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How groups of nursing home residents respond to “the CRDL”: a pilot study
Abstract
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.
... Building on this extensive body of work on music in dementia [4][5][6][7][8][9][10][11][12][13][15][16][17][18], researchers have begun exploring the potential benefits of everyday sounds or nonmusical sounds perceived in everyday life for people with dementia [19][20][21][22][23][24][25]. Like music, everyday sounds that are perceived as pleasant can evoke positive emotions [24,26]. ...
... Reexperiencing sounds from everyday life can provide feelings of comfort or safety [27], can prompt memories of life events and loved ones [20], and can support storytelling by people with dementia to relive meaningful past experiences in the present [18,19]. These responses to sound provide opportunities for social connection and interaction [21,22] and for improvement in the living environment of care facilities, where sounds can be perceived and enjoyed by residents regardless of their limitations or illness [23]. ...
... These research explorations have resulted in new accessible interfaces for people with dementia to enable them to play personal music content [34][35][36] and virtual instruments adapted to the skills and abilities of residents with dementia to support participation during music therapy sessions [7,17,37,38]. ABT, such as music pillows [22,29] and collaborative interfaces [17,21,39], support social activities and stimulate engagement between people with dementia, their relatives, and professional caregivers [21,22]. ...
Music and familiar everyday sounds can be meaningful for people with dementia by providing benefits such as evoking memories and emotions or prompting social interactions with caregivers or relatives. Motivated by this potential, researchers and designers are investigating how to leverage these beneficial effects of sound in care environments through audio-based technology. However, there is a gap in the knowledge of how audio-based technology can be successfully implemented within everyday care practice. In this paper, we present the outcome of three participatory workshops with 18 professional caregivers to explore how audio-based technology can add value to existing care processes and activities in residential dementia care. During the participatory workshops, professional caregivers (1) mapped existing care activities; (2) linked findings in research with practice, and (3) designed scenarios for the Vita sound cushion. Care professionals indicate how audio-based technology can support existing care practice by influencing the mood of residents and by supporting social interaction during moments of care, daytime activities, or situational sessions. This study bridges research findings with insights from practice, contributing to a shared understanding of opportunities for embedding audio-based technology in dementia care. These opportunities motivate future research to implement and evaluate audio-based technology in residential dementia care.
... Studies indicate that nature sounds can promote rest and be calming for residents in care home environments (van den Bosch et al., 2017), and familiar sounds can give structure and provide auditory cues to enhance safety (Devos et al., 2019). Furthermore, sounds that are integrated into the care space have the potential to shape social relations (Graham, 2018) by providing prompts for meaningful conversations (Houben et al., 2019) and non-verbal communication for people with dementia (Houben, Brankaert, Bakker, Kenning, et al., 2020;Luyten et al., 2018). Sharing narratives or stories from the past can provide enjoyment and social activity for people with dementia (Fels & Astell, 2011). ...
... Sonically enhancing the care environment opens up new possibilities to provide shared experiences (Graham, 2020) by prompting care home residents to relate to each other (Graham, 2018). Research has demonstrated how non-musical sounds can evoke associations, memories, and emotions (Frohlich et al., 2020;Houben et al., 2019), leading to conversations, playfulness, and social activities (Houben, Brankaert, Bakker, Kenning, et al., 2020;Luyten et al., 2018). However, as soundscapes regulate and are regulated by the social context (Rudi, 2013), more insight is needed into the quality of the listening experiences for people with dementia and their caregivers. ...
Researchers are investigating how soundscapes can reduce agitation and contribute to the well-being of people with dementia. We advance this research by exploring further how to incorporate the personal background and preferences of individuals with dementia in soundscapes to evoke storytelling and meaningful activity in their everyday surroundings. In this study, we assembled personal soundscapes that were evaluated in individual participatory workshops with six care home residents with dementia. The workshops provided insights into the experiences of people in the mid to advanced stages of dementia listening to personal sounds. The results demonstrate how these soundscapes evoked: interaction with surroundings; open-ended storytelling; activation through pleasurable experiences; and rest and comfort. We propose implications for design to adopt personal soundscapes in care to support engaging and meaningful one-on-one activities in the care home.
