Tag Archives: dementia care

The Healing Power of Touch. Why are we Depriving our Elders?

It the first sense to develop in the womb and one of the last ones to go during the dying process.

It is one of our most fundamental human needs.  It remains for a lifetime.

As we experience decline of the body or mind due to aging or illness, the need for human touch may be accentuated in the search for reassurance,  comfort, and connection.

Is Touch Deprivation Real?

Touch deprivation in old age is very real, especially for the medically frail elder, persons living with dementia, and older adults living alone.  Despite their need for touch and being especially receptive to touch, they are often the least likely to receive healing or expressive touch from health care providers or family members.  Studies have confirmed that nursing students have been shown to experience anxiety about touching older adults.  This anxiety, along with demands on staff time and duties, lack of training on distinguishing the differences between effective and ineffective touch, and simply society’s fear of touching ill and frail elders has led to wide-spread touch deprivation in our aging adult population.

Touch deprivation leads to feelings of isolation, anxiety, poor trust in caregivers, insecurity and decreased sensory awareness.  These kinds of distress can lead to behavioral responses or expression.

“It is well known in professional circles that young nursing students tend to avoid touching elderly patients, and especially the acutely ill…touching as a therapeutic event is not as simple as a mechanical procedure or a drug, because it 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, Touching: The Human Significance of the Skin

Physiological Effects of Touch

Healing, compassionate touch tilts a person’s response away from stress towards well-being.

Touch stimulates the production of oxytocin, a chemical in our brain that leads to feelings of closeness and security.  When oxytocin is released, feelings of safety, caring, trust and decreased anxiety take place in a person’s body.  Oxytocin has often been referred to as the “care and connection” hormone.  Simply put, when your brain releases oxytocin, you feel good!

At the same that oxytocin is released, another chemical is decreasing when we experience healing touch.  Cortisol is a hormone that increases when we are stressed.  Studies show that cortisol levels decrease after even five minutes of skilled touch.  Apart from the physical relaxation, skilled touch increases our emotional well being.

Is the Tide Changing?  

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

We are witnessing transformational shifts in dementia care across the globe.   No longer is status quo acceptable, as we now understand the importance of person-centered care, the meaning of life enrichment and our responsibility to create moments of joy and purposefulness.

We have the opportunity to get back to the basics of human needs with effective, feasible and transformative tools that are literally in our hands.

Pam Brandon is President/Founder of AGE-u-cate® Training Institute and worked with leading Touch expert, Ann Catlin, ORT, LMT in the development of Compassionate Touch® program for eldercare providers, hospitals, practitioners and families.  Pam is a passionate advocate for creating positive change in aging care.  Pam may be reached at pam@AGEucate.com

To learn more about the Compassionate Touch program visit www.AGEucate.com

 

Are we Confusing Life Enrichment with Activities in Dementia Care?

What exactly is the meaning of Life Enrichment?  

Quite simply, Life Enrichment it is the act of bringing purpose and joy to persons living with memory loss. As dementia progresses, engaging in a life skill or routine task becomes increasingly challenging, and seniors need the support of someone who can adapt activities so they can still feel a sense of accomplishment, success and enjoyment.

How do Activities differ?

In senior care,  Activities are the entertainment, planned events, exercise classes etc. that are posted on weekly and monthly charts for anyone who is able to join in.

So, the question then is, are we too often confusing Life Enrichment with Activities?   

Too often, the answer is yes.  These are not the same, although they often intersect.  Person-centered or resident-centered care models must focus on the individual (life enrichment), as opposed to the whole (activities).    While activities are important to everyone living with dementia, those activities must bring purpose and joy to the individual, giving them a feeling of accomplishment.

When we fulfill the purpose, joy, accomplishment needs of an individual, we have a life enrichment model.  For each person, that may or may not coincide with the activities that are offered to all the residents.

Digging Deeper into Life Enrichment

The needs of persons living with dementia change, sometimes daily or even hourly.  Resident-centered care starts with understanding who they are now,  and their life story, allowing us to capture the who, what, why, when and how of their life.  Why is this so critical? Those long-ago snapshots allow us opportunities to engage with that person’s memories that are still intact.  Persons with Alzheimer’s disease and other forms of dementia will most likely retain those distant memories of their younger years while short-term memories fade.

When we take the time to dig deeper,  we discover the person they once were – and still are!  Let’s look at an example:

Kate came into memory care with mid-stage dementia.  She was listless and had no interest in taking part in the Activities that were offered daily.  On the surface, you would think Kate was depressed and had no interest at all.  After a life history assessment and talking with her family, the staff learned that Kate was a landscape architect, master gardener, and avid hiker!  No one would have guessed coming in that Kate had such an interesting career and such knowledge and passion for gardening.

What might life enrichment look like for Kate?  Spending time in the community’s outdoor garden, possibly taking part in garden activities with assistance, certainly photos of projects that she designed as a young architect would capture memories and spark conversation.  How about finding out where some of her hiking adventures were and finding  National Geographic and Travel shows that she might engage with?  Perhaps your community hasVirtual Reality programming in place.  There are tremendous products now that literally transform life experiences for persons with dementia. A memory basket of gardening items, tools that she used in her career and personal photos of her gardens, hiking adventures and certainly her projects could all be kept in a place where staff and families can access easily to engage in quality time together.

