Touch and dementia

A Reflection on the Language of Touch

A hug can provide solace. A gentle massage can soothe and calm. Holding hands can reassure. In short, “touch” can be a powerful “therapy” that comforts a loved one with dementia.

Study of Dante holding the hand of Love by Dante Gabriel Rossetti

Study of Dante holding the hand of Love by Dante Gabriel Rossetti

Some of my best memories in caring for my mother center around sitting together on the porch of the assisted living facility, without saying much, but just gently stroking her hands and seeing her smile.

I realize that not all family members feel comfortable about touching or hugging their relatives. There can even be issues rooted in a fear or stigma that touching a person with dementia will result in “catching” the disease.

If you are caring for a loved one in your home, caregiving might inevitably involve touching intimate areas, like changing incontinent pads or panties, toileting, or bathing a relative of the opposite sex. How do you become comfortable with the vital role that “touch” plays?

The first step is to reflect on the nature of touch as one of our most basic human needs, no matter age or physical or mental condition. The second step might be in confronting your own reservations about touch. For a person with dementia, the need to be comforted and reassured by the loving, gentle touch of a hand or hug can be life-affirming, decreasing their feelings of anxiety, fear, or loneliness.

The reflection below was composed by Merle Stern, to guide in a deeper understanding of the importance of the gift of “touch” in your caregiving role. In her own words, Merle notes: “I remember many years ago, as though it was yesterday. I took the two week old baby from the arms of her mother and held her close to my heart. The synchronization of the baby’s heart beat with my own heart beat was a memorable experience, and at that moment I became aware of the power of touch.”

Jan 21 baby hugged cropped-1345736_640

To begin that inward journey of processing your personal experiences, you will need to withdraw to your sanctuary – that quiet place within you and surrounding you. Then, gently close your eyes and focus your awareness on your breathing. Experience the space around you and become at one with it.

Now, try to think of touching as a language: a language that speaks to the innermost sense of who we are; a language that has the potential to convey the depth of a relationship. The person whom you touch, and their response to your touch, has the ability to create a bond, and to build bridges that transcend words and invisible barriers. It simultaneously penetrates two different worlds.  

Take a moment now to gently stroke your arm. Feel the softness of your skin as your touch communicates gentleness and tenderness. Note how you are giving and receiving at the same time. After a few moments, and through the medium of your touch, try to communicate different issues; for example approval, objection, or whatever comes to your mind. Become aware of how and what you are feeling simultaneously, both as the transmitter and receiver of that touch.

Focus again on your breathing. After a few moments scan over some of your life’s experiences, making notes in your journal as you go along:

  •  The touch that conveys your joy and well being;
  •  The touch that conveys your appreciation/gratitude for help given by a stranger;
  •  You have not seen a person for a long time and you reach out with a spontaneous hug – a hug that enhances your bonding and friendship that transcends time and distance;
  •  The way you touched a child who came to you for comfort and solace;
  •  The touch that expresses “welcome,” and one that expresses “goodbye;”
  •  The difference in touch when you stroke a kitten or dog, or other pet animal;
  •  The touch that conveys your compassion, empathy, and understanding.

 Jan 21 grandma enbraces child-577494_640

Again, scan over your life and become aware of your own personal “touch history,” making notes in your journal as you go along:

 Visualize yourself as a baby, reaching out to touch your mother’s breast or comforting your teddy bear;

  •  As a young child, the experiences of being touched by your mