Massage and dementia: A case study

A report in 2019, commissioned by Alzheimer’s Society from the London School of Economics and Political Science (LSE), estimates there are 57.4 million people living with dementia around the globe. It is projected that this number will rise to 152.8 million by 2050. 

The same report estimates around 900,000 people are living with dementia in the UK. This is projected to rise to 1.6 million people by 2040.

Furthermore, the Office for National Statistics (ONS) in England reported in April 2022 that dementia and Alzheimer’s disease were England’s biggest killer. 

Broadly speaking, the symptoms suffered by patients of dementia and Alzheimer’s include communication disorders associated with behavioural and psychiatric disorders (Van Dyke 2013). 

Currently, there is no cure for dementia or Alzheimer’s so treatment is focused on living well for as long as possible; as written in the advice from The Alzheimer’s Society. Treatment is patient focussed as each presentation and person with the disease will have varying symptoms and will have a different response to treatment. 

There are limited research studies into non-pharmacological treatments available, however, this is slowly changing with some good research around music, singing and manual therapy. 

Specifically focussing on manual therapy, Margenfeld (2019), found that manual massage may serve as a non-pharmacological strategy to improve behavioural and psychological symptoms in persons living with dementia. Additionally, when Hansen et al (2006), studied “Massage and touch for dementia”, they found that hand massage relieved symptoms of agitation and that touch helped with communication, particularly when aiding to eat.

They conclude that, although further research is required, massage and touch may serve as alternatives or complements to other therapies for the management of behavioural, emotional and other conditions associated with dementia such as anxiety and depression. In a previous blog, I have written about massage and stress and the positive effect this course of treatment has on our cortisol levels (the stress hormone).

Although more detailed studies are required to determine the parameters of treatment, there are little to no side effects with trying massage and I would like to present a specific case study to show how beneficial this type of treatment can be for dementia and Alzheimer’s patients. It is a rewarding and humbling case, and the reason I seek to help more people with these disorders. 

A case study - 'Sonya'

'Sonya', aged 78.

Sonya has had Alzheimer's disease for several years. She was active, enjoying lovely walks and exercise sessions, managing the steady cognitive decline of dementia. In 2020, a devastating fall down the stairs led to a time in hospital. Miraculously, there were no broken bones or abnormal scans into brain activity, but something was triggered and this incident led to immobility and loss of speech.

She has amazing around the clock care at home, but the needs have now changed. From working on exercise for motor control and strength with tailored exercises round the living room, it was now my role to help with appropriate soft tissue and manual therapy, and to build our relationship and trust again.

After a period of recovery and absence coupled with progression of Alzheimer's, I was no longer a familiar face. From a once chatty, active woman, to now bed or chair bound, mute and with further cognitive decline, there were additional challenges. 

Before re-meeting her, I felt expectantly nervous as I needed to gain Sonya's trust again, working safely and effectively to help, not cause discomfort, and be aware of personal space and gauge reaction to the treatment.

But, I needn't have worried, her gorgeous smile and cheeky personality were still very much present and, although I wasn't recognised, I felt welcomed. 

It is important to me in my job to use vital skills of touch and movement to relax and reassure the client. Without speech as means of communication, it is ever more important to recognise and acknowledge other signs such as body language, facial expression and reaction.

Massage is thus much more powerful and we can be in tune with one another, really noticing the deep sighs of relaxation, and the improvement of dementia symptoms such as agitations and tremors, the latter backed up by research (Hansen, 2006). 

Even more rewarding are the occasional words. On my second visit, upon entering Sonya's room and greeting her as usual, she responded with her lovely smile and said "I like your hair" - this was the best welcome and reassurance for commencing treatment that day, no other words were whispered in this session. But it was enough. 

Sometimes Sonya may have a down day, perhaps a slower morning, as we all do. "No smiles today yet", the carers might say. 

