About 800, 000 people in Britain now have dementia, & this number is set to rise to 1 million by 2021 as the population ages. Howeverdementia is affecting ever younger people, with many people being diagnosed asyoung as in their forties. Alzheimer's disease affects the majority of thosewho have dementia.
Dementia is a progressive disease for which there is no cure,although certain medicines & cognitive stimulation therapy can slow its progress.Much research is still needed as to the cause of the disease, & thisdepends on the type of dementia diagnosed, but vascular dementia &Korsakoff's syndrome can be related to lifestyle choices. For example, if youlead a lifestyle which compromises your vascular system, you may become moreprone to dementia if vascular disease causes brain damage, & similarly,prolonged alcohol abuse can increase your risk of developing Korsakoff'ssyndrome.
Increasingly, the approaches to caring for those who live withdementia is to focus on stimulating the individual through meaningfulengagement, exercising the brain, reminiscence or through the senses. TheNational Dementia Strategy 2009 set a challenge to use therapeutic interventionin order to reduce the need for medication & help people live well withdementia.
As therapists involved in caring for those who live withdementia, it is our responsibility to allow space for expression of feelings& nurture a person's core or spirit. Massage is one such way to do this,but massage alone is not enough. Understanding the world on your client's termsis paramount to them feeling comfortable about allowing you into their space sothat you can address their innermost feelings, anxieties, fears & of courseaddress any physical complaints they may wish to have treated.
There are many benefits of massage for someone who lives withdementia. It can ease anxiety brought about by the disease itself or by themedication taken.
It is well known that as people get older, they tend to receivenurturing touch less & less and you may be the only person touching aclient in a loving, therapeutic way. The average amount of time that people with dementia in care homes spend interacting with staff or otherresidents (excluding care tasks) is 2 minutes in every 6 hours. (Alzheimer's Society 'Home from Home'report '07)
Massage can promote clients' mental & emotional state as ithelps release the hormones; dopamine & oxytocin, which induce feelings oflove, attachment & heightened wellbeing, especially if you massage thefront of their body.
Touch is rarely misunderstood & people living with dementiarespond beautifully & often want to reciprocate the act of love &kindness. It can give them an opportunity to express affection appropriately. It can also be an opportunity for someone to release pent up emotions eitherthat they are feeling presently; feelings connected to older memories withwhich they may have more affinity; or due to reliving past experiences. Reassuringtouch & validation can gently coax them into a safer place. This mayinvolve entering their world so you can walk with them & bring them to aplace where they feel safe again.
Many people living with dementia become depressed. Gentle massage& hand holding are recommended by the Alzheimer's Society as some ways ofhelping ease depression.
Circulation is improved & can help the blood & oxygensupply to the brain. It can also relieve oedema, stiffness & aches &pains & stimulate lymph. Such conditions often occur because the client isless mobile than they used to be, either due to their lack of motor skillsbecause their brain function has become so impaired, because of otherillnesses, side effects from medication, dehydration, lack of staffing, orsimply deterioration that can come with age.
Massage can help improve or retain proprioception, our 6thsense responsible for location, movement & posture of our bodies within ourphysical space. Helping retain this sense helps a person retain the ability tocontinue to do more for themselves & maintain meaningful engagement indaily life.
Sleep patterns that have been disrupted due to damage to thetemporal lobe or side effects from medication can be improved.
Touch can bring comfort & peace to people at the end of theirlife. Combine this with the appropriate use of essential oils such asfrankincense, sandalwood & fragonia, & you can aid a more gentle,dignified death.
Before you enter the space of someone with dementia, it isparticularly important to leave behind any agendas you may have as people withdementia are experts at living in the moment & focusing on body language,facial expression & intonation. Being genuinely concerned with only themwill help build rapport. Smiles and compliments go down well too.
Introductions should always be positive & give clues aboutyourself & what your intentions are. Permission should be obtained prior toeach treatment & you should be aware of any non verbal clues that someonemay display if they are finding what you do uncomfortable for any reason. Youmay need to introduce massage in a way that is acceptable to the person in away that fits with their reality. One gentleman always thought massage hadsleazy connotations, but when I introduced it as having neck treatment, he washappy to have his neck rub & hands massaged, which relaxed him, reduced hisanxiety which manifested as tension in his neck & shoulders, & easedhis stiff, achy joints. We built a positive relationship through touch. He maynot have remembered who I was specifically, but often approached me asking mein his way to address the pain in his hands. Positive relationships can bebuilt on positive experiences, despite short term memory issues.
