rated quality, prioritising higher-quality studies. We separated results by intervention type and agitation level. As we were unable to meta-analyse results except for light therapy, we present a qualitative evidence synthesis. In addition, we calculated standardised effect sizes (SESs) with available data, to compare heterogeneous interventions. In the health economic analysis, we reviewed economic studies, calculated the cost of effective interventions from the effectiveness review, calculated the incremental cost per unit improvement in agitation, used data from a cohort study to evaluate the relationship between health and social care costs and health-related quality of life (DEMQOL-Proxy-U scores) and developed a new cost-effectiveness model. Results: We included 160 out of 1916 papers screened. Supervised person-centred care, communication skills (SES = -1.8 to -0.3) or modified dementia care mapping (DCM) with implementing plans (SES = -1.4 to -0.6) were all efficacious at reducing clinically significant agitation in care home residents, both immediately and up to 6 months afterwards. In care home residents, during interventions but not at follow-up, activities (SES = -0.8 to -0.6) and music therapy (SES = -0.8 to -0.5) by protocol reduced mean levels of agitation; sensory intervention (SES = -1.3 to -0.6) reduced mean and clinically significant symptoms. Advantages were not demonstrated with 'therapeutic touch' or individualised activity. Aromatherapy and light therapy did not show clinical effectiveness. Training family carers in behavioural or cognitive interventions did not decrease severe agitation. The few studies reporting activities of daily living or quality-of-life outcomes found no improvement, even when agitation had improved. We identified two health economic studies. Costs of interventions which significantly impacted on agitation were activities, £80-696; music therapy, £13-27; sensory interventions, £3-527; and training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM, £31-339. Among the 11 interventions that were evaluated using the Cohen-Mansfield Agitation Inventory (CMAI), the incremental cost per unit reduction in CMAI score ranged from £162 to £3480 for activities, £4 for music therapy, £24 to £143 for sensory interventions, and £6 to £62 for training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM. Health and social care costs ranged from around £7000 over 3 months in people without clinically significant agitation symptoms to around £15,000 at the most severe agitation levels. There is some evidence that DEMQOL-Proxy-U scores decline with Neuropsychiatric Inventory agitation scores. A multicomponent intervention in participants with mild to moderate dementia had a positive monetary net benefit and a 82.2% probability of being cost-effective at a maximum willingness to pay for a quality-adjusted life-year of £20,000 and a 83.18% probability at a value of £30,000. Limitations: Although there were some high-quality studies, there were only 33 reasonably sized (> 45 participants) randomised controlled trials, and lack of evidence means that we cannot comment on many interventions' effectiveness. There were no hospital studies and few studies in people's homes. More health economic data are needed. Conclusions: Person-centred care, communication skills and DCM (all with supervision), sensory therapy activities, and structured music therapies reduce agitation in care-home dementia residents. Future interventions should change care home culture through staff training and permanently implement evidence-based treatments and evaluate health economics. There is a need for further work on interventions for agitation in people with dementia living in their own homes. Protocol registration: The study was registered as PROSPERO no. CRD42011001370. Funding: The National Institute for Health Research Health Technology Assessment programme.
Article
Full-text available
Objective To assess the impact of massage versus ear acupuncture on behavior and participation in occupational therapy of dementia patients. Methods We performed a controlled, randomized longitudinal trial approved by the Bioethics Commission of the University of Extremadura. One hundred twenty elderly subjects with dementia institutionalized in residential homes in Extremadura (Spain) received treatment based on massage and ear acupuncture over three months. Behavior alterations, sleep disturbance, and participation in rehabilitation and eating were assessed every month during the three months of intervention, and at one and two months of follow-up after the end of treatment. The assessment was performed through a structured questionnaire with closed format questions done by an occupational therapist not involved in the study. Results There was a statistically significant positive effect of massage and ear acupuncture (P<0.001) on measured variables in the third month of intervention, which were maintained at two months after completing the treatment (P<0.021), when compared to the control group. Conclusions Massage therapy and ear acupuncture can improve behavior and sleep disturbances, and increase the participation in eating and rehabilitation organized in residential homes, in dementia patients.
