Massage for 96 year old with severe dementia - dilemma

[Paige Welsh]

I recently went to massage a 96 year old in a nursing home with severe dementia. Her son recruited my services. She has a shoulder problem and her chiropractor recommended massage.

It turned out that the massage was rather "traumatic" for her. She kept on asking if she was going to be cut with a knife, was she on an operating table? why was she having it? She didn't get distraught but asked the same questions over and over again in a rather matter of fact way. Although at one point she got agitated and the attending carer had to hold her hand. She did fall asleep and relax now and again but when she came to would aks all the same questions again.

I could do nothing more than ultra light effleurage, otherwise she said it hurt and jumped and flinched.

I advised her son afterwards that I wasn't sure it had any therapeutic value for her as I could do nothing but lightly stroke her. I said that as she doesn't sleep well this could help her relax and sleep better but other than that I wasn't sure how beneficial it was.

He said she had another trip to the chiro last week and would let me know what he said. He's since called me up and left a msg saying that the he wants to continue with the massage.

I'm still not convinced if this is wise. Do you think I should talk to the chiropractor - as I can't imagine what manipulation he does with her when she can stand no pressure.

Any advice appreciated - as I need to decide if I should proceed with treatment or not. I have no experience of dealing the dementia.

Thanks

 

[misskelleygirl]

Hi ya YJ

Do you do reflexology? May a bit of massage on the hands and feet. I can't explain why at the moment, its kind of intuitive.

Best Wishes

RP

 

[Alyssa Godin]

Hi RP - no I don't. I was thinking along the lines of doing legs, hands and feet for relaxation if I continue. As spending 45 minutes stroking the back feels to repetitive for me and for her.

 

[Jonas S]

Its quite difficult knowing what to do if you don't get sufficient feedback from the client - though she does give you an indication of pain. She may think that you are a medic and make the connection of surgery in that respect, just keep reassuring her.

A light effleurage movement can be incredibly soothing especially where there is a lot of pain, as it gets the endorphins going. Also I should imagine it is very comforting for her to receive the caring touch of a therapist. I would do back neck and shoulders hands and arms to start with as I agree 45 minutes of effleurage on the back is onerous for you as a therapist.

Luv Binah
x

 

[local_gurl_808]

The dementia/alzheimers clients that I have cannot cope with any longer than 25/30 minutes tops. I rarely treat their backs (most are in their 80's and 90's) so confine sessions to hands and feet, and shoulders through clothes, but only if they are receptive. I have been seeing them for several years, but recently, in 3 cases, they have become increasingly worse, and don't know who I am and I have told the families that I no longer see any benefit in treatment - they get too upset.

I would be interested to know what a chiropractor is doing with a 96 yr old so perhaps it would be a good idea to have a chat with him/her, and ask if they beleive that your intervention is in the interest of the client. If he says it is the way to go, and doesn't offer massage him/herself, then could you shorten the session? I think that 45 minutes is too long. Are you putting her onto a portable couch? Could you treat her seated in her own chair? If she is obviously distressed, then she is getting no benefit and there is no point in pursuing it. Sometimes treatment is just not what they need.

 

[pink]

I had a similar issue with a cancer client I was working on a while back. Her husband had asked that I give her treatment, but the nature of her cancer combined with her medication meant that she was extremely confused and also slept a lot.

When I treated her, she would curl up into a ball and go to sleep, sometimes waking distressed and not knowing who I was.

I was quite concerned, as she often got quite agitated. I also felt that she wasn't really consenting to treatment and I think that's an important issue, regardless of what family members may think. Eventually, after discussion with the staff in her nursing home, we decided that she wasn't really benefitting from the therapy.

 

[Poobbernogy]

I think it is probably not worth pursuing this client. I think it could lead to many other issues plus there must be a number of contraindications with a patient this age.
It is obviously giving you a dilema so you are unlikely to feel comfortable doing the treatments.
The son is probably trying his best for his mother and going down every route he thinks of to try and improve her quality of life. That is not your problem, don't get roped into something you're not comfortable with.

