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Massage and Touch Therapy to Reduce Agitation in Dementia Patients

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Massage and Touch Therapy to Reduce Agitation in Dementia Patients

Dementia is not a natural part of growing older, but its risk rises drastically with age, and its occurrence is predicted to rise intensely with advancement in age (Ijaopo, 2017). Memory loss, accompanied by other cognitive and intellectual problems such as agnosia, functioning problems, apraxia, and aphasia can be experienced when patients develop dementia. Most patients with dementia exhibit psychological and behavioral symptoms, where agitation is one of the most common symptoms. Agitation, in many cases, exacerbates a patient’s discomfort, thus increasing caregiver burden as they need to be constantly monitored to avoid self-injury, hence the need for institutionalization (Ijaopo, 2017). Pharmacotherapy has been used for a long time to treat dementia patients who are agitated to help them stay calm (Liu et al., 2018). Nonetheless, the drugs are associated with serious side effects on the patients. The most commonly recommended pharmaceutical classes for agitation that happens in dementia could lead to side effects such as stroke, heart complications, risks of falls, and even death (Liu et al., 2018). There is, therefore, the need for safer therapeutic interventions to address agitation related to dementia. This project recommends the use of massage and touch therapy as an evidence-based intervention to deal with agitation in dementia patients in a nursing home.  

The project will be supported by the management team of the nursing home. The management team will mobilize the specialists who will train and educate the nurses about massage and touch therapy. The project will be important to the nursing home as it will create a solution to deal with agitated patients, which is also an effective relaxation method for other patients with cognitive disorders. The project will also improve patient care by reducing the burden of care. 

Literature Review of the Problem

           Carrarini et al. (2021) conducted a study to establish the correlation between agitation and dementia. The authors found out that agitation was observed in up to 70% of dementia patients, and it was very common in patients with moderate to severe phases of the illness. Alzheimer's disease (AD) had a prevalence of 30 to 50 percent, a prevalence of 40% for frontotemporal dementia (FTD), a prevalence of 40% for vascular dementia (VaD), while dementia with Lewy bodies (DLB) had a prevalence of 30% (Carrarini et al., 2021). The authors established that agitation can harm the patient’s quality of life, functional status, and cognitive function, and also increase caregiver discomfort (Carrarini et al., 2021). Furthermore, agitation is linked to a higher risk of on-term hospitalization, admission to assisted living facilities, increased pharmaceutical use, and mortality (Carrarini et al., 2021). The authors also stated that some studies have attributed agitation to the external display of anxiety (Carrarini et al., 2021). As a result, some authors have proposed that the existence of anxiety in Alzheimer's disease, which is a common symptom of the disease's early stages, should also be viewed as a risk factor for future agitation. Non-pharmacological treatments are recommended as the priority treatment for dementia-related agitation in current management guidelines, although most research is also focusing on preventative measures. 

           The study is relevant to this project because the findings provide an in-depth understanding of agitation related to dementia, its effects, and how it can be handed. The research also brings another view of addressing agitation by suggesting that it might be an external anxiety problem. Now, with the high risks associated with pharmacological therapies, current guidelines suggest non-pharmacological therapies as the effective ways for decreasing agitation in dementia. Carrarini et al. (2021) recommended the prioritization of non-pharmacological interventions when treating agitation in dementia patients. 

           Kongpakwattana et al. (2018) conducted a systematic review on pharmacological treatments for alleviating agitation in dementia. The authors stated that agitation is prevalent in patients with dementia. Although medications such as risperidone and serotonin reuptake inhibitors have proven to be efficient in providing short-term relief for agitation, they, however, do not give long-term agitation relief and they are associated with adverse events if used for a long time (Kongpakwattana et al., 2018). If agitation produces severe discomfort or an urgent risk of injury, clinical practice guidelines indicate that pharmacological therapies be provided at the lowest feasible dose for the shortest time possible in combination with non-pharmacological methods (Kongpakwattana et al., 2018). 

           The study is relevant in this project because it highlights that agitation exposes patients and caregivers to higher safety risks sometimes. Although it proves to be difficult to completely do away with pharmacological therapies in the treatment of agitation in dementia, due to the quick relief for agitation, non-pharmacological therapies are indicated as safe and effective for long-term management of the problem. 

Literature Review for Solution

           A study conducted by Schaub et al. (2018) investigated the effects of hand massage on reducing agitation in dementia patients. The participants involved both dementia patients and other patients with cognitive impairment. The study found out that hand massage done through intervals of hours conducted for three weeks was effective in reducing agitation in patients with dementia. The authors found it necessary for therapists to delve deeper into the background of nurse-patient interactions during the massage. Also, the study suggested that before observing biological modifications in patients with dementia, it is important to do massage severally. This study relates directly to the recommended project intervention, which is massage and touch therapy. It has proven that the successful application of hand massage can decrease agitation in dementia patients and also help other cognitively impaired patients.

