Growing Old with Massage
In Facility Care
By Dawn Nelson, C.M.T.
Originally published in Massage & Bodywork magazine, February/March 2001.
Copyright
2003. Associated Bodywork and Massage Professionals.
All rights reserved.
While the changes accompanying aging can be unsettling and frightening to the
elderly, it's comforting to know that something as simple as frequent touch can
stimulate maturing minds and bodies, ensuring that the concomitant traumas of
our later years are minimized. As a bodyworker,
bringing touch to this facility-bound population can bring both heartache and
joy, but the value of your work cannot be denied.
As most people age, they begin to notice a gradual slowing down of their
physical and mental capabilities. Joints become worn, making them susceptible
to crippling and painful conditions such as arthritis, bursitis and tendinitis. The skin loses some of its elasticity and
moisture, as well as changes in pigmentation. Lung capacity decreases as does blood flow to the brain. Decreased mobility contributes
to poor circulation and constipation, as well as a gradual loss of muscular
strength and tone. And changes in physical and mental acuity, including hearing
deficiencies and visual impairments, often lead to decreases in functional
abilities.
Growing older also means facing a number of irreversible and potentially
stress-producing life changes like retirement, relocation and widowhood. The
losses associated with aging often are permanent (as opposed to losses in
earlier stages of life from which we more readily recover) and occur closer
together with less time to adjust between events. Chronic illness and
functional limitations can increase anxiety about the future and create greater
dependency on others.
As life spans increase, the number of people requiring long-term health care is
also increasing. It is estimated that in the coming year, almost 9 million
older Americans will need extended health care services. Some of these men and
women transfer to nursing homes for rehabilitation after an accident or injury,
or to convalesce after a serious illness. Others will live out their lives
confined to care facilities. Those people may be too frail to take care of
themselves and live safely, or they may suffer from a chronic illness and need
medical attention. Family care may not be an option because there is no family
member available, or because family members are unable to provide the care that
is needed.
A Loss of
The move into a health care facility signals a significant loss of independence
and constitutes a major lifestyle change for both the person involved and their
family. Relocation may create additional losses, including forfeiture of one's
home, familiar surroundings and privacy. Treasured possessions may need to be
sold, put in storage or given away. Also, those living their lives in care
facilities usually have less contact with the outside world and fewer social
relationships than those who live independently or with family.
When a person becomes a resident of a care facility, he or she is suddenly
relegated to rules. Meals, rest periods and activities are scheduled for
efficiency in management and convenience of caregivers rather than according to
individual preferences, lifestyle choices or personal habits and rhythms.
Depression and Stress
Multiple losses combined with decreased mobility and
functional impairments frequently lead to depression. According to a recent
article by Paula Dranov entitled "Depression and
the Elderly," the suicide rate among people over 65 is higher than any
other age group.
Combined with health conditions requiring medical attention, a gradual decline
in functioning and increased dependency on others can make these losses
extremely stress-producing. While a certain amount of stress can be positive,
we all know too much or prolonged stress can be unpleasant and unhealthy.
Stress lowers resistance to viruses and can lead to more acute, chronic or even
life-threatening health problems.
Massage therapists know stress affects the physical body by causing muscular
tightness, tension, stiffness and restricted energy flow. Continued stress can
lead to muscle spasms, as well as bodily contraction, restricted movement and
rigidity. Other signs of stress may include headaches, backache, fatigue,
insomnia, stiff neck, cold hands and/or feet, perspiration, shortness of
breath, constipation, etc. Physical stress tends to produce more emotional
stress, thus setting up a cycle of disease, discomfort and anxiety which can
generate feelings of confusion, frustration, isolation and vulnerability for
the elderly. Such feelings eventually lead to inertia, despondency, withdrawal
and a "failure to thrive" syndrome.
Reaching Through Isolation
In his classic book, Touching: The Human
Significance of the Skin, Ashley Montague says it is the "emotional
involvement of touch that can reach through isolation."1 Touch can communicate love,
affection and warmth which can help alleviate feelings of loneliness and
separation. Touch becomes especially important for those confined to health
care institutions who may receive few visitors from the outside world. Though
basic needs are met, these individuals often remain starved for the nourishment
that comes through caring, attentive touch and skin-to-skin human contact.
Massage and touch therapy are, in fact, ancient healing modalities which
somehow became lost in the maze of modern medical technology, pills and
paperwork. Back rubs were once routinely and effectively administered by nurses
as a non-invasive therapeutic tool to promote rest and relaxation. Fortunately,
massage is being rediscovered as a complementary and alternative therapy in caregiving. Age-appropriate, gentle massage and attentive
touch techniques are particularly effective in providing comfort care and in
enhancing quality of life for those who reside in a nursing home or extended
care facility environments.
Massage therapy is well-known for its ability to reduce muscular tension, relieve
minor aches and pains, increase circulation and induce a relaxation response in
the body. Tiffany Field, through her research at the Touch Institute in Miami,
has gained worldwide attention in discovering that therapeutic massage seems to
stimulate the release of endorphins - the body's natural painkillers - into the
brain and nervous system, boost the immune system and promote faster healing
after injury, trauma or surgery.2
While little hard research is, at present, being conducted on the benefits of massage
for nursing home residents, anecdotal reports from those working in this field
have been extremely positive.
