A Touch of Compassion: Massage Therapy and Alzheimer's Disease

Learn what you can expect when working with clients with Alzheimer’s disease.

By Michelle Vallet, November 15, 2011

You believe in the benefits of massage therapy. Chances are you talk to your clients fairly regularly about how massage therapy can help with everything from pain relief to stress relief. With your skills, education and passion, you have the ability to reach a wide variety of people who will benefit from massage therapy. 
Today, there’s a lot of opportunity out there for you to work with different client populations. And, as more and more research is done on the benefits of massage therapy, the opportunity you have will only grow. To make informed decisions about what working environments best fit your personal and professional goals, however, you need information.

In the following, you’ll find detailed information on what you can expect when working with clients with Alzheimer’s disease, as well as many residents in long-term care facilities with chronic care needs more generally.

Understanding The Need

The numbers. It’s no secret the population is aging and life expectancy is increasing. But some of the numbers regarding aging might surprise you. According to the Alzheimer’s Association, 5.3 million people currently have Alzheimer’s disease, and the disease is the seventh leading cause of death in adults. Particularly with the aging population, some estimates suggest that 16 million people will have Alzheimer’s by the year 2050. “It’s been said that in 25 years, the United States will have two kinds of people: those who have Alzheimer’s disease and those who are caring for someone with Alzheimer’s disease,” says Ann Catlin, founder of the Center for Compassionate Touch and an expert in the field of massage therapy in elder care and hospice.

For those massage therapists interested in working with this special demographic, that’s a lot of people who can benefit from your professional services.
The benefits. “People with Alzheimer’s disease don’t lose the capacity for human emotion or recognition of a caring touch,” Catlin says. “What I've seen is that even a person in the very late, severe state of Alzheimer’s retains all these capacities.”
There are several benefits massage therapy offers people with Alzheimer’s disease, including increased body awareness and alertness, as well as a reduction in the feelings of confusion and anxiety. “You also build reassurance and trust,” says Catlin, “and help calm agitation.” 
Massage therapy can also help ease the effects of isolation, loneliness and boredom while encouraging feelings of worthiness and well-being, Catlin believes.
The research. Although Catlin believes that more research needs to be done, she does point to studies that indicate that the use of some forms of massage are effective in managing some of the challenging behavior exhibited by elders living with Alzheimer’s and other forms of dementia.
For example, a 2002 study by R. Remington on the effect calming music and hand massage had on agitated behavior in persons with dementia found that both calm music and hand massage reduced verbal agitation, and the benefit was sustained for up to one hour.

A 1995 study conducted by Snyder et. al. examined the effect a five-minute hand massage protocol had on care activities that were often associated with agitation behaviors. Both aggressive and non aggressive forms of agitation were studied. The hand massage took five minutes, and was performed in the morning and afternoon for 10 days. Results showed that hand massage decreased the frequency and intensity of agitated behavior during morning care routines, but not during evening care.

Video from AMTA National Convention

Hear AMTA 2011 National Convention speaker Ann Catlin talk more about who will be impacted by Alzheimer's disease as our population continues to age, as well as why educating consumers on the role massage therapy can play is important.

What You Need to Know

Special skills. As with most special populations, working with clients with Alzheimer’s requires massage therapists have some specific skills, many of which aren't directly related to massage therapy. “Massage therapists need to have a basic understanding of the disease process,” Catlin says. “They also need to be comfortable with a person that exhibits characteristics of the disease, such as confusion, disorientation, memory loss and personality changes.”
You also need to be prepared for the changes that occur in a person
who has a progressive disease, Catlin believes. “You’re going to need special communication skills, both verbal and nonverbal,” she explains. “You’re also going to need to learn unique hands-on techniques specifically designed to benefit this population.”
Above and beyond the client, however, massage therapists need to pay particularly close attention to self-care when working with this special population—specifically the emotional aspects of the work. “Massage therapists need to have personal awareness of the emotional impact this unique form of service can have,” Catlin explains.

Technique. Right away, massage therapists in this environment will notice that the techniques they’ll use are simpler than in other massage therapy environments. “A hand massage, back massage or simply holding a person has the power to elicit positive, life-affirming feelings and responses,” explains Catlin. “Simple touching of hands is so familiar, hand massage may be gladly accepted by elders in long-term care.”
Paying attention to nonverbal cues, however, is key to working with this population. “Facial expression, movement and breathing all provide feedback about the receptivity and benefit from touch,” says Catlin, “as well as verbal expression.”
Catlin gives an example of a simple five-minute hand massage technique that can be used with Alzheimer’s patients, beginning with asking permission to put lotion on the person’s hands. “Hold the hand of the person receiving the touch,” Catlin suggests. “Doing this, you create a connection and can become focused and centered.” Then, massage therapists should apply hypoallergenic massage lotion, giving each of the fingers a few gentle squeezes from the base to the fingertip, pausing periodically to make gentle circular motions.
“Turn the hand over and make tiny circular motions on the palm of the hand with the thumbs and massage the soft, fleshy areas on the palm,” Catlin recommends. “Finish by thanking the recipient while holding both of their hands and sharing eye contact.”

