More Than Comfort: Therapeutic Presence in Alzheimer’s and Dementia Care

woman in grey jacket
This month I invited a dear friend, Heather Campbell Grimes, to guest blog for Boulder Acupuncture and Herbs. Heather writes about her experience working as a massage therapist in a memory care facility for patients with Alzheimer’s and dementia. Her insights on the importance of touch and the power of grounded presence in caring for this unique population are welcome inspiration for anyone working with elders. Thank you, Heather

Her real name is not Mary, but we’ll call her that for now. I knock on Mary’s door and then announce who I am before unlocking it with a key. The door leads directly into her bedroom. She’s where she always is: curled up and contorted in her bed, watching DVD re-runs of the TV show MASH.

She says, “Thank god it’s you. They’ve been coming in all morning, trying to get me to go to exercise.” Mary is in her early seventies, but a nasty fall about six months earlier—which resulted in a broken leg, a broken hip, and three major surgeries—left her looking frail and much older. I assume this, however, because I didn’t know her before she came to the Alzheimer’s and dementia residence where she lives now, where I work. From what her family tells me, her physical traumas—and a move cross-country to live in a place where she can receive constant care and that is closer to her daughter—exacerbated her dementia.

Propping herself up is a slow and painful process. Her shoulder-length gray hair is tied up in a little-girl ponytail, with at least a dozen bobby pins attempting to restrain the wispy side pieces. Mary has all-over body pain, as she describes it, and is prescribed legitimate pain-killers to take twice a day. They may or may not help the pain, but they do not free Mary enough —physically or emotionally—to want to leave her bed.

“Good morning, Mary,” I say and lug the massage table into her space. I set it up, loud and clunky, while she scoots herself to the edge of her bed, wincing from the pain. I roll her walker over to her and help her to stand before she shuffles herself to her bathroom. (Her home consists of a bedroom and a bathroom.) She voluntarily gets up for meals and that’s about it. And her weekly massage.

It’s a struggle for her to undress and climb onto the massage table, but she would have it no other way. I have tried to massage her fully clothed and in her recliner, half-clothed in her bed, but nothing is as satisfying to her as having her on the table for the full hour-long experience.

I’ve learned that she loves Frank Sinatra, so I bring my phone with me and we listen to the “Ultimate Sinatra Collection.” Mary is very inquisitive about Frank, so we’ve looked up quite a bit of his history on my phone—he was married four times and recorded over a thousand songs. She lights up when she talks about him, as if we had not had the very same conversation the week before, and the week before that.

Within minutes on the massage table, her body shifts from a tense assortment of stiff and rigid bones to feeling as though there is some space in there between the joints—some slight sense of buoyancy that I am pretty sure she doesn’t experience on a regular day. Her mood shifts from laser-focusing on her ailments to wanting to chat about music, my family, the words that go ‘on’ things. (Mary often talks about what words she would put ‘on’ things to describe them. She often says she’d put the word ‘ache’ on her leg, ‘sore’ on her foot, or ‘underwear’ on her Depends.)

The specific massage strokes are of no particular importance, though I know to work extra gently on most of her body, to focus on her shoulders and back, and to lay off her feet. What is most important, at least I believe, is the invitation for Mary to inhabit her body without resentment. Our one hour a week may be one of the few occasions where she can feel the sensations of her body without bracing herself against them. This increases her overall body awareness as well as palpably easing her anxiety.

And without all that struggle, she is able to relax and connect with me in a very human way. She doesn’t always remember my name (though I wear a nametag), and she repeats the same sentences over and over. But she always remembers that I have two daughters and am in the process of adopting the youngest. She asks about them every time.

Mary is one example of the numerous people with Alzheimer’s and dementia who I have had the good fortune to work with over the years. I’ve been a massage therapist for eleven years but have focused primarily on working with folks who have Alzheimer’s and dementia for the past six years. I work at a memory care facility that houses only this specific population.

Every one of my clients is supremely unique, with specific needs and thresholds. More often than not, I work with the residents for frequent, shorter chunks of time—fifteen minutes, twice a week is the most common—where they stay fully clothed and sit in a comfortable chair in a public area. It takes them such a long time to undress and re-dress, and the effort of climbing on and off of a standard massage table is just too much for most of them. But there are a few—Mary being one of them— who are agile enough to get on the massage table and who want only that.

Regardless of where the massage session is located, or how long it lasts, the connection is still there and is the pinnacle of our work. Every human has a basic need for caring touch, and although the staff where I work is exceptional, the fact is they have many people to look after. Often the residents’ experience touch primarily when they are getting dressed or toileted—the daily necessities.

The touch provided by a massage therapist is of a very different variety. It provides nurturance and attendance, sometimes helping a drowsy resident to grow more alert, sometimes aiding an agitated resident to calm down.

I also work as another set of eyes and ears to help provide the best care for these residents, letting the nurses and family know if a resident is more restless or confused than usual, or if they are complaining of pain in a certain area. This provides many of the families (as they are the ones who hire me) with a bit more peace of mind. It certainly does take a village.

