Massage in the Management of Agitation in Nursing Home Residents with Cognitive Impairment

The Effect of Foot Reflexology on Amnesia in Patients Undergoing Electroconvulsive Therapy: A Randomized Clinical Trial

Introduction: Electroconvulsive therapy (ECT) is the oldest procedure among the early biological treatments introduced in psychiatry. However, the most debated and treatment-limiting adverse effect of ECT is amnesia. Therefore, due to the restriction of the use of drugs to manage amnesia in patients undergoing ECT, the present study investigated the effect of reflexology on amnesia.

Methods: In this randomized controlled trial, 68 patients who met the inclusion criteria were randomly allocated to intervention and control groups. The intervention group received foot reflexology with olive oil 20 minutes a day for 3 days, while the control group was given a gentle foot rub with olive oil 20 minutes a day for 3 days. The amnesia rate of all patients was measured by the Galveston Orientation and Amnesia Test (GOAT) 30 minutes after the end of ECT. The data were analyzed using SPSS software version 11.5 and t-test, chi-squared test, and repeated measures ANOVA.

Results: The results showed that reflexology significantly increased recalling scores in the intervention group compared to the control group. Foot reflexology seems to be effective in managing amnesia in patients after ECT.

Conclusion: Foot reflexology, as a relatively simple, inexpensive, and non-invasive technique with few side effects, can be used to manage amnesia in patients after ECT.

ABH Gel: Comforting Cure or Pricey Placebo?

Despite a lack of evidence of benefit, the compounded product ABH gel (lorazepam, diphenhydramine, and haloperidol) continues to be prescribed for individuals in hospice and palliative care settings for the treatment of nausea and vomiting and terminal delirium. More effective and reliable pharmacological and nonpharmacological strategies exist for the treatment of these conditions in the palliative care and hospice settings. We discuss the pharmacokinetic and clinical evidence for the individual components of ABH gel, as well as the compounded product, and attempt to understand the mechanism of effect that some purport to see, as well as why the compound continues to enjoy such a cult following. Truly, the continued use of ABH gel makes for a pricey placebo and delays the treatment of end-of-life symptoms with modalities that work.

Organisational interventions for preventing and minimising aggression directed towards healthcare workers by patients and patient advocates

BACKGROUND

Workplace aggression is becoming increasingly prevalent in health care, with serious consequences for both individuals and organisations. Research and development of organisational interventions to prevent and minimise workplace aggression has also increased. However, it is not known if interventions prevent or reduce occupational violence directed towards healthcare workers.

OBJECTIVES

To assess the effectiveness of organisational interventions that aim to prevent and minimise workplace aggression directed towards healthcare workers by patients and patient advocates.

SEARCH METHODS

We searched the following electronic databases from inception to 25 May 2019: Cochrane Central Register of Controlled Trials (CENTRAL) (Wiley Online Library); MEDLINE (PubMed); CINAHL (EBSCO); Embase (embase.com); PsycINFO (ProQuest); NIOSHTIC (OSH-UPDATE); NIOSHTIC-2 (OSH-UPDATE); HSELINE (OSH-UPDATE); and CISDOC (OSH-UPDATE). We also searched the ClinicalTrials.gov (www.ClinicalTrials.gov) and the World Health Organization (WHO) trials portals (www.who.int/ictrp/en).

SELECTION CRITERIA

We included randomised controlled trials (RCTs) or controlled before-and-after studies (CBAs) of any organisational intervention to prevent and minimise verbal or physical aggression directed towards healthcare workers and their peers in their workplace by patients or their advocates. The primary outcome measure was episodes of aggression resulting in no harm, psychological, or physical harm.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods for data collection and analysis. This included independent data extraction and 'Risk of bias' assessment by at least two review authors per included study. We used the Haddon Matrix to categorise interventions aimed at the victim, the vector or the environment of the aggression and whether the intervention was applied before, during or after the event of aggression. We used the random-effects model for the meta-analysis and GRADE to assess the quality of the evidence.