I always approach clients from the side or front so as not totake them by surprise. When someone is near the end of their life theirperipheral vision may be impaired, so it is best to approach them from thefront. I often use physical introductions, placing my hands on their feet oruse slow, rhythmical, gentle pressure release techniques to define the area Iwish to massage. This leads into a very leisurely, repetitive effleuragesession.
Repetition should become your friend, not only verbally butphysically too. Your recent memory recorder, located in your temporal lobe, hasabout 30 seconds before it dumps information into your long term memory. Ifthis transferral of information is interrupted it means that short term memorycan become increasingly affected. It also means that it may take longer forinformation to sink in; I usually allow at least 5 times as long for someone tounderstand what I may be saying verbally or with my hands. Bearing this inmind, it makes sense to repeat massage moves in your sequence many more timesthan you usually would.
I gently apply pressure points when appropriate; not only fortheir connected benefit (eg ST36 which is widely used in China for the elderly, boostingenergy, immunity & general wellbeing) but also because it allows you bothto connect in the stillness of the present & enjoy the peace therein.
Obtaining a full history of your client, not only medically butfinding out about their life history, interests, hobbies & passions willequip you with more information to tailor your approach to better suit theirneeds. It helps builds rapport enabling your client to feel more comfortableabout having you place your hands on them, giving you clues as to the style& approach you may use. I regularly communicate with staff, family, friends& advocates, which helps me continue to build a picture about what isimportant to my client. It can provide reassurance to their loved ones too formany reasons, including knowing they are having on-to-one intervention,therapeutic input & hearing about positive experiences their loved one isexperiencing.
Addressing hotspots can make a huge difference to some clients.Some of these tend to manifest around the cervical & upper thoracicvertebrae. Holding tension in this area can restrict vital blood flow to thebrain. Releasing tension in this area can improve oxygen & nutrient supplyto the brain. The area on the skull between GV19 to GV23 can be gentlystimulated to relieve depression & improve memory. It is also useful forcalming & inducing emotional harmony.
As dementia progresses, it becomes increasingly important toengage with people on their own terms to bring about wellbeing & to nurturetheir core. It is helpful to pass on our knowledge & skills to loved ones& carers so that they may continue this important connection between theperson living with dementia & those around them. People at the very end oftheir lives deserve to be treated with dignity, respect & love. Ireiterate, touch is rarely misunderstood & has a pathologically positiveresponse for almost everyone, & with it comes the gift of truly being inthe moment with someone. Touch is one of the last senses to connect us to theouter world, & massage is a wonderful medium through which to express oove & care to someone, as well as allow them an opportunity to express howthey feel, because feelings matter most.
About the author:
Nicolle Mitchell I.T.E.C., CTha, MFHT Holistic Massage Therapist & Trainer The Little Massage Clinic, 3 Bond Street, Redruth, Cornwall, TR15 2QA Tel: 01209 711686 Email: firstname.lastname@example.org Nicolle has been practicing massage since 1998. She has worked therapeutically with children, young people & people with special needs for 20 years, specialising in the field of dementia in the past 6 years. Nicolle has developed the first approved/accredited course about Â?How to Massage People with DementiaÂ? in the UK. She was awarded the FHT Excellence in Practice Innovation Award on 5th October 2012, at the Grange Hotel, St PaulÂ?s, London, for developing her course & raising the profile of communicating compassionately with & enabling people with dementia & their carers. Janey Lee Grace who compered the evening introduced the presenation of the award, "This lady has developed a course for massaging people who have dementia, managing & understanding the special needs of this special group and empowering therapists to work knowledgeably, sensitively and safely. With dementia diagnosis on the increase, this innovative course has been developed, some would say, just in time." Nicolle regularly visits clients with dementia to administer integrated massage treatments which involve aromatherapy, validation therapy & reminiscence work. She has her own range of TLC in a Bottle Â?Sense & SeasonÂ? aromatherapy products designed to encourage positive reminiscence, & further address mental, emotional, physical & core issues. Nicolle has travelled across Cornwall delivering information sessions to carers, friends, family & neighbours of people who live with dementia, giving practical tips regarding behaviours that challenge, communication, stress management as well as signposting to vital support services. This work also included supporting groups of carers, friends & family on how to use Cognitive Stimulation Therapy at home to help exercise loved oneÂ?s brains.
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