The effect of expressive physical touch on patients with dementia

Abstract

This study explored the effect of expressive physical touch with verbalization (EPT/V) on anxiety and dysfunctional behavior in patients with dementia using a one group repeated measures design. The study findings are that (1) anxiety is lower immediately following EPT/V and (2) EPT/V causes decreasing episodes of dysfunctional behavior. Therefore, it behooves caregivers and family members to use expressive physical touch and verbalization when caring for these patients, since it is cost-effective, simple to learn and practice and it is most effective in improving and maintaining patient's high quality of life.

Introduction

Dementia refers to acquired intellectual deterioration characterized by cognitive impairment, personality change and behavioral disturbances. Alzheimer's disease (AD) is the most common form of 70 different types of chronic irreversible dementia which occur in the middle and late years Blass, 1982, Stolley et al., 1993. The overall prevalence of clinically diagnosed AD among persons age 65 and over is 10.3% Evans et al., 1989, Bennett and Evans, 1992. By the year 2050, as many as seven to nine million Americans will be affected by AD (Butler et al., 1991). In addition, more than 11 million people in Asia will be suffering from AD by the year 2000 Finch, 1985, Bayles and Kaszniak, 1987.

Noncognitive/emotional and behavioral disturbances such as anxiety, depression, delusions, hallucinations and several types of abnormal behaviors can occur on a daily basis and affect 70–90% of patients with dementia Teri et al., 1992, Folstein and Bylsma, 1994. Although these behaviors can impede care and impoverish the quality of life for both the patient and the caregiver, little is known about effective management (Teri et al., 1992).

In general, interventions patients with dementia provide supportive care for the patients and their family and maintain the quality of life. Some researchers and clinicians are beginning to advocate on behalf of nonpharmacologic intervention such as environmental management Burnside, 1979, Cleary et al., 1988, Burgener and Barton, 1991, Burgener et al., 1992, Swanson et al., 1993, the use of a reassuring and gentle voice (Bartol, 1979) and the judicious use of touch as a form of nonverbal communication Burnside, 1979, Hollinger and Buschmann, 1993, Buschmann et al., in press, Kim and Buschmann, in press.

Communication is sharing ideas with or without words. Verbal communication gives patients a sense of security knowing that there is someone who listens and that they are not alone (Beck and Heacock, 1988). Cognitive impairment due to dementia includes loss of the normal use of language and shows an increase in levels of stress and frustration. This results in an increase in the potential for anxiety and dysfunctional behaviors and is presented in the progressively lowered stress threshold (PLST) model (Hall and Buckwalter, 1987). Thus, caregiver's normal verbal communication patterns need to be altered to compensate for the loss of language in patients with dementia. Interpersonal touch, which is physical contact between humans, is one way to alter communication patterns. When touching, people share their feelings, engage in nonverbal communication and establish human relationships by using the tactile sense. This is demonstrated in the touch model (Hollinger and Buschmann, 1993) and is an appropriate approach for individuals with dementia because they maintain their emotions and their sense of touch. Bartol (1979) reported that the persons with dementia are still capable of perceiving the emotional climate of their environment. The occurrence of noncognitive problems such as anxiety and dysfunctional behaviors can be triggered by situational stressors and also minimized by maintaining a pleasant, calm, supportive and caring environment Hall and Buckwalter, 1987, Hall, 1994. Some researchers asserted that the use of touch, as a form of nonverbal communication, alleviates anxiety in situations of stress through providing comfort, reassurance, and support to patients with dementia Burnside, 1979, Hollinger and Buschmann, 1993, Taft et al., 1993, Buschmann et al., in press.

The combined use of the touch model and the PLST model (Kim and Buschmann, in pressb) provides the basis for nonverbal communication. Based on this touch–stress model, it is predicted that the resulting expressive physical touch intervention employed in patients with dementia soothes the stress and then reduces their emotional disorders and dysfunctional behaviors. Using touch as an intervention, environmental stimuli can be modified and then the patient with a progressively lowered stress threshold is more likely to maintain normative behavior.

The purpose of this study was to determine the effects, if any, of expressive physical touch with verbalization (EPT/V) on anxiety and dysfunctional behavior in patients with dementia. Additionally, this study determined the length of time that EPT/V continues to have an effect, if any, on anxiety and dysfunctional behavior after the intervention was stopped.

The research hypotheses under study are

• Pulse rate will be lower immediately following expressive physical touch with verbalization;

• Expressive physical touch with verbalization will cause decreasing episodes of dysfunctional behavior.

Expressive physical touch, which is affective, is the use of touch behavior for 5$\text{1}\text{2}$ min. This behavior is accomplished by handmassage to each hand for 2$\text{1}\text{2}$ min (Snyder et al., 1995) and intermittent gentle touch on the arm and shoulder was administered before and after the massage (Buschmann et al., in press).

Verbalization refers to calm soothing speech. Its importance is the emotional sense or feeling that is conveyed and not the meaning of the words used Bartol, 1979, Buschmann et al., in press.

Anxiety has been variously described as a feeling, a body reaction, and a psychiatric disorder. In this study, it was defined as a bodily reaction to stress assessed by the measurement of the pulse rate.

Dysfunctional behavior is manifested as behavioral symptoms which are psychotic phenomena. These include delusional thinking, suspiciousness, hallucinations, agitation, violence and verbal outbursts (Reisberg et al., 1987). In this study, dysfunctional behavior was measured with the Empirical Behavioral Pathology in Alzheimer's Disease (E-BEHAVE-AD) rating scale (Auer et al., 1996).