MAIN RESULTS

We included seven studies. Four studies were conducted in nursing home settings, two studies were conducted in psychiatric wards and one study was conducted in an emergency department. Interventions in two studies focused on prevention of aggression by the vector in the pre-event phase, being 398 nursing home residents and 597 psychiatric patients. The humour therapy in one study in a nursing home setting did not have clear evidence of a reduction of overall aggression (mean difference (MD) 0.17, 95% confidence interval (CI) 0.00 to 0.34; very low-quality evidence). A short-term risk assessment in the other study showed a decreased incidence of aggression (risk ratio (RR) 0.36, 95% CI 0.16 to 0.78; very low-quality evidence) compared to practice as usual. Two studies compared interventions to minimise aggression by the vector in the event phase to practice as usual. In both studies the event was aggression during bathing of nursing home patients. In one study, involving 18 residents, music was played during the bathing period and in the other study, involving 69 residents, either a personalised shower or a towel bath was used. The studies provided low-quality evidence that the interventions may result in a medium-sized reduction of overall aggression (standardised mean difference (SMD -0.49, 95% CI -0.93 to -0.05; 2 studies), and physical aggression (SMD -0.85, 95% CI -1.46 to -0.24; 1 study; very low-quality evidence), but not in verbal aggression (SMD -0.31, 95% CI; -0.89 to 0.27; 1 study; very low-quality evidence). One intervention focused on the vector, the pre-event phase and the event phase. The study compared a two-year culture change programme in a nursing home to practice as usual and involved 101 residents. This study provided very low-quality evidence that the intervention may result in a medium-sized reduction of physical aggression (MD 0.51, 95% CI 0.11 to 0.91), but there was no clear evidence that it reduced verbal aggression (MD 0.76, 95% CI -0.02 to 1.54). Two studies evaluated a multicomponent intervention that focused on the vector (psychiatry patients and emergency department patients), the victim (nursing staff), and the environment during the pre-event and the event phase. The studies included 564 psychiatric staff and 209 emergency department staff. Both studies involved a comprehensive package of actions aimed at preventing violence, managing violence and environmental changes. There was no clear evidence that the psychiatry intervention may result in a reduction of overall aggression (odds ratio (OR) 0.85, 95% CI 0.63 to 1.15; low-quality evidence), compared to the control condition. The emergency department study did not result in a reduction of aggression (MD = 0) but provided insufficient data to test this.

AUTHORS' CONCLUSIONS

We found very low to low-quality evidence that interventions focused on the vector during the pre-event phase, the event phase or both, may result in a reduction of overall aggression, compared to practice as usual, and we found inconsistent low-quality evidence for multi-component interventions. None of the interventions included the post-event stage. To improve the evidence base, we need more RCT studies, that include the workers as participants and that collect information on the impact of violence on the worker in a range of healthcare settings, but especially in emergency care settings. Consensus on standardised outcomes is urgently needed.

The Effects of Hand Massage on Stress and Agitation Among People with Dementia in a Hospital Setting: A Pilot Study

Agitation in people with dementia is a growing concern as it causes distress for both patients and their nurses and may contribute to relational disorders. Previous studies involving patients with dementia living in long-term care facilities have reported decreased agitation following massage. The objective of this pilot study was to investigate the effect of hand massage on agitation and biological markers of stress in patients with dementia hospitalized in an acute geriatric psychiatry service. In this randomized controlled trial we included 40 agitated patients with dementia with an intervention group and a control group. The study is designed to test the effect of seven hand massages over three continuous weeks on agitation and levels of salivary cortisol (sC) and alpha-amylase (sAA). Compared to the control group, the intervention group exhibited larger increases in sC and sAA at week 1 from before to after the massage, but larger decreases at week 2 and 3, with a significant group effect for sAA at week 2. Agitation scores were not significantly different between the groups but tended to decrease more in the intervention group than the control group. This study provides first encouraging results suggesting that hand massage might have beneficial effects on stress and agitation in hospitalized patients with dementia. It also highlights the challenges associated with conducting such studies with this complex patient population. Further studies are needed to confirm these findings and the benefits of hand massage as part of routine care for patients with dementia.

Feasibility of Training and Delivering Compassionate Touch in Long-Term Care

OBJECTIVES

Limited evidence supports the use of therapeutic touch for people with dementia (PWD). Interventions incorporating a person-centered approach to touch delivered by staff may benefit PWD and staff in long-term care settings. The Compassionate Touch^® (CT) program provides skilled human touch and a compassionate presence following a person-centered approach and touch protocol. The purpose of this study was to determine the feasibility of training and delivering CT.

