Category Archives: Compassionate Touch®

Is Stress Reaction a form of Behavioral Expression in Dementia?

Stress Reaction is a term being used more often to describe communication in persons living with dementia.  Behavioral expression, too, is communication.  In a growing number of circles, the term behavioral expression is being replaced by stress reaction simply because behaviors sometimes leans toward being a negative descriptive of how persons with dementia express unmet needs.

Stress reaction is communication that is caused by changes taking place in the brain caused by the progression of dementia.  These changes can cause behaviors such as:

  • Aggression
  • Irritability
  • Pacing or wandering
  • Withdrawing
  • Resistance to care
  • Crying
  • Yelling

It is important for care partners to understand that stress reaction is always caused by an unmet need.  The most common causes of unmet needs can be categorized in the following areas:

  1.  Physical discomfort – perhaps caused by pain, hunger, thirst, fatigue or other barriers.
  2. Nonsupportive environment – this might include noise, chaos, inadequate lighting, temperature changes or excessive clutter.
  3. Unmet social needs – boredom, lack of sense of purpose, lack of companionship, touch deprivation are some examples.
  4. Ineffective care partnering – examples include unrealistic expectations from caregivers, distrust from either care partner or inappropriate care (care that is not conducive to caring for persons with dementia)

Now that we’ve discussed stress reactions from persons living with dementia, we must then look at stress reactions from caregivers.  Understanding that it is how we as caregivers react to their stress reactions, is a core value of person-centered caring practices.

We cannot control their behavior, but we can control how we respond to their behavior.   Healthy care partnering means we understand that they cannot change what’s going on in their brain.  Their behaviors or stress reactions are a response to unmet needs, and it is the care partner’s responsibility to put the puzzle pieces together to help their care partners meet their unmet needs!

A few basic guidelines for care partners to keep in mind when there is a stress reaction:

Allow adequate space (in other words, step back if necessary)

The rule is always safety first for both care partners

Observe the environment, and what can quickly be changed, such as taking the person from a noisy room to a calm atmosphere

Observe body language and facial expressions, especially if the person is non-verbal.  What might they be trying to express?  And care partners, observe your own body language and expressions, as your stress reaction can either cause the situation to escalate or de-escalate

Watch your tone of voice!  It’s amazing how a calming voice will immediately bring calm to another person.  And just the opposite is true.  If stress reaction is met with similar behavior, it’s almost always a certainty that the outcome will not be positive.

And finally, learn techniques and tools that can prevent stress reactions.  Touch, music, redirection techniques, companion pets or dolls and more can have amazing outcomes and are simple to implement with the correct training.

Pam Brandon is the President/Founder of AGE-u-cate® Training Institute, creator of the Dementia Live® Sensitivity and Empathy Training program and directed the development of Compassionate Touch® for persons living with dementia and end-of-life.  She is a passionate advocate for older adults and those who care for them.

 

 

 

 

The Transformative Power of Music in Ageing Care

By Sue Silcox, AGE-u-cate® Training Institute, Australia

Does anyone remember the banning of public music in Iran? Back in 1979 Ayatollah Rubollah Khomeini banned all music from radio and television in Iran. He likened it to opium and said it “stupefies persons listening to it and makes their brain inactive and frivolous.” (New York Times, 1979).

I remember it happening and being horrified by the ban. Every culture has music and it has always been such a blessing for me. From the first music I heard my parents play, the first record I ever bought (Cathy’s Clown, The Everly Brothers) to using Spotify now when I take Ageless Grace® classes locally, I am thankful for what it brings me.

How amazing that a study in 2001 from Leicester University, UK, found that babies recognise the music they heard in the womb even twelve months later. In this study, mothers played a single piece of music repeatedly during the third trimester. A year after birth, the infants recognised and turned towards that sound, preferring it to a similar sounding piece of music, even though they had not heard the music in the interim. Music certainly has power!

I’m one of the first baby boomers so I’ve had the pleasure of listening and moving through music styles such as pop, rock and roll, country music and jive, twist just for a start. I also have the remembrance of swing and big band as my parents would dance together or get us to dance with them. Many a tune brings a memory of the old HMV turntable my aunt had. She would play her favourite artist, in particular Nat King Cole and I wonder how many of my preferences have been influenced by those early sounds.

For me, to be without music as I age would be like living in the dark ages. Although I like to move my body to contemporary music I also find myself emotionally transported as I listen to music I love. A 2017 study found that physical exercise done to music showed greater increase in cognitive function than just exercise alone, and may be of benefit in delaying age-related cognitive decline. It also makes changes to the brain structure. My love and use of music and exercise seems to be validated! Music should be also be considered a drug therapy, providing benefits linked to reward, motivation and pleasure. (Howland, R. H, 2016).

In Australia the Arts Health Institute brought a music and memory program to aged care, now overtaken by the music enrichment program, “Music Remembers Me” in aged care. Perhaps we also need to encourage movement during the music enrichment program.

Whether music is enjoyed on its own or shared, it can be an intensely special time for the listener. Now it seems the joy of the music can provide considerable benefit to our ageing and dementia communities.