... Moreover, it is important to use materials and form factors that are attractive to touch by using the appropriate materials and shapes [61]. This is in line with studies using the Crdl instrument, a wooden interactive object designed to support touch in direct personal contact between residents with PMID or dementia and their caregivers or family members [56,80,81]. ...
Previous work has shown that technology can facilitate the communication of emotions, social touch, and social presence through haptic devices, meaning devices that provide a haptic stimulation. However, for special user groups living in long-term care facilities, such as people with dementia, the applications of these haptic devices are not apparent. The aim of this study is to understand how haptic devices can be used in intramural care facilities in times of social isolation, focusing on haptic devices that utilize haptic sensation. Five haptic devices were tested at three care facilities. Insights from this study highlight the potential of haptic devices to enhance sensory, affective, and social experiences during video calling between residents and their relatives. Moreover, the importance of the tactile sensation and form factor of haptic devices in the care context is addressed, along with insights on how to create the appropriate atmosphere during video calling.
... Care Routines Study 1 was grounded in a large body of research [5,41,89] on how music or meaningful sounds can support reminiscence [39,53,62,68,95], positive emotions or pleasure [57], social interactions [41,46,53,71,79], and stimulate the exploration and manifestation of identity and selfhood in dementia [6,45,79]. The first field study aimed to explore how these beneficial effects of sound could be leveraged into care environments for people with dementia [54]. ...
Research in HCI is increasingly investigating the role of technology in supporting meaningful and social activities to enhance the lived experiences of people with dementia. However, to further enrich the daily experiences in care, more insight is needed into how technology can directly promote social participation and pleasurable experiences in everyday care situations. This paper discusses the deployment of VITA and SAM: two research products that address the social and emotional needs of residents in day-to-day dementia care. We report how both products offered aesthetic and sensory enrichment, created new experiences in the everyday, and were integrated into the care environment. Furthermore, we identify implications for design to provide: 1) aesthetics in care, 2) authentic experiences, 3) reinforcing everyday life, and 4) community-driven use in practice. We contribute to existing research by demonstrating how technology for dementia care can transcend instrumental use and culminate in warm-felt everyday experiences.
The Camberwell Assessment of Need for the Elderly (CANE) is an internationally accepted tool for assessing the needs of older people. Needs are assessed in twenty-four areas of life and cover a broad range of health, social and psychological domains. Two items that measure the needs of those who care for the older person are also included. The CANE is suitable for use in research, clinical practice and for evaluating health and social services provided to older people. It has been used for over twenty years in a range of settings, populations and countries. This book outlines the evidence for its use in effectively measuring the needs of older people across primary care, community, inpatient and care home settings. Both the full version CANE and short version (CANE-S) are included, along with a detailed manual and scoring guidance. The assessment forms are freely available to download from researchintorecovery.com/can and cambridge.org.
Demographic, epidemiological and societal changes are challenges to which all European countries are forced to find solutions. In addition, the so-called “digital transformation” is taking place, with digitization proceeding rapidly in all European countries, although with differing intensity and speed. With high expectations and hopes being placed on technical systems in health and social care, numerous innovations have been developed and piloted. However, for various reasons, many of these are not in regular use. Whereas technology is developing rapidly, policy, research and practice are advancing at a significantly slower pace, lagging behind the potential of technical innovations.
To maximize the current and future benefits of technological innovation in the field of care, the Joint Programming Initiative “More Years, Better Lives – The Potential and Challenges of Demographic Change” has initiated a review and synthesis of knowledge, in the form of a “fast-track” project. Bringing in experts and stakeholders to collect available knowledge in a short time. This process aims to develop a common vision of care in times of digitization and explore what contribution new and emerging technologies can make to good life bearing in mind the critical role of care, health and welfare services as people age. This is designed to help guide policy development, resource allocation and research efforts in this field.
Acknowledging the limited duration of the fast-track process, from March to October 2020, a pragmatic approach was taken. The project focuses on a challenge-driven perspective. The target audiences of this report are hence decision-makers in research policy, social policy and labour market policy, researchers and research funders addressing ageing, health and social care and technology, and tech companies active in that context.