Article
Full-text available
Within the treatment of dementia, management of behavioural and psychological symptoms (BPSD) is a complex component. We wanted to offer a pragmatic synthesis of existing specific practice recommendations for managing BPSD, based on agreement among systematically appraised dementia guidelines. We conducted a systematic search in MEDLINE and guideline organisation databases, supplemented by a hand search of web sites. Fifteen retrieved guidelines were eligible for quality appraisal by the Appraisal of Guidelines Research and Evaluation instrument (AGREE), performed by 2 independent reviewers. From the 5 included guidelines, 18 specific practice recommendations for BPSD were extracted and compared for their level of evidence and strength. No agreement was found among dementia guidelines for the majority of specific practice recommendations with regard to non-pharmacological interventions, although these were recommended as first-line treatment. Pharmacological specific practice recommendations were proposed as second-line treatment, with agreement for the use of a selection of antipsychotics based on strong supporting evidence, but with guidance for timely discontinuation. The appraisal of the level of agreement between guidelines for each specific practice recommendation was complicated by variation in grading systems, and was performed with criteria developed a posteriori. Despite the limited number of recommendations for which agreement was found, guidelines did agree on careful antipsychotic use for BPSD. Adverse events might outweigh the supporting evidence of efficacy, weakening the recommendation. More pivotal trials on the effectiveness of non-pharmacological interventions, as well as guidelines specifically focusing on BPSD, are needed.
Article
Objective: Research is needed to determine specific factors that contribute to the success of nonpharmacologic interventions. In this study, we examined the influence of personal characteristics (demographic, medical, and functional variables) and possible barriers (eg, staff or family barriers) on the efficacy of nonpharmacological interventions in reducing agitation. Method: Agitation was systematically observed at baseline and intervention stages using the Agitation Behavior Mapping Instrument (ABMI) in a sample of 89 residents from 6 Maryland nursing homes (mean age = 85.9 years). Each participant received interventions based on an individualized algorithm (TREA-Treatment Routes for Exploring Agitation), which identifies unmet needs and matches interventions to needs and to the participant's sensory, cognitive, and functional abilities, as well as to self-identity and preferences. The study was conducted between June 2006 and December 2011. Results: Analyses revealed that decreased levels of agitation during intervention correlated significantly with higher levels of cognitive function (r = 0.36, P < .001), with fewer difficulties in the performance of activities of daily living (r = 0.29, P < .01), speech (r = 0.47, P < .001), communication (r = 0.23, P < .05), and responsiveness (r = 0.28, P < .01). In addition, less reduction of agitation during intervention was significantly related to the presence of staff barriers (eg, refusals, interruptions) (r = -0.38, P < .001) and the occurrence of pain (r = -0.21, P ≤ .05). Conclusions: The findings elucidate the characteristics of those who are most likely to respond to TREA intervention, and point to the need of systemic changes to reduce staff-related barriers and to improve methodologies for increasing the impact of intervention on those at the lowest levels of functioning.
Article
Objective This study compares different non-pharmacological interventions for persons with behavioral symptoms and dementia on frequency of use and perceived efficacy in terms of change in behavior and interest. Methods Participants were 89 nursing home residents from 6 Maryland nursing homes with a mean age of 85.9 years (SD=8.6). Research assistants presented interventions tailored to the participants` needs and preferences in a pre-intervention trial phase and in an intervention phase. The impact of each intervention on behavioral symptoms and on the person’s interest was rated immediately after the intervention by a research assistant. Results The most utilized interventions in both trial and treatment phases were the social intervention of one-on-one interaction, simulated social interventions such as a lifelike doll and respite video, the theme intervention of magazine, and the sensory stimulation intervention of music. In contrast, the least utilized interventions in both phases were sewing, fabric book, and flower arrangement. Interventions with the highest impact on behavioral symptoms included one-on one social interaction, hand massage, music, video, care, and folding towels. Other high impact interventions included walking, going outside, flower arranging, food or drink, sewing, group activity, book presentation ball toss, coloring or painting, walking, and family video. Conclusions The results provide initial directions for choosing specific interventions for persons with dementia and also demonstrate a methodology for increasing knowledge through ongoing monitoring of practice.