Kate may not find any interest in the Activities offered, but that doesn’t mean Life Enrichment has been sacrificed.  For Kate, what gives her purpose, joy, and feelings of accomplishment are not found in the activities area.  That’s okay!  We’ve found the sparks with Kate, and maybe our activities can incorporate some of her needs, but we are certainly not relying on our Activities program to provide Life Enrichment to her as an individual.

For more information on reminiscence training and other innovative dementia programs, please visit http://www.AGEucate.com

Pam Brandon is President/Founder of AGE-u-cate® Training Institute, the creator of the Dementia Live® simulation experience, and Flashback™️ Reminiscence Training.  She is a passionate advocate for aging adults and those who serve them.  Pam may be contacted at pam@AGEucate.com

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

 

 

 

Communicating with Terms of Endearment – A Big NO NO

Dear, Honey, Hun, Sweetie, Buddy, Chief, That’s a good boy, Let’s go potty now.  No, I am not talking to my 18-month-old, I am repeating terms of endearment and phrases I hear in memory care and assisted living every day. There is so much research behind the use of this type of language researchers refer to it as elderspeak. I know I am guilty of using terms like these and I know you are too but explore the impact it may be having on our residents.

Although our intentions are generally well-meaning, communicating in such a way with a resident conveys a message of vulnerability, frailty, and inferiority. In fact, communicating with terms of endearment can be viewed as a caregiver trying to control or take charge of the situation rather than providing help and support to their resident.   You may be thinking “this doesn’t matter to me, my resident has dementia, they won’t remember anyway”. And while it is true that your resident may have little to no short-term memory, they are capable of associating feelings with interactions. They will pick up on the tone of your voice and the inflections that you are using.

I feel it’s important to mention that not all residents will respond negatively to the use of elderspeak, but to keep things consistent for all our residents we should stop using terms of endearment, they can be viewed as belittling, condescending and can trigger negative behaviors.  Did you know that using terms of endearment with a resident could lead to a state citation?

Let’s talk about some negative and positive examples:

When helping Ann, a pleasantly confused woman, after lunch the caregiver says “Sweetie” let’s go change your shirt, you spilled juice all over it, and then we will go potty, OK Annie?” The caregiver reaches out her hand to guide Ann to her room and says, “that’s a good girl, come this way” While the caregiver only means to help Ann and show that she cares for her the impact of her words could have a negative effect on how Ann will respond to the care she is about to receive. She may pull away from the caregiver and the caregiver will think that Annie is just being resistive when really Ann is feeling disrespected or confused.

The caregiver’s tone and language may remind Ann of a time when she was young, and her mother would call her Annie when she was caring for her, it could help to create feelings of a safe environment for “Annie”. OR depending on where Ann is at in her current reality it may trigger negative feelings. She could be reminded of a time after she was physically abused by her spouse when he would use terms of endearment to control or belittle her, maybe he only called her Annie after a nasty fight. OR consider this Ann was a high school principal and the use of a term like this offends her! She demanded that her students and staff respect her and the education she worked hard to achieve, and they called her Mrs. Brown, never Ann and most certainly never Annie!

The immediate impact of Elderspeak may not always be apparent and we must never assume that using a term of endearment is appropriate. Always call a resident by their proper name and if they have a title like Dr. or Professor until you have gained permission to call them by another name. If they have a nickname that they prefer to be called it must be documented in their ISP. For example, John has been called Bub his entire adult life, this is ok! If fact Bub might respond negatively to be calling John.

Research has shown there are 3 main factors on a caregiver use of Elderspeak.

  1. Familiarity with the resident- The more comfortable we are with the resident the more likely we are to use elderspeak.
  2. Whether the resident has dementia- the level of dementia plays a huge role in our use of elderspeak, the further progressed the dementia is the more likely we are to use a term of endearment. Maybe we view the resident as helpless or frail and in our effort to show or convey caring we may use elderspeak.
  3. If the resident is alone with the caregiver or if there are others present during the interaction. In the presence of family, other residents, or other caregivers we are less likely to use elderspeak, maybe because deep down we know it is disrespectful and we are more aware of what others would think if we used endearing terms.

So, have you ever caught yourself addressing a resident with Elderspeak? I know I have. And the only way we can change this behavior is to be aware of it then stop it.

My challenge to you is to be more aware of not only your communication methods but of those around you.  Maybe you need to remind a co-worker, in private that they shouldn’t use endearing terms. Or you may need to be reminded yourself on occasion.  After you catch yourself using elderspeak you may need to apologize to your resident when you call her Sweetie and correct your actions by using her preferred name. I challenge each of you to focus on the strengths of your residents and not their inabilities or weaknesses. Remember that everyone has value and should be treated in a respectful way.

Emmy Kaczmarksi, RN is a Master Trainer for AGE-u-cate® Training Institute, Dementia Educator, Behavioral Specialist, and works at White Pine Senior Living in Hudson, WI.  

http://www.AGEucate.com