The coordination of the overall fast-track project has been funded by the Department of Interactive Technologies for Health and Quality of Life at the German Federal Ministry of Education and Research (BMBF), and operationally supported by its funding agency VDI/VDE Innovation + Technik GmbH. In addition, the participants and authors of Chapters are funded by their countries.
This paper reports the responses of nursing home residents who live in a psychogeriatric ward to the abstract interactive art installation ‘Morgendauw’, which was specifically designed for this study. All stakeholders were involved in designing and implementing Morgendauw. The artwork seems able to evoke responses in both the residents and their caregivers, but the amount and duration of the responses observed during the study were limited. 15 interactions over the course of 14 h were noted and almost all of them were initiated by the nursing home staff, physiotherapy students or visitors (n = 12). Interactions lasted for about 3 min on average. Although the nursing home residents initially did not seem to notice the artwork, the threshold of acknowledging and approaching the artwork was quickly overcome when staff nudged or directed the residents’ attention towards the artwork. Beyond this point, nursing home residents generally needed little explanation of the interface to interact with the artwork. The location in which Morgendauw was placed during the study or the characteristics of the installation seemed to create a threshold. Further research should focus on the importance and the effects of context when designing and implementing an interactive art installation in a nursing home environment.
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 main aim of this systematic review was to describe responses of
participants to physical, open-ended interactive digital artworks. Although
human-to-artwork and human-to-human responses were found in the
22 identified artworks, more human-to-artwork responses were reported. Both
types of responses were further categorised into physical, verbal, and
cognitive/emotional responses. The artworks varied from small table-top
installations to large, dark open spaces, and had a range of interactive
components and features from a heart rate interface to complete body
movements. 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. Creating interactive artworks that
challenge new audiences and/or evoke specific responses requires more
knowledge about the dynamics of the interaction between people and
interactive artworks.
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 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. In this study, 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 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. Implications for rehabilitation VENSTER can facilitate different types of responses ranging from verbal reactions to active physical engagement. The choice of a type of content is critical to the intended experience/usage in practice. Activating content seems suitable for use as a meaningful experience during the spare time in between existing activities or therapy. Sessions with interactive content are short (avg. 30 mins) and intense and can therefore potentially be used as an activating therapy, activity or exercise. In order to actively engage residents with dementia, the role of the care provider seems very important.
Significance
Touch is a powerful tool for communicating positive emotions. However, it has remained unknown to what extent social touch would maintain and establish social bonds. We asked a total of 1,368 people from five countries to reveal, using an Internet-based topographical self-reporting tool, those parts of their body that they would allow relatives, friends, and strangers to touch. These body regions formed relationship-specific maps in which the total area was directly related to the strength of the emotional bond between the participant and the touching person. Cultural influences were minor. We suggest that these relation-specific bodily patterns of social touch constitute an important mechanism supporting the maintenance of human social bonds.
Background Agitation in dementia is common, persistent and distressing and can lead to care breakdown. Medication is often ineffective and harmful. Aims To systematically review randomised controlled trial evidence regarding non-pharmacological interventions. Method We reviewed 33 studies fitting predetermined criteria, assessed their validity and calculated standardised effect sizes (SES). Results Person-centred care, communication skills training and adapted dementia care mapping decreased symptomatic and severe agitation in care homes immediately (SES range 0.3-1.8) and for up to 6 months afterwards (SES range 0.2-2.2). Activities and music therapy by protocol (SES range 0.5-0.6) decreased overall agitation and sensory intervention decreased clinically significant agitation immediately. Aromatherapy and light therapy did not demonstrate efficacy. Conclusions There are evidence-based strategies for care homes. Future interventions should focus on consistent and long-term implementation through staff training. Further research is needed for people living in their own homes.
Royal College of Psychiatrists.