 

[McBraas]

I have two clients in their late eighties who have a massage every week. They are quite frail and can be unsteady, but they really benefit from the treatments. I use a lot of light effluarge movements and very gentle petrissage (with no tapotement). If it ever got too much for them to be able to have a massage or it upset them in any way then I would have to stop treating them. I suppose as I see them every week I have built up quite a bond with them and it would be upsetting if it got to the stage where I felt massage was no longer benefitting them.

My nan has severe Altzheimer's (she doesn't even recognise me ) and I've tried to massage her before. A back/full body massage is out of the question as she gets too agitated, but I've found that she really likes to have her arms and hands massaged. It relaxes her and she always seems a lot calmer afterwards.

Kerrie-Joanna

 

[shark4056]

Thanks for all your comments, they've been a real help.

I agree that having her on the massage couch face down isn't the way to go - even though she managed to get onto the couch with assistance - as I think being in that position upsets and confuses her. I'm going to say that I'd rather massage her in a chair and do her hands, legs and feet which will relax her and also provide the therapeutic value of touch.

P.S I'm mobile and this client is at the outer edges of my area - so doing less than a 45 min treatment isn't really financially viable for me and I don't generally offer anything less than a 45 min treatment for this reason.

 

[irishgreenc16]

just to through my suggestion into the mix, you could try massaging her on the couch but have her lying on her side rather than face down etc

what I would like to know is how she slept after the treatment, until you get that feed back it is hard to say if she had any visible signs of benefit.

hth

 

[annonymous]

I think over 20min is too much massage for someone that age, BUT I think 45min of attention is incredibly beneficial. I think you should treat it as 20min of light massage (hands, arms, lower legs and feet, shoulders very lightly through clothing), and 25 min of hand holding, you might feel like a bit of a sham doing that, but really it is very very very helpful for them. Regardless of the level of care they are getting in the nursing home, they don't get that quality time of someone just being with them, the staff are always concerned about getting onto the next person before their shift is up.

If you feel too uncomfortable hand holding for 25+min maybe you could offer a slight discount since you aren't taking our couch? Or after you've had a couple of visits like that, if the feedback is good about how she is sleeping better, less distressed, not as disruptive as it gets dark, whatever her usual problem behaviour is (and they all have a problem behaviour the staff know to be wary of) maybe ask the staff if they could recommend you to some of the others to see on the same visit, that way the travel time will be less of a concern. If the staff are happy with her progress, you might be able to get more clients out of it, and it is less taxing than lugging your table around and uses less oils etc (I'd recommend you only use jojoba on someone of that age, you don't want them at all slippery, and if she is still walking around, use a cornstarch powder type thing on the feet, don't want any oil on the bottom of the feet at all!)

I doubt you'll get much progress on the shoulder pain, there are so many possible contributions to it, and actually getting any sensible feedback from her may be a challenge (it's usually everything hurts, or nothing hurts!), but if you can get in some work on the upper arm it might loosen the shoulders up quite a bit. I too am amazed she's seeing a chiropractor! Unless she has been a go to the chiro every fortnight for the last 50 years person, it's the type of thing that could be a bit traumatic, but a chiro appointment is usually only 30min at top, so it's the right timeframe.

 

[clncarplz]

It might be easier to refer the patient to a remedial/sport injury therapist who is trained to deal with this sort of thing, massage is given to release the soft tissue so the manipulative therapist can manipulate the joint without causing too much discomfort to the patient.

This can be done with the patient sat up on the side of their bed or a low backed chair if they are not happy to sit on a treatment couch, I have treat lots of people in their late eighties and into their early ninety's, they receive the same length of treatment as any other patient.

The only problem with someone with dementia is that you have to constantly keep assuring them of what you are doing, and then go through the same procedure of introducing yourself etc. each time you see them as they will not remember you.