As I walk in, I can see her down turned mouth, a little fed up, or vacant as is the case with dementia sufferers. No response from my greetings of "Hello Sonya, I'm Laura, here for your massage today". Sonya continues to stare forward. Then, after gently placing my hand on her leg to introduce touch, and proceeding with some gentle reassuring massage strokes and techniques and all important eye contact, I hit the jackpot. The frown turned upside down, an acknowledging smile, the one that so often lights up her face. I'm encouraged to continue on and we share glances, and smiles and sometimes the odd giggle or even some mumbled words and pointing at objects of interest.

Other days there may not be such great activity but a deep sigh of energy release and notable relaxation through the body is enough to feel reassurance that the session is working, and helping. They are encouraging responses, and fill me with joy that I am able to offer such release to a person suffering such a complex and frustrating disease. 

Since treating Sonya twice a week over the last few months I have observed a reduction in tremors of the feet and hands, a sign often termed as agitations. As Sonya has less movement in her legs and feet than her hands due to immobility - treatment has helped to provide some assisted movement and stretching to the lower body. Perhaps this has had a positive effect on the nervous system as well as improving stiffness, swelling and lymphatic drainage leading to the improvements observed. 

It is hard to understand the extent to which Sonya remembers who I am each session. Once she has seen me, usually after the first touch, her warm smile tells me she does, but this could also be an example of her warm, happy and friendly personality I was lucky to know. Sonya and other dementia clients have taught me that, despite the cruel effects Alzheimer's has on our mind and body, in some cases, the people we know and love are still with us, sometimes hidden deep inside the frustrations of this cruel disease, but there are ways we can help them and their families enjoy the essence of who they are. Recently I have been welcomed with, “hello my darling”. Such joy and warmth in this greeting, one we may simply take for granted pre-dementia.

Our Mother has been suffering from Alzheimer's for several years. We wanted to explore how best to help her and Laura came up with an excellent treatment plan which seemed to really benefit our mother. Our mother trusted her and really enjoyed the exercises and massage.

Sonya's family 

Massage is one tool I believe we should be using in these cases, as well as singing and music, where research has shown our brains can remember lyrics and tunes due to repetition and differing connection pathways.

I can vouch for this personally, as my very own beloved Grandma of age 94, a dementia sufferer, doesn't recognise who we are but, when we are with her, she is often heard singing the alphabet backwards! Mind you, she isn't aware it is the alphabet backwards, but it is a song she always knew as an English teacher. We know our Grandma/Mother is still with us. 

Types of massge for dementia and Alzheimer's 

Effective massage sessions can range between 20 to 60 minutes and can include a bespoke blend of different styles, techniques and uses. Some examples include:

• 20 minute hand massage - helps connect to emotions, aids agitations and sense of touch.
• Head, neck and shoulder massage - for tension and stress relief, ease anxiety. 
• Lymphatic drainage - great for those immobile clients to help the flow of fluid around the body.
• Joint stretching and mobility to ease stiff joints. 

There are little to no side effects to massage therapy, well qualified therapists will ensure appropriate techniques, use of oil and consideration towards conditions and age are of top priority.

Although the one drawback is the need to self-pay for these treatments, it without doubt helps the whole family. Treatments need to be carried out by trained and insured experts, it is always wise to check before asking someone to perform massage therapy.

For more information, or to arrange a chat, contact us at (email) info@pwroom.co.uk, text 07474 9555 44 or book sessions online at info@pwroom.co.uk.

References

• Hansen, Jørgensen, and Ørtenblad, (2006) Massage and touch for dementia. Cochrane Database Syst Rev. 
• Margenfeld, Klocke, Joos, (2019) Manual massage for persons living with dementia: A systematic review and meta-analysis. Int J Nurs Study.
• Schaub, Gunten, Morin, Wild, Gomez, and Popp, (2018) The Effects of Hand Massage on Stress and Agitation Among People with Dementia in a Hospital Setting: A Pilot Study. Appl Psychophysiol Biofeedback. 43(4): 319–332.
• Van Dyke MR, Kohler M, Camus AKV, Von Gunten A. Prise en charge globale et thérapies actuelles de la démence de type Alzheimer. In: Schenk F, Leuba G, Büla C, editors. Du vieillissement cérébral à la maladie d’Alzheimer: Autour de la notion de plasticité. Bruxelles: De Boeck; 2013. pp. 277–307.