Universal precautions.  As with every massage therapy session, you need to be aware of some important precautions when working with this demographic. For example, Catlin says, massage therapists should wash their hands before and after giving a hand massage. Also, you need to proceed with care when certain conditions are present, including thin, dry skin, impaired range of motion or fragile bones."There are conditions that contraindicate even gentle hand massage,” Catlin adds. “These include bruises, cuts or openings in the skin, severe pain, edema or inflammation.”

Marketing Yourself

Getting your foot in the door. Making connections with long-term care establishments you might like to work with can seem like a daunting task, but introducing yourself—and massage therapy—to some of your local facilities can be very rewarding. Here are a few tips that will help you take that first step:
Do your homework. “You need to learn about the facility you’re interested in working with,” Catlin says. “All facilities have printed marketing materials, and many have websites outlining the scope of care and services they provide.” So, don’t just pick an establishment out of the Yellow Pages or drop in as you drive by one day. Spend time learning about what they do, the care they provide and their mission, and then think about how you might fit into their existing culture.
Network. “The best place to meet people working in a long-term care facility is a senior wellness or health fair,” Catlin suggests. “These community fairs are sponsored by hospitals or senior citizen service organizations.” When attending these events, take some business cards with you and don’t be shy about handing them out.
Identify the gatekeepers. Talking to people who don’t make the decisions isn't a bad idea. But if you want to be taken seriously and give yourself the opportunity to really shine, you need to get in front of the people who have the power to hire you—or have direct access to to the people responsible for hiring and long-term care decisions. “These are often the managers,” Catlin suggests. If you have trouble finding contact information for these people in printed material or online, don’t be afraid to ask other staff directly. You might even go to the front desk and say, “I’m interested in speaking to the person responsible for resident benefits, can you give me their contact information?”
Schedule a face to face meeting. Once you know who you need to talk to,make sure you schedule an appointment to talk face to face. “Don’t rely on sending information to the facility,” Catlin advises. “It’s far more effective to go in person.”
Provide printed material. When you go to your face to face meeting, don’t forget to bring relevant printed material, along with some business cards, that you can leave behind for further consideration. Doing so is also a good way to keep your name in front of the facility you’re trying to build a relationship with.

Follow up. After the meeting, don’t be afraid to follow up. Give your contact a call back in a week or two and see if they have any additional questions for you, or need any additional information to help in the decision-making process. Let them know you’re interested in working with them, and briefly reiterate what you have to offer.
You might also consider sending a thank-you note after the meeting. Showing appreciation for someone taking time out of their busy schedule to meet with you can make a real impression.
Preparing to make your case. “Long term care facilities operate under heavy federal and state regulations, and are cautious about initiating new services for their residents,” Catlin cautions. “Most facilities will not have considered massage therapy.”
What this information means is that you’ll have to be proactive and savvy when promoting massage therapy. A good first step is to prepare detailed, thorough answers to the following questions, as chances are you’re going to have to explain how your services will benefit both the facility and the residents:
How does massage help our residents? A good place to start with this question is with the holistic nature of massage therapy. Talk about how massage therapy can contribute to the physical, emotional and mental well being of the residents. Here, think about how massage might help with agitation or promote relaxation. In other words, tie your skills to specific needs the facility has. Whenever possible, discuss the available research regarding the benefits of massage therapy for this population.
How do massage services benefit the facility? “Nursing homes and long-term care establishments are in business, too,” Catlin says. “They will want to know how offering massage to their residents will improve their bottom line.”
To illustrate this point, Catlin offers a few examples. “Adding this benefi t for their residents will demonstrate their commitment to raising their standard of care,” Catlin suggests. “Doing so may give the facility an edge in the competitive marketplace.”
Resident and family satisfaction might also be improved by adding massage therapy to the core benefits offered. When a loved one responds positively to massage therapy, family members feel better, and the perceived value of the facility may increase. “Staff members also benefit,” Catlin adds, “when the elders they care for have fewer complaints of discomfort and are more content.” Lastly, Catlin says, massage therapy can be an innovative way to add a bedside activity. 
“Federal guidelines require nursing homes to provide one-to-one activity for residents confined to their rooms or beds,” she says. “Massage therapy can be a great way to fi ll that need.”
Who pays for massage services? Answering this question really depends on the facility, and so be prepared to discuss these expectations with whomever you talk with. “A facility may hire you as a staff member, in which case you’d be paid an hourly wage to provide massage with or without employee benefits,” says Catlin. “More likely, however, you will be brought on as an independent contractor.” 

What is Alzheimer's Disease?

The Alzheimer’s Association defines the disease as a gradual onset, progressive, degenerative disease that attacks the brain and results in impaired memory, thinking and behavior, reducing the ability to perform routine activities. Symptoms of Alzheimer’s and dementia include memory loss, confusion,difficulty communicating, disorientation in time and place, mood swings, restlessness, sleeplessness, behavioral disturbances, personality changes and perceptual motor problems. To date, there is no known cause or cure, and treatment for symptoms usually involves drug therapy.

For more information, visit alz.org