Touch massage for dementia

This document was published more than 2 years ago. The nature of the evidence may have changed.

Findings by SBU Alert

Version: 1

Technology and target group

Touch massage can be used as a general term to cover, eg, tactile stimulation, peripheral tactile nerve stimulation, tactile massage, aromatherapy massage, hand massage, expressive physical touch, and effleurage. Touch massage is given to patients, eg, with dementia, as a complement to other treatment and nursing care, as a part of daily care activities. The aims of treatment are to give patients a greater sense of well-being, reduce stress, and relieve pain, thereby decreasing anxiety and aggressive behaviors in the patient. Touch massage may be applied to different areas of the body and carried out by staff or family carers. The frequency and length of massage treatment varies, and the potential target group is large.

Patient benefit

The effects of touch massage, mainly hand massage, have been investigated in a few small, short-term studies. Long-term studies have not been reported. One controlled study of 16 patients has been reported. The results suggest that massage can have positive effects on depression, anxiety, mood, activity, contactability, and some memory functions. Three studies using a pretest-posttest design with no control groups have been identified. One of these reported significant effects as regards a lower frequency and intensity of hitting, yelling, grabbing, and trying to get to another place. One study reported fewer anxious behaviors after intervention and two studies reported lower pulse rates after each massage session as compared to before the sessions. In another study addressing the effects on agitated behavior in severe dementia, massage yielded conflicting results. In summary, it appears that massage may have positive effects in people with dementia. However, the studies are too small to draw firm conclusions.

Ethical aspects

In treating patients with low autonomy, as is the case in dementia, the concepts of "free will" and consent are central issues that concern the patient and family. Voluntary participation is essential so that massage is not perceived as intrusive and offending by the patient nor obligatory for the caregiver.

Economic aspects

There are no economic studies on the effects of massage.

Scientific evidence

There is poor* scientific documentation concerning the effects of touch massage for dementia patients. There is no* scientific documentation on the costs or cost effectiveness.

Since knowledge on the effects and costs for massage is very limited, large multicenter studies should be conducted to assess massage before it is adopted by the health services as routine care.

*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.

This summary is based on a report prepared at SBU in collaboration with Assoc. Prof. Mona Kihlgren, Centre for Nursing Science, Örebro University Hospital, Örebro, Åsa Krusebrant, RN, MSocSc, Caring Edu., The Swedish Red Cross University College of Nursing, Stockholm, and Kirsti Skovdahl, MS, doctoral student, Centre for Nursing Science, Örebro University Hospital, Örebro. It has been reviewed by Prof. PO Sandman, Department of Nursing Science, Norrland University Hospital, Umeå and Prof. Kenneth Asplund, Department of Caring Sciences, Mid Sweden University, Sundsvall.

The complete report is available in Swedish only.

Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.

References

  1. Ardeby S. Taktil stimulering - ett sätt att kommunicera när orden inte räcker till. Utbildningsmaterial. Studieförbundet Vuxenskolan 1993.
  2. Braverman DL, Schulman RA. Massage techniques in rehabilitation medicine. Phys Med Rehabil Clin N Am 1999;10(3):631-649.
  3. Brooker DJ, Snape M, Johnson E, Ward D, Payne M. Single case evaluation of the effects of aromatherapy and massage on distributed behaviour in severe dementia. Br J Clin Psychol 1997; 36 (Pt 2):287-296.
  4. Field TM. Massage therapy effects. Am Psychol 1998;53(12):1270-1281.
  5. Finkel SI, Costa e Silva J, Cohen G, Miller S, Sartorius N. Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Int Psychogeriatr 1996;8 Suppl 3:497-500.
  6. Forbes DA. Strategies for managing behavioural symptomatology associated with dementia of the Alzheimer type: a systematic overview. Can J Nurs Res 1998;30(2):67-86.
  7. Hall GR, Buckwalter KC. Progressively lowered stress threshold: a conceptual model for care of adults with Alzheimers disease. Arch Psychiatr Nurs 1987;1(6):399-406.
  8. Kilstoff K, Chenoweth L. New approaches to health and well-being for dementia day-care clients, family carers and day-care staff. Int J Nurs Pract 1998;4(2):70-83.
  9. Kim EJ, Buschmann MT. The effect of expressive physical touch on patients with dementia. Int J Nurs Stud 1999;36(3):235-43.
  10. Opie J, Rosewarne R, O´Connor DW. The efficacy of psychosocial approaches to behaviour disorders in dementia: a systematic literature review. Aust N Z J Psyhiatry 1999;33(6):789-799.
  11. Scherder EJA, Bouma A, Steen AM. Effects of simultaneously applied short term transcutaneous electrical nerve stimulation and tactile stimulation on memory and affective behaviour of patients with probable Alzheimers disease. Behav Neurol 1995;8:3-13.
  12. Scherder E, Bouma A, Steen L. The effects of peripheral tactile stimulation on memory in patients with probable Alzheimers disease. American Journal of Alzheimers Disease 1995;10:15-21.
  13. Scherder E, Bouma A, Steen L. Effects of peripheral tactile nerve stimulation on affective behaviour of patients with probable Alzheimers disease. American Journal of Alzheimers Disease 1998;13:61-69.
  14. Snyder M, Egan EC, Burns KR. Efficacy of hand massage in decreasing agitation behaviors associated with care activities in persons with dementia. Geriatr Nurs 1995;16(2):60-63.
  15. Snyder M, Egan EC, Burns KR. Interventions for decreasing agitation behaviors in persons with dementia. J Gerontol Nurs 1995;21(7):34-40.
  16. Uvnäs-Moberg K. Oxytocin may mediate the benefits of positive social interaction and emotions. Psychoneuroendocrinology 1998;23(8):819-835.

SBU Assessment presents a comprehensive, systematic assessment of available scientific evidence. The certainty of the evidence for each finding is systematically reviewed and graded. Full assessments include economic, social, and ethical impact analyses.

SBU assessments are performed by a team of leading professional practitioners and academics, patient/user representatives and SBU staff. Prior to approval and publication, assessments are reviewed by independent experts, SBU’s Scientific Advisory Committees and Board of Directors.

Published: 5/7/2002
Contact SBU: registrator@sbu.se
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