           In another study done by Scales et al. (2018), an evidence-based strategy proposed the use of non-pharmacological measures to address behavioral and physiological symptoms in patients with dementia. Massage which involves a therapeutic touch on the neck, shoulders, back, and legs were among these measures. The authors stated that massage helped in offsetting social isolation which is a trigger for negative behaviors (Scales et al., 2018). They added that massage does no only reduce agitation but also reduces stress, depression, disruptive vocalization, and anxiety. This study is relevant to this project because the aspect of non-pharmacological therapy in the reduction of agitation is widely accepted and massage, in particular, provides more than just relaxation in agitation but also helps in addressing other psychological problems experienced by dementia patients.  

Implementation

           The intervention to be implemented in the nursing home is a massage and touch therapy to reduce agitation in patients with dementia. The nursing home management team will get three specialists in massage therapy who would work together with the nurses to implement the massage therapy program. The program will run for six weeks at an interval of 1 hour per patient every day for the first three weeks, and then four days a week for the remaining three weeks. The intensity and strokes used in the massage will start from moderate strokes to intense strokes, but will also depend on the severity of the problem. The massage will be applied using different massage oils to examine which fits each patient as per their skin sensitivity. The patient will have a conducive environment with secluded beds specifically for massage to ensure their privacy is maintained and that they are comfortable during the program. The massage will be applied on the neck, hands, shoulders, lower legs, and feet, and on the back, using big or slow strokes, noncontact therapeutic touch, acupressure or rubbing, and kneading.

The massage and touch therapy program will be scheduled in between other activities in the facility. Considering that massage and touch therapy needs an agreement between the therapist and the patient, a consent form will be provided for each patient to sign as well as a verbal agreement. This will ensure the program will be voluntary and not coerced. In case a patient does not agree more patient education will be done to ensure the patient understands the benefits associated with the intervention. Massage and touch therapy will be important for reducing agitation in patients with dementia and reduce the possibilities of negative behaviors. Also, it will bring positive changes in the quality of life for dementia patients as massage and touch therapy will act as a coping mechanism for the negative experiences experienced by dementia patients and reduce the burden of care for the nursing team.

The project will be evaluated through observation and recording. At the end of the first three weeks, the number of patients who were exacerbating agitation followed with negative behaviors should have reduced intensively. At the end of the six weeks, it will be necessary to measure the average length of time required for the message and touch therapy to be effective. The project team will measure intensity of the massage and touch therapy that would be appropriate for mild, moderate and severe agitation to significantly reduce the distress experienced by dementia patients with agitation problems. 

References

Carrarini, C., Russo, M., Dono, F., Barbone, F., Rispoli, M. G., Ferri, L., ... & Bonanni, L. (2021). Agitation and dementia: prevention and treatment strategies in acute and chronic conditions. Frontiers in Neurology, 12, 480. https://doi.org/10.3389/fneur.2021.644317

Ijaopo, E. O. (2017). Dementia-related agitation: a review of non-pharmacological interventions and analysis of risks and benefits of pharmacotherapy. Translational Psychiatry, 7(10), e1250. https://doi.org/10.1038/tp.2017.199

Kongpakwattana, K., Sawangjit, R., Tawankanjanachot, I., Bell, J. S., Hilmer, S. N., & Chaiyakunapruk, N. (2018). Pharmacological treatments for alleviating agitation in dementia: a systematic review and network meta‐analysis. British Journal of Clinical Pharmacology, 84(7), 1445-1456. https://doi.org/10.1111/bcp.13604

Liu, K. Y., Stringer, A. E., Reeves, S. J., & Howard, R. J. (2018). The neurochemistry of agitation in Alzheimer’s disease: a systematic review. Ageing Research Reviews, 43, 99-107. https://doi.org/10.1016/j.arr.2018.03.003

Scales, K., Zimmerman, S., & Miller, S. J. (2018). Evidence-based nonpharmacological practices to address behavioral and psychological symptoms of dementia. The Gerontologist, 58(suppl_1), S88-S102. https://doi.org/10.1093/geront/gnx167

Schaub, C., Von Gunten, A., Morin, D., Wild, P., Gomez, P., & Popp, J. (2018). The Effects of Hand Massage on Stress and Agitation Among People with Dementia in a Hospital Setting: A Pilot Study. Applied Psychophysiology and Biofeedback, 43(4), 319–332. https://doi.org/10.1007/s10484-018-9416-2