METHODS

An online survey was sent via email to 112 staff who attended the CT coach training. Descriptive statistics and thematic analysis were used to analyze closed-and open-ended questions of the survey.

RESULTS

Twenty-four staff members completed the survey and reported positive perspectives about the training, use of the program, and benefits for PWD and themselves. Five themes emerged, including (1) benefits for residents, (2) challenges in using CT, (3) when to use CT, (4) training staff, and (5) needed support.

CONCLUSIONS

Preliminary findings from the present research show potential benefits of using the CT program for residents, challenges participants faced in using the program and training other staff, and support needed to overcome these challenges.

CLINICAL IMPLICATIONS

Programs such as CT may benefit PWD and staff in residential care settings.

Effect of Hand and Foot Massage Therapy on Psychological Factors and EEG Activity in Elderly People Requiring Long-Term Care: A Randomized Cross-Over Study

Massage therapy is widely used as a complementary therapy in the elderly. Here, we investigate the effect of hand and foot massage therapy on psychological factors and electroencephalographic (EEG) activity in elderly people requiring long-term care. We included 12 elderly people requiring long-term care, who were randomly divided into two groups (A and B). Group A received hand massage and group B received foot massage, both for 15 min each. After 1 week, group A received foot massage and group B received hand massage, both for 15 min each. We assessed emotions and mood states with a Likert scale after each massage and resting-state EEG activity was measured before and after each massage. Our results showed that both hand and foot massage led to a high degree of pleasant, relaxed, and refreshed feelings. Moreover, resting-state alpha activity significantly increased in the left insular cortex after hand massage (p < 0.05), and in the right and left posterior cingulate cortex after foot massage (p < 0.05). This study suggests that hand and foot massage therapy modulate psychological factors and EEG activity in elderly people requiring long-term care.

Massage Therapy for Psychiatric Disorders

This article reviews the current state of knowledge of the role of massage therapy in the treatment of common psychiatric disorders and symptoms. It briefly discusses the prevalence of psychiatric disorders and the popularity of complementary and integrative treatments in the general population. The authors touch on the growing literature describing the biology and neurobiology of massage therapy. The impact of massage as both a therapy for major psychiatric disorders and a treatment for psychiatric symptoms is reviewed, and how massage therapists conceptualize and treat their patients with psychiatric complaints is discussed. If psychiatrists are going to partner with massage therapists, they need to understand how massage therapists' perspectives differ from those of traditional practitioners of allopathic medicine. A model of how psychiatrists and other mental health professionals can work with massage therapists to care for patients is proposed, followed by a summary of the article's key points.

Complementary medicine for treatment of agitation and delirium in older persons: a systematic review and narrative synthesis

BACKGROUND

Agitation and delirium frequently occur in cognitively impaired older people. We conducted a systematic review with narrative synthesis of the literature aiming to assess effectiveness of complementary and alternative medicine (CAM) modalities to address these conditions.

METHODS

Following preliminary search, we included 40 original researches on CAM treatment of delirium and agitation in older persons. Then, the quality of these studies was assessed using the Downs and Black Checklist and Quality Assessment Tool for Studies with Diverse Designs, and the effect sizes were calculated. We subsequently conducted a narrative synthesis of the main findings, including theory development, preliminary synthesis, exploration of relationships within and between studies, and assessment of synthesis robustness.

RESULTS

Forty articles that met the inclusion criteria were analyzed. Sixteen of these were randomized controlled trials. One article specifically addressed CAM treatment of delirium in patients without dementia, and the remaining 39 articles described treatments of agitated older persons with dementia. Thirty-five of the 40 included studies suggested that the investigated CAM therapies may ameliorate the severity of agitation and delirium. The physiological surrogates of agitation assessed in these studies included cortisol level, chromogranin A level, and heart rate variability. Very few of the studies systematically assessed safety issues, although no major adverse effects were reported.

CONCLUSION

Overall, the systematic review of the literature suggests that several CAM modalities are potentially beneficial in the treatment of agitation and delirium among older persons. We suggest that promising CAM modalities should be further explored through large-scale randomized controlled trials in different clinical settings. Copyright © 2017 John Wiley & Sons, Ltd.

Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series

OBJECTIVE

To provide an overview of non-pharmacological interventions for behavioural and psychological symptoms in dementia (BPSD).

DESIGN

Systematic overview of reviews.

DATA SOURCES

PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO (2009-March 2015).