This article presents the mental health aspects of 'touch' associated with a funded research project: Avoiding 'high tech' through 'high touch' in end-stage dementia: Protocol for care at the end-of-life. These mental health aspects highlight the human need for touch that continues up until and inclusive of the final stages of life. This study was informed by Simard's (2007) 'high touch' protocol based on the End-of-Life Namaste Care programme for people with dementia. The article is situated in relation to the research project which used a three-phase mixed methods approach. Data explored in this article are derived from focus groups conducted at three residential aged care facilities located in metropolitan and regional areas of NSW, Australia. The exploration of touch vis-a-vis mental health fell under two broad themes: touch by others and touch by the person. Sub-elements of these themes comprised touch towards a physical objective, touch towards an emotional objective, touch of objects and touch of others. The overarching outcome of interconnectedness embraced environmental awareness and human and life awareness. These two broad themes, with their accompanying elements, express the essential nature of mental health as a reciprocal connectedness, with reciprocal impacts on both those people with advanced dementia and their carers.
The study of emotional signaling has focused almost exclusively on the face and voice. In 2 studies, the authors investigated whether people can identify emotions from the experience of being touched by a stranger on the arm (without seeing the touch). In the 3rd study, they investigated whether observers can identify emotions from watching someone being touched on the arm. Two kinds of evidence suggest that humans can communicate numerous emotions with touch. First, participants in the United States (Study 1) and Spain (Study 2) could decode anger, fear, disgust, love, gratitude, and sympathy via touch at much-better-than-chance levels. Second, fine-grained coding documented specific touch behaviors associated with different emotions. In Study 3, the authors provide evidence that participants can accurately decode distinct emotions by merely watching others communicate via touch. The findings are discussed in terms of their contributions to affective science and the evolution of altruism and cooperation.
Background:
Massage and touch have been suggested as a non-pharmacological alternative or supplement to other treatments offered in order to reduce or manage a range of conditions associated with dementia such as anxiety, agitated behaviour and depression. It has also been suggested that massage and touch may counteract cognitive decline.
Objectives:
To assess the effects of a range of massage and touch therapies on conditions associated with dementia, such as anxiety, agitated behaviour and depression, identify any adverse effects, and provide recommendations about future trials.
Search strategy:
We identified trials from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 12 July 2005 using the terms massage, reflexology, touch and shiatsu. This Register contains records from all major healthcare databases and many ongoing trials databases and is updated regularly. In addition, general and specific literature databases were searched and patient and therapist organizations contacted.
Selection criteria:
Randomized controlled trials (RCTs) in which a massage or touch intervention was given to persons suffering from dementia of any type, compared with other treatments or no treatment, and in which effect parameters included measures of behavioural problems, caregiver burden, emotional distress or cognitive abilities, were eligible for inclusion. Furthermore, we employed a set of minimal methodological quality criteria as a selection filter.
Data collection and analysis:
We identified 34 references in the initial searches. Of these, seven were actual or possible RCTs, but only two were found to meet the requirements of the set of minimal methodological criteria.
Main results:
The very limited amount of reliable evidence available is in favour of massage and touch interventions for problems associated with dementia. However, this evidence addresses only two specific applications: hand massage for the immediate or short-term reduction of agitated behaviour, and the addition of touch to verbal encouragement to eat for the normalization of nutritional intake. The existing evidence does not support general conclusions about the effect or possible side effects of such interventions. No severe side effects were identified.
Authors' conclusions:
Massage and touch may serve as alternatives or complements to other therapies for the management of behavioural, emotional and perhaps other conditions associated with dementia. More research is needed, however, to provide definitive evidence about the benefits of these interventions.
Background:
Many original studies have explored the effectiveness of massage and touch on behavioral and psychological symptoms of dementia. However, the study design, interventions, measurements and outcomes varied among studies.
Aim:
To systematically evaluate the effectiveness of massage and touch on the behavioral and psychological symptoms of older people with dementia.
Design:
A quantitative systematic review and meta-analysis.
Data sources:
Cochrane Library, The Joanna Briggs Institute (JBI) Library, PubMed, CINAHL, ProQuest Health & Medical Complete, SinoMed, China National Knowledge Infrastructure (CNKI) and Wanfang were searched from the date the database established to January 2016.
Review methods:
Randomized controlled trials (RCTs) or quasi-experimental studies, involving massage and touch intervention for older people with dementia were considered to be included. Risk of bias assessment was performed using the Cochrane Collaboration's tool and meta-analysis was performed using Revman 5.3.