Sue Silcox leads AGE-u-cate® Training Institute, Australia and is a Certified Master Trainer for Dementia Live®, Compassionate Touch®, and other AGE-u-cate programs.  She lives in Brisbane, Queensland.   She may be contacted at sue.silcox@ageucate.com

References:

Kifner, J. 1979. Khomeini Bans Broadcast Music, Saying It Corrupts Iranian Youth. New York Times. Retrieved from https://www.nytimes.com/1979/07/24/archives/khomeini-bans-broadcast-music-saying-it-corrupts-iranian-youth.html

BBC News, July 2011. Babies remember womb music. Retrieved from http://news.bbc.co.uk/2/hi/health/1432495.stm

Ken-ichi et al. (2017). Physical Exercise with Music Reduces Gray and White Matter Loss in the Frontal Cortex of Elderly People: The Mihama-Kiho Scan Project. Frontiers In Aging Neuroscience, Vol 9 (2017), doi:10.3389/fnagi.2017.00174/full

Howland, R. H. (2016). Hey Mister Tambourine Man, Play a Drug for Me. Journal Of Psychosocial Nursing & Mental Health Services54(12), 23-27. doi:10.3928/02793695-20161208-05

 

 

Why Touch is Good Medicine in Caring for Persons with Dementia

“Touching as a therapeutic event is not as simple as a mechanical procedure or a drug, because is, above all, an act of communication…the use of touch and physical closeness may be the most important way to communicate to acutely ill (and aged) persons that they are important as human beings…” – Ashley Montagu

Touch is good medicine.  Research supports the beneficial effects of skilled touch as a powerful, yet under-utilized means to address an urgent need:  person-centered care for people with dementia.

Let’s look at the need.  Our aging population is having a major impact on hospitals, long-term care companies, aging and regulatory services and hospice providers.  Clinicians and front-line staff will serve more people over age 75 than any other age group and prevalence of dementia is being seen in every sector of senior services.

  • About one-quarter of all older hospital patients are people with dementia
  • People with dementia constitute about half of all nursing home and assisted-living facility residents
  • An estimated 15 million family and friends in the U.S. provided care to a loved one with dementia in 2013

Touch deprivation leads to feelings of isolation, anxiety, poor trust in caregivers, insecurity and decreased sensory awareness.  Older adults living with chronic illness, dementia and other conditions are especially receptive to touch.  Unfortunately, they are the least likely to receive expressive human touch from health care providers and caregivers.

Touch stimulates the production of oxytocin, leading to feelings of safety, caring, trust and decreased anxiety.  It’s been called the care and connection hormone.  When your brain releases oxytocin, you feel good.

At the same time, cortisol is a hormone that increases when we are stressed.  Studies show that cortisol level decrease after even five minutes of skilled touch.

Instrumental vs. Expressive Touch

Touch in caregiving is NOT the same.  There are two basic kinds of touch that commonly occur during caregiving:  Instrumental touch is necessary to perform a task or procedure such as transferring or bathing.  Expressive Touch is offered spontaneously to show care, concern, reassurance, affection, and empathy.  It has the power to affect our feelings about others, ourselves and the world we live in.  The person receiving the touch feels validated and distress in the moment is eased.

Skilled Touch has a structure and method designed to achieve a desired clinical impact.

Compassionate Presence is both a personal quality and professional skill that can be learned and developed.  With compassionate presence:

  • you connect with individual rather than the disease
  • you connect in the moment as it unfolds
  • you accept the reality and current experience of the person you are serving

“The most important innovation in medicine to come in the next 10 years:  the power of the human hand.” – Dr. Abraham Verghese

Expressive touch provides a feasible, effective tool to respond to behavioral expression in persons living with dementia;  reduce stress for both care partners, and a means to calm, connect and comfort.  With training, it is a powerful tool that is literally in the hands of those caring for our older adults.

Research supports positive changes in physical behavior, mood and expression, resistance to care, and reduced stress for both care partners, leading to greater staff satisfaction.

Skilled touch:

  • alleviates aches and pains
  • provides tactile and sensory stimulation
  • induces a relaxation response
  • supports psycho-social well-being

There is an urgent need to provide more effective and feasible tools to improve dementia care and reduce the use of psychotropic drugs.

We can transform care… it’s in our hands!

Pam Brandon is President/Founder of AGE-u-cate® Training Institute and worked with Ann Catlin, OTR, LMT in the development of the ground-breaking Compassionate Touch® program, used throughout the US, Australia and Canada to improve care for persons with dementia and end-of-life.  

To learn more about the Compassionate Touch® program please visit http://www.AGEucate.com

 

 

 

Why Competency-Based Training Improves Dementia Care

There is an urgent need to equip caregivers to better respond to and care for persons living with dementia.  Traditional training models have focused on the number of classroom hours an individual must spend in training, assuming that a person who completes the required training hours is ready to work successfully with people living with dementia.  The shift to competency-based training improves dementia care by focusing on mastery of tasks and tools that are learned.

Competency-based learning empowers learners to focus on mastery of valuable skills and knowledge and learn by practicing.  This can be valuable for direct care staff in applying techniques, tools and other skills with other staff and their care receivers.

General benefits of competency-based training include:

  • Greater understanding of learning outcomes by applying skills taught.
  • Increased  retention and higher probability that what is taught will be applied
  • Learners’ improved ability to recognize, manage, and continuously build upon their own competencies and evidence of learning
  • Employers’ improved ability to track competencies and achievements

With growing focus on person-centered practices in dementia care, staff may gain knowledge training, but if it is not applied and practiced, the risk of “losing” the skills increases.  Competency-based training includes assessments on whether a person has the knowledge, skills, attitudes, and abilities required to work with individuals with dementia;  understand how to support their dignity and individuality, and can apply his or her training to the unique needs of persons living with dementia.

We face challenges in equipping our workforce to deal with the unique needs of those living with dementia.  As this number increases drastically,  practical, feasible and effective tools for caregivers is urgently needed.  They must be provided with more real-life training before they are asked to help people living with dementia and their families.

Competency-based dementia training should be integrated into every elder care providers’ ongoing training program.

Pam Brandon is President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and those that serve them.  Pam is the creator of the internationally recognized Dementia Live® simulation program.

http://www.AGEucate.com