ELIGIBILITY CRITERIA

Systematic reviews (SRs) that included at least one comparative study evaluating any non-pharmacological intervention, to treat BPSD.

DATA EXTRACTION

Eligible studies were selected and data extracted independently by 2 reviewers.The AMSTAR checklist was used to assess the quality of the SRs.

DATA ANALYSIS

Extracted data were synthesised using a narrative approach.

RESULTS

38 SRs and 129 primary studies were identified, comprising the following categories of non-pharmacological interventions: (1) sensory stimulation interventions (25 SRs, 66 primary studies) that encompassed: shiatsu and acupressure, aromatherapy, massage/touch therapy, light therapy, sensory garden and horticultural activities, music/dance therapy, dance therapy, snoezelen multisensory stimulation therapy, transcutaneous electrical nerve stimulation; (2) cognitive/emotion-oriented interventions (13 SRs; 26 primary studies) that included cognitive stimulation, reminiscence therapy, validation therapy, simulated presence therapy; (3) behaviour management techniques (6 SRs; 22 primary studies); (4) Multicomponent interventions (3 SR; four primary studies); (5) other therapies (5 SRs, 15 primary studies) comprising exercise therapy, animal-assisted therapy, special care unit and dining room environment-based interventions.

CONCLUSIONS

A large number of non-pharmacological interventions for BPSD were identified. The majority of the studies had great variation in how the same type of intervention was defined and applied, the follow-up duration, the type of outcome measured, usually with modest sample size. Overall, music therapy and behavioural management techniques were effective for reducing BPSD.

Massage, a complementary therapy effectively promoting the health and well-being of older people in residential care settings: a review of the literature

AIMS

To explore the potential benefits of massage within daily routine care of the older person in residential care settings.

BACKGROUND

Globally, the proportion of people over 65 years is rapidly rising. Increased longevity means older people may experience a rise in physiological and psychological health problems. These issues potentially place an increased demand for quality long-term care for the older person. Complementary approaches such as massage appear to be needed in quality residential care.

DESIGN

A critical literature review was undertaken.

METHODS

A literature review pertaining to massage in the older resident was conducted using a range of online databases. Fourteen studies dated 1993-2012 met the inclusion criteria and were critically evaluated as suitable resources for this review.

RESULTS

Evidence suggests massage may be advantageous from client and nursing perspectives. Clients' perceive massage to positively influence factors such as pain, sleep, emotional status and psychosocial health. Evidence also demonstrates massage to benefit the client and organisation by reducing the necessity for restraint and pharmacological intervention. Massage may be incorporated into care provision and adopted by care providers and family members as an additional strategy to enhance quality of life for older people.

CONCLUSION

Massage offers a practical activity that can be used to enhance the health and well-being of the older person in residential care.

IMPLICATIONS FOR PRACTICE

Massage offers benefit for promoting health and well-being of the older person along with potential increased engagement of family in care provision. Integration of massage into daily care activities of the older person requires ongoing promotion and implementation.

Masoterapia en las alteraciones conductuales de ancianos con demencia

Objetivo

Diseño

Fuente de datos

Selección de los estudios

Extracción de datos

Resultados

Conclusiones

Treatment of dementia with lewy bodies

OPINION STATEMENT

Dementia with Lewy bodies (DLB) is a multisystem disorder with diverse disease expression. A treatment regime restricted to the cognitive aspects of the disease does no favor to patients. Instead, patients should be educated to recognize the symptoms of this multisystem involvement. There are no treatments that slow the progression of disease, but symptomatic treatments can be effective. When thinking about treatment, we find it useful to divide the symptoms and signs into five categories: (a) cognitive features, (b) neuropsychiatric features, (c) motor dysfunction, (d) autonomic dysfunction, and (e) sleep dysfunction. Clinicians, funding bodies and industry are increasingly recognizing the importance of this common and debilitating disease.

Foot massage versus quiet presence on agitation and mood in people with dementia: a randomised controlled trial

BACKGROUND

There is increasing interest in using complementary and alternative treatments to manage behavioural and psychological symptoms of dementia such as agitation, aggression and depressed mood.

OBJECTIVE

To compare the effect of foot massage (intervention) and quiet presence (control) on agitation and mood in people with dementia.

DESIGN

A randomised controlled trial using a within-subjects, crossover design.