Results:
A total of 11 studies, involving 526 older people were included. The results of the meta-analysis showed the total score of behavioral and psychological problems with older people with dementia and subgroup scores of physical aggressive behavior, physical non-aggressive behavior, verbal aggressive behavior and verbal non-aggressive behavior decreased significantly after receiving massage or touch, while the subgroups scores of anxiety, sadness and anger did not decreased significantly.
Conclusions:
Due to relatively small sample size and low quality of the included studies in this review, it is difficult to draw a conclusion on the effect of massage and touch on behavioral and psychological syndrome of dementia or implications for practice. This article is protected by copyright. All rights reserved.
Aims:
To explore the potential benefits of massage within daily routine care of the older person in residential care settings.
Background:
Globally, the proportion of people over 65 years is rapidly rising. Increased longevity means older people may experience a rise in physiological and psychological health problems. These issues potentially place an increased demand for quality long-term care for the older person. Complementary approaches such as massage appear to be needed in quality residential care.
Design:
A critical literature review was undertaken.
Methods:
A literature review pertaining to massage in the older resident was conducted using a range of online databases. Fourteen studies dated 1993-2012 met the inclusion criteria and were critically evaluated as suitable resources for this review.
Results:
Evidence suggests massage may be advantageous from client and nursing perspectives. Clients' perceive massage to positively influence factors such as pain, sleep, emotional status and psychosocial health. Evidence also demonstrates massage to benefit the client and organisation by reducing the necessity for restraint and pharmacological intervention. Massage may be incorporated into care provision and adopted by care providers and family members as an additional strategy to enhance quality of life for older people.
Conclusion:
Massage offers a practical activity that can be used to enhance the health and well-being of the older person in residential care.
Implications for practice:
Massage offers benefit for promoting health and well-being of the older person along with potential increased engagement of family in care provision. Integration of massage into daily care activities of the older person requires ongoing promotion and implementation.
Touch massage (TM) is a form of pleasant touch stimulation used as treatment in clinical settings and found to improve well-being and decrease anxiety, stress, and pain. Emotional responses reported during and after TM have been studied, but the underlying mechanisms are still largely unexplored. In this study, we used functional magnetic resonance (fMRI) to test the hypothesis that the combination of human touch (i.e. skin-to-skin contact) with movement is eliciting a specific response in brain areas coding for pleasant sensations. The design included four different touch conditions; human touch with or without movement and rubber glove with or without movement. Force (2.5 N) and velocity (1.5 cm/s) were held constant across conditions. The pleasantness of the four different touch stimulations was rated on a visual analog scale (VAS-scale) and human touch was rated as most pleasant, particularly in combination with movement. The fMRI results revealed that TM stimulation most strongly activated the pregenual anterior cingulate cortex (pgACC). These results are consistent with findings showing pgACC activation during various rewarding pleasant stimulations. This area is also known to be activated by both opioid analgesia and placebo. Together with these prior results, our finding furthers the understanding of the basis for positive TM treatment effects.
Surprisingly little scientific research has been conducted on the topic of interpersonal touch over the years, despite the importance of touch in our everyday social interactions from birth through to adulthood and old age. In this review, we critically evaluate the results of the research on this topic that have emerged from disciplines, such as cognitive and social psychology, neuroscience, and cultural anthropology. We highlight some of the most important advances to have been made in our understanding of this topic: For example, research has shown that interpersonal tactile stimulation provides an effective means of influencing people's social behaviors (such as modulating their tendency to comply with requests, in affecting people's attitudes toward specific services, in creating bonds between couples or groups, and in strengthening romantic relationships), regardless of whether or not the tactile contact itself can be remembered explicitly. What is more, interpersonal touch can be used to communicate emotion in a manner similar to that demonstrated previously in vision and audition. The recent growth of studies investigating the potential introduction of tactile sensations to long-distance communication technologies (by means of mediated or 'virtual' touch) are also reviewed briefly. Finally, we highlight the synergistic effort that will be needed by researchers in different disciplines if we are to develop a more complete understanding of interpersonal touch in the years to come.
The science of interpersonal touch: an overview
Gallace, A. and Spence, C. (2010), "The science of interpersonal touch: an overview", Neuroscience &
Biobehavioral Reviews, Vol. 34 No. 2, pp. 246-59.