Article
To assess the impact of massage versus ear acupuncture on behavior and participation in occupational therapy of dementia patients. We performed a controlled, randomized longitudinal trial approved by the Bioethics Commission of the University of Extremadura. One hundred twenty elderly subjects with dementia institutionalized in residential homes in Extremadura (Spain) received treatment based on massage and ear acupuncture over three months. Behavior alterations, sleep disturbance, and participation in rehabilitation and eating were assessed every month during the three months of intervention, and at one and two months of follow-up after the end of treatment. The assessment was performed through a structured questionnaire with closed format questions done by an occupational therapist not involved in the study. There was a statistically significant positive effect of massage and ear acupuncture (P < 0.001) on measured variables in the third month of intervention, which were maintained at two months after completing the treatment (P < 0.021), when compared to the control group. Massage therapy and ear acupuncture can improve behavior and sleep disturbances, and increase the participation in eating and rehabilitation organized in residential homes, in dementia patients.
Article
Nearly 9 out of 10 patients with dementia also suffer from behavioral symptoms. Several nonpharmaceutical interventions hold promise.
Article
Opinion statement: Dementia symptoms are often complicated by behavioral disorders such as repetitive verbalizations, aggressive behavior, and pacing. In clinical practice, the most common responses to behavioral disorders are pharmacologic, mostly using antipsychotic medication, or ignoring the behavior. However, multiple research studies support the notion that these behavioral disorders in dementia are related to unmet needs that can be addressed by nonpharmacologic interventions. Persons with dementia present multiple unmet needs, most commonly pain and discomfort, need of social contact and support, and need of stimulation that alleviates boredom. A wide range of interventions that address these needs has been investigated, though the rigor of the investigations varied greatly depending on factors related to the behavioral disorder, setting, and resource limitations. In practice, the avenues to address the unmet needs should depend on the person's abilities and preferences. Thus, nonpharmacologic interventions that are individually tailored to the person with dementia comprise a superior response to behavioral disorders and should be at the frontline of treatment of these disorders.
Article
Objective: Behavioral and psychological symptoms are common in dementia, and they are especially stressful for family caregivers. Nonpharmacological (or psychosocial) interventions have been shown to be effective in managing behavioral and psychological symptoms, but mainly in institutional settings. The authors reviewed the effectiveness of community-based nonpharmacological interventions delivered through family caregivers. Method: Of 1,665 articles identified in a literature search, 23 included unique randomized or pseudorandomized nonpharmacological interventions with family caregivers and outcomes related to the frequency or severity of behavioral and psychological symptoms of dementia, caregiver reactions to these symptoms, or caregiver distress attributed to these symptoms. Studies were rated according to an evidence hierarchy for intervention research. Results: Nonpharmacological interventions were effective in reducing behavioral and psychological symptoms, with an overall effect size of 0.34 (95% CI=0.20-0.48; z=4.87; p<0.01), as well as in ameliorating caregiver reactions to these behaviors, with an overall effect size of 0.15 (95% CI=0.04-0.26; z=2.76; p=0.006). Conclusions: Nonpharmacological interventions delivered by family caregivers have the potential to reduce the frequency and severity of behavioral and psychological symptoms of dementia, with effect sizes at least equaling those of pharmacotherapy, as well as to reduce caregivers' adverse reactions. The successful interventions identified included approximately nine to 12 sessions tailored to the needs of the person with dementia and the caregiver and were delivered individually in the home using multiple components over 3-6 months with periodic follow-up.
Article
To explore the effects of foot massage on agitated behaviours in older people with dementia living in long-term care. Seventeen men and 5 women (mean age 84.7 years), with a diagnosis of dementia and a history of clinically significant agitation, received a 10-minute foot massage each day for 14 days. The short form of the Cohen-Mansfield Agitation Inventory (CMAI-SF) and the Revised Memory and Behavior Problems Checklist (RMBPC) were completed at baseline, post-test and 2-weeks follow up. CMAI-SF and RMBPC scores were significantly reduced at post-test and remained significantly lower than baseline at follow up. This study provides preliminary evidence suggesting that limited short-duration foot massage reduces agitation and related behavioural problems in people with dementia, and that these behaviour changes are maintained after the massage ceases. A randomised controlled trial is required to confirm these findings.