Issue link: https://www.massageandbodyworkdigital.com/i/1488451
A COSTLY DISEASE According to the Alzheimer's Association, 55 million people worldwide live with Alzheimer's disease and dementia. By 2050, the number of adults living with Alzheimer's in the US will more than double, costing the nation nearly $1 trillion. The human cost to care for people living with Alzheimer's and dementia is just as weighty. In the US alone, 11 million people—mostly family and friends—are unpaid caregivers for people in this group. 1 While there are more than 100 types of dementia, Alzheimer's is the most notable and prevalent. The dominant sign of Alzheimer's is memory loss that disrupts daily life. Other signs include difficulty with reasoning or problem-solving, confusion with time or place, decreased judgment, and changes in mood or personality. Finding ways to bring comfort to these patients is high on the caregiver's list. And while manual therapies cannot stop the progression of Alzheimer's or dementia, they can help improve the patient's quality of life. According to Ruth Werner, author of A Massage Therapist's Guide to Pathology, research has shown that massage for patients with Alzheimer's can help with some of the disease's primary symptoms: orientation confusion, restlessness, and combativeness. 2 Anecdotally, those who work with these clients know massage and bodywork can do so much more. PATIENCE AND ADAPTABILITY Dawn Castiglione, owner of Day-Break Geriatric Massage Institute, says that while working with clients who have Alzheimer's or dementia can be challenging, "It is also one of the most rewarding experiences you'll ever encounter as a massage therapist." But this work is the epitome of "it's not about you." The client who has Alzheimer's or dementia may never "know" you. You may be a stranger to them each time you arrive for an on-site session, so the context of what you do and the intention with which you deliver your work are critical. Sometimes, the most important part of your session is simply holding the client's hand. It's important to remember that each client you see in this population is unique and has their own story. Carefully navigating intake protocols, remaining present throughout your session time, and knowing you may have to pivot in a moment's notice are all part of the work. "Every person with dementia and Alzheimer's presents differently," says Dr. Joi Edwards, PT, MT, who started working with this population in 2014. "Some may be in the end stages, or late stages, or anywhere in the middle. At my clinic, we don't get a lot of combative patients, but I have worked with them before and that can be challenging. Some patients may be very forgetful—in a 30-minute conversation, they may repeat the same statements or questions 3–5 times." So, patience and good verbal and nonverbal communications skills are key. Beyond that, practitioners who work with elderly clients need a "quality of presence that is informed by a respectful attitude and caring intention," says Mary Kathleen Rose, author of Comfort Touch: Massage for the Elderly and Ill and founder of Comfort Touch, a nurturing form of acupressure to address the special needs of people in medical settings. Rose says MTs also need training in the physical and psychosocial issues associated with illness and aging. Ultimately, she says, the intention is to "bring comfort to the client, respecting their physical and emotional needs with safe, effective, and appropriate techniques." TIPS FOR THERAPEUTIC SUCCESS Working with clients who have dementia requires a slightly different protocol. From the health intake to frequent check-ins throughout your session, you need to be more attentive to, and more attuned to, this client. Castiglione says it requires advanced skill to "engage and benefit these clients without threatening the delicate balance of thoughts and emotions by which they often seem trapped." Here are some expert tips for making your work with clients who have Alzheimer's or dementia the most successful it can be. Focus on Communication "Our usual method of communication—speaking— will likely be a bit challenging, especially as the client's condition progresses," Castiglione says. "And being aware of what not to say, as well as what is appropriate to say, is very important." She says beginning a sentence with, "Do you remember . . ." is not a good idea. "This often elicits a great deal of frustration if they are struggling to focus on particular memories, or struggling with how to get words out on the subject if they do remember, or experiencing irritation over not being able to even connect with the details of your question at all," Castiglione says. 34 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 3