In 1996, a six-month pilot program on the use of massage therapy as an
intervention for problem behaviors in nursing home residents with dementia,
conducted at the Methodist Home in Chicago, found correlations between certain
types of massage - and where it was applied on the body - and managing specific
behaviors. For example:
- Back rubs worked wonders for those confined to wheelchairs, for people in
chronic pain and for residents exhibiting irritability or even anger.
- Foot massage proved calming for those exhibiting hyperactive behavior or
restlessness and "wandering" behavior.
- Hand massage or face stroking seemed to help those exhibiting anxiety, worry,
sadness and fearfulness.
- Massaging the temples, scalp and forehead helped reduce headaches and
tension, and shoulder and neck massage seemed useful for those exhibiting
tiredness, irritability or mild upset.3
An unpublished report from a case study conducted by Christine Gruschke, nurse consultant for Beverly Health and
Rehabilitation Services, Inc. (1997), showed a tremendous improvement in mood
and anxiety levels in residents receiving geriatric massage therapy in a
Florida nursing home once a week for an average of three months. Perhaps most
noteworthy was the documented reduction in medications (representing a
significant financial savings) taken for pain management for many of the 21
residents in this particular study.
Nursing manuals have long prescribed massage to help in the prevention of skin
ulcers (pressure sores), a chronic problem for the frail elders who spend most
of their time in a bed or wheelchair. Even very gentle massage can help improve
circulation.
The focused attention afforded in massage and touch therapy sessions to
residents of health care facilities also has significant psychosocial benefits,
including:
- one-on-one attention
- skin-to-skin contact
- tactile and sensory stimulation
- an opportunity for social interaction
- nurturing
- comfort
- reassurance
- pleasure
Touch is a universal language. Gentle massage is a way of communicating with
those who are non-verbal or unable to express themselves well orally. The
practitioner who is able to keep her attention on the individual who inhabits
the body and who is alert to the subtle nuances and changes in the physical
being, breathing patterns and so on, will have little trouble understanding
what the person needs.
Massage therapist Jeannie Battagin tells a beautiful
story about sitting next to a lady in an intermediate care facility who was
seldom able to speak in intelligible language but would babble for long periods
of time as though she was trying to communicate.
"As she continued to 'talk,' I put my hand on hers. I began to slowly
stroke down her arm from the shoulder, very gently. She seemed to relax into
this, so after a little while I did the same thing with her other arm, stopping
to spend extra time massaging her hands. For some reason, I felt drawn to put
one of my hands on her cheek. She closed her eyes at this point, as if she was
savoring the touch there. So I put my other hand on her other cheek and just
stayed there cradling her face in my hands. A minute or so went by and I
realized by the weight of her head and by her breathing that she had let go
enough to fall asleep."4
Combating Dementia
At least half the population in most skilled nursing
facilities suffer from some form of dementia. Massage offers therapeutic
support for such people by increasing body awareness and helping to ground
those who are confused and disoriented, bringing them back into present time
and physical reality.
The use of conscious and compassionate touch helps address quality-of-life
issues common among residents of long-term care facilities:
- touch deprivation
- low self-esteem
- anxiety
- boredom
- depression
- lethargy
In addition, skilled touch is a great aid in managing challenging behaviors
sometimes characteristic of those living with dementia-related conditions, like
Alzheimer's disease, restlessness, wandering, agitation, fearfulness and
withdrawal. Utilizing skilled touch can help in such situations by focusing and
engaging attention, redirecting energy, promoting interaction and calming.
A back rub or lotion massage to hands or feet might also be used as a
distraction, if necessary, to help in accomplishing the tasks of daily care.
Years ago, nurses were taught how to give back massages, instead of pills, to
help lull their patients into restful sleep at bedtime. Unfortunately, most
nurses these days are kept so busy dispensing pain-reducing and sleep-inducing
medications they have no time to give their patients one-on-one attention or to
touch them in a conscious, caring way.
Much has been made of the fact that human contact in the form of touch is
crucial during the early stages of life. Research has proven that
institutionalized infants deprived of caring touch soon stop eating and fail to
thrive. Similarly, my observation and experience in working with the elderly
has shown that those who are deprived of nurturing physical contact experience
a diminishing quality of life, a lessening of their desire to relate to others
and a weakening of what may already be a fragile relationship with physical reality.
As a therapeutic modality, age-appropriate massage is a cost-effective,
non-pharmacological resource for reducing stress, managing challenging
behaviors and enhancing quality of life for the elderly and ill, particularly
those who are confined to care facilities. Montague writes, "The use of
touch and physical closeness may be the most important way to communicate to
ill and aged persons that they are still important as human beings."5
Unconditional, caring touch is a powerful acknowledgment to the individual
that, regardless of the condition of the physical body, he or she is still a
part of the human race, and still has value as a whole human being. This is
healing in its true and deepest sense.
Dawn Nelson, CMT, founder and director of Compassionate Touch® for those in
later life stages, is an internationally recognized speaker, author and
educator, and a pioneer in the effort to include massage in care plans for
those in Alzheimer's facilities, nursing homes and hospice programs. Her first
book, Compassionate Touch: Hands-On Caregiving for
the Elderly, the
References
1. Montague, Ashley. Touching: The
Human Significance of the Skin, 3rd ed. (Harper and Row: New York, 1986).
2. Field, Tiffany. Keynote to AMTA National Convention,
3. Belle, Cynthia. 4th National Alzheimer's Disease
Education Conf. presentation,
4. Battagin, Jeannie, CMT. Personal
Communication, 1997.
5. Montague.