One of the things I love most about working with this specific population is the genuineness of our interactions. There is nothing to ‘fix’, as it were, simply comfort and connection to offer. Most of my clients are not able to hold a typical conversation, so finding a way to relate with them requires a bit more curiosity and imagination. When I am attentive and grounded, my time with my residents feels incredibly valuable and satisfying. So when something is off, I can usually trace it back to where my mind and heart are at, how present I am being with them. This is a great service to me.

So when I am about to leave Mary in her room after her massage session, she may or may not want to come out to the common area with me. Likely not. But she does have a certain sparkle in her eye and a smile on her face as we hug and she says, thank you.

Heather Campbell Grimes is a blogger, freelance writer, and stage performer. Heather is also a massage therapist who specializes in working with elders who have Alzheimers and dementia. She is a devoted mother and foster-mother, and she lives with her husband and family outside Boulder, Colorado. You can find Heather at hcgrimes.org.

Acupuncture for Alzheimer’s and Dementia

senior in hat

Alzheimer’s disease and dementia impact over 5 million people in the United States. According to the Alzheimer’s Association, nearly 70,000 people in Colorado live with memory loss. With Alzheimer’s and dementia on the rise, complementary care options are critical for helping manage this widespread health crisis. Acupuncture can be an effective part of treating the many symptoms that occur with Alzheimer’s and other forms of dementia.

Alzheimer’s is a difficult condition to treat. Like many complex diseases, the causes are not well understood. Western medical intervention can help patients manage certain symptoms, but conventional treatment options have been ineffective in halting the progression of the disease. Given the increasing number of patients diagnosed with this illness, and the growth of our aging population, pharmaceutical companies and research institutions are scrambling to find a cure for this devastating disease.

Alzheimer’s and dementia primarily affect people over 65, though early-onset dementia does occur. There are currently 5.5 million people living with Alzheimer’s or dementia in the United States, and that number is expected to rise as our population ages. The widespread prevalence of these conditions has shot up dramatically over the last 17 years; since 2000, deaths from Alzheimer’s disease have gone up 89%. Alzheimer’s is now the sixth leading cause of death in Colorado and the United States as a whole.

The course of cognitive diseases like these can be long. Some patients live a decade with progressively complicating symptoms. There are currently no known cures or preventative methods to stop Alzheimer’s disease. This means the full burden of the disease usually comes in old age when one’s health may already be compromised. It is not uncommon for older adults living with Alzheimer’s or dementia to have diabetes, heart disease, or other chronic illnesses.

Even in elders who do not exhibit memory loss, old age brings a host of physical and mental difficulties. Acupuncture excels in treating many conditions that show up in our later years, including arthritis, digestive issues, insomnia, hypertension, depression, and anxiety. It is important to remember that although Alzheimer’s and dementia are memory disorders, patients may suffer from physical illnesses that are manageable through complementary medicine, such as massage and acupuncture.

We know that the personality changes that accompany dementia can be challenging, both for patients and caregivers. Recent research in the U.S. on the efficacy of acupuncture in treating depression and anxiety in Alzheimer’s patients has been promising. These diseases can instigate profound feelings of despair and cause an increase in social isolation. Acupuncture, different from talk therapy, offers a body-mind treatment that can calm feelings of anxiety and lift the mood. Treatment offers patients the chance to interact with someone outside their normal sphere of care, which can stimulate social connection.

Acupuncture also excels in treating pain of all kinds. Many seniors report living with pain, which can lead to a decrease in physical activity and changes in sleep patterns. Movement is critical for maintaining health and inspiring participation in activities that bring us joy. Many dementia patients are still capable of physical exercise and should be encouraged to stay active as a way of promoting their overall health. Acupuncture keeps seniors moving by alleviating back, knee, neck, and foot pain.

Expanded research on using acupuncture and Chinese herbs in treating Alzheimer’s is being explored in China and Japan where prevalence of the disease is also on the rise. While we cannot claim that East Asian medicine currently offers a strong method for halting or reversing this disease, we can provide supportive care in the realm of helping to manage co-existing symptoms. Hopefully, as research on Alzheimer’s and dementia increases, comprehensive approaches to treatment will become available to patients at all stages of the disease. Ideally, we will discover ways of preventing these conditions as well.

At Boulder Acupuncture and Herbs, we treat patients in the early and middle stages of Alzheimer’s and dementia. We use both acupuncture and Shiatsu to help manage pain, depression, fatigue, and anxiety in patients with cognitive disorders. Our approach to each patient is dependent on the client’s comfort level, receptivity, and physical condition. Some patients may be seen privately, while others need a care partner present. We can also visit patients in their homes or in memory care facilities in Boulder.

The challenges of living with dementia can be overwhelming for many patients, especially during the early stages of the disease when rapidly changing capabilities can cause intense distress. Similarly, caring for a loved one diagnosed with dementia is also incredibly challenging. Managing this disease is a group effort, and we want to be of service. Call us to discuss how acupuncture might help ease the discomfort of living with dementia.