SETTINGS

Five long-term care facilities in Brisbane, Australia. The primary outcome was the Cohen-Mansfield Agitation Inventory (CMAI) and the secondary outcome was the Observed Emotion Rating Scale (OERS). The screening and data collection research assistants, families, and care staff were blinded to participant allocation.

PARTICIPANTS

Participants of the study were 55 long-term care residents aged 74-103 years (mean age 86.5), with moderate to severe dementia and a history of agitated behaviour according to the Pittsburgh Agitation Scale. A computer-program randomised participants to 10-min foot massage (intervention) or quiet presence (control), every weekday for 3 weeks.

RESULTS

A carry-over effect was identified in the data, and so the data was treated as a parallel groups RCT. The mean total CMAI increased in both groups (reflecting an increase in agitation) with this increase greater in the quiet presence group than the foot massage group (p=0.03). There was a trend towards a difference on OERS General Alertness, with a positive change in alertness for participants in the foot massage group (indicating reduced alertness) and a negative change for participants in the quiet presence group (indicating increased alertness) (F(1,51)=3.88, p=0.05, partial ή(2)=0.07).

CONCLUSIONS

The findings highlight the need for further research on the specific conditions under which massage might promote relaxation and improve mood for people with dementia. The unfamiliar research assistants and variations in usual activity may have contributed to the increase in agitation and this needs further research.

TRIAL REGISTRATION

ACTRN12612000658819.

The effect of massage on agitated behaviours in older people with dementia: a literature review

AIMS AND OBJECTIVES

To review the literature on massage used to manage agitated behaviours in older people with dementia, assess its efficacy as a non-pharmacological approach and provide recommendations for future research.

BACKGROUND

Agitation has traditionally been managed with chemical or physical restraint. There has been a growing interest in complementary therapies such as massage.

DESIGN

A literature review.

METHODS

 Cooper's five-stage model of synthesising research guided the review process. The search terms 'massage', 'agitation' and 'dementia' were defined, and 10 databases were searched in October 2011. No date limitations were applied, although searches were limited to articles written in English. For relevant records, full-text copies were obtained and assessed in terms of inclusion criteria and methodological quality using the Validity Rating Tool (VRT). Data were extracted using a form constructed with reference to the checklist of items to consider in data extraction, produced by the Cochrane Handbook for Systematic Reviews of Interventions.

RESULTS

Thirteen studies met the inclusion criteria and were assessed on the VRT. One study was considered of adequate methodological quality to be included in the review. This prospective study found that massage significantly reduced levels of agitation in 52 cognitively impaired residents in two long-term care facilities.

CONCLUSIONS

There is a severe paucity of research that considers the effects of massage on managing agitated behaviours in older people with dementia. Whilst conclusions cannot be drawn from the one study included in this review, it did provide evidence to support the use of massage as a non-pharmacological approach to managing agitation in older people with dementia. More research, of better methodological quality, is needed.

RELEVANCE TO CLINICAL PRACTICE

There is a need for health practitioners to be aware of the limited evidence for massage as an intervention for agitation and to provide opportunities to validate massage practice.

Use of complementary and alternative medicine in residential aged care

OBJECTIVES

There is increasing evidence of the use of complementary and alternative medicine (CAM) by older people living in the community; however, little is known about the use of CAM in residential aged-care facilities (RACF). This review examined the literature on the use of CAM in RACF, focusing on prevalence, motivations, and support for use.

METHODS

A search of multiple databases between 2000 and 2010 was conducted. Articles were analyzed under five key themes: prevalence of CAM use, CAM user profile, motivations for use, expectations for and satisfaction with CAM use, and institutional and/or staff support for CAM use.

RESULTS

Only five articles were found that met the inclusion criteria. The review highlights the absence of evidence regarding the use of CAM by older people in RACF.

CONCLUSIONS

To inform policy and improve clinical practice in line with the aging of the population, nationally representative, population-based studies are required.

Anxiety and related symptoms in older persons with dementia: directions for practice

Anxiety disorders and related symptoms commonly occur in older people with cognitive impairment or dementia, significantly worsening functioning and reducing quality of life. This review of the literature outlines the extent of the problem, and focuses on current best practices in psychosocial interventions anxiety in persons with dementia. Discussion follows on promising nonpharmacological interventions that are recommended for further consideration and future research.