Current Activities in Long Term Care
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Alzheimer’s Update
By Lorena Tonarelli, M.Sc. Research Reporter

Agitation in Alzheimer’s Elders
Randomized study provides more evidence on benefits of music and
massage

As we reported in previous issues, there is growing evidence that music
and massage can help decrease dementia-related agitation.
New Canadian research in the journal Dementia has now found that even a
10-minute session of hand massage, music listening, or a combination of
both can  significantly reduce agitation and disruptive behaviors in people
with Alzheimer’s disease (AD) during the intervention and up to one hour
after.

 Dementia-related agitation is a widespread concern facing caregivers, say
Dr. Sandee Hicks-Moore and Dr. Bryn Robinson of the University of New
Brunswick, Saint John, Canada: “It includes behaviors such as aimless
wandering, pacing, cursing, screaming, biting, and fighting.”
Not only does agitation negatively affect the quality of care elders receive,
but it also has a major impact on staff stress. This, in turn, results in an
increasing number of dementia caregivers’ quitting their job and in high
turnover levels for those in that end of healthcare.

Hicks-Moore and Robinson studied 41 agitated nursing home residents with
mild to moderate Alzheimer’s, whose age ranged from 69 to 92 years.
These were randomized to receive hand massage,  favorite music, the two
interventions combined together, or no intervention (i.e., control group).
“The residents assigned to the treatment groups were randomly exposed
to each of the three treatments on different days,” explain the researchers.
Each session lasted 10 minutes and was conducted as follows.

The interventions

Favorite music.

•        Participants listened to music played on a portable CD player. CDs
contained selections of each elder’s favorite music, based on information
gathered from family members. In particular, the researchers asked about:
o        type of music enjoyed;
o        favorite artists; and
o        preferred songs.
•        The music volume was kept high enough to cover the environmental
noise, but low enough to allow conversation to be heard.
•        The researchers ensured that participants could hear the music by
asking questions or observing their behaviors. For example, they looked at
whether the elders sung the songs’ words or swayed with the rhythm of the
music.

Hand massage.

Participants had each hand massaged for five minutes. This was done using
       o slow strokes;
       o light pressure; and
       o an even rhythm.
The massage was applied to the entire hand, including the palm, fingers,
thumb, and back of the hand.
Favorite music plus hand massage.
During this intervention, participants received hand massage while listening
to their favorite music, as described above.

When and where

It’s important to note that all sessions were conducted either in the
residents’ room or in a familiar area of the facility, as this was considered
crucial to a good outcome of the interventions.
The elders were observed for signs of irritability and frustration at various
times of the day and evening and were administered the interventions
before an episode of agitation occurred.

The results

Listening to favorite music and receiving hand massage, both alone or in
combination, led to statistically significant reductions in physical and verbal
agitation, as measured with the Cohen-Mansfield Agitation Inventory
(CMAI). More specifically, elders who received the interventions showed
significant reductions in the following behaviors:
•        Wandering;
•        Pacing;
•        Disrobing in public places;
•        Restlessness;
•        Hoarding;
•        Screaming;
•        Request for attention;
•        Repeating the same sentence; and
•        Complaining.
These improvements were observed at the end of the sessions and lasted
at least one hour.

No changes were observed in the control group.

“Historically, strategies to manage agitation have primarily included the use
of physical restraints,… segregation of patients from activities… and
pharmacological interventions,” say the researchers. This is in spite of the
deleterious adverse effects frequently observed, especially in older
persons.

This study shows that music and massage, individually or combined, “have
the capacity to soothe and replace agitation and anxiety with calmness and
relaxation.”

It is thought that this beneficial effect is due to the ability of music and
massage to evoke pleasant memories and feelings, which calm the person
down and lift their mood.

The study was published in the Feb. 2008 issue of the journal.

Hick-Moore S., Robinson B.A. “Favorite music and hand massage: Two
interventions to decrease agitation in residents with dementia,” Dementia,
February 2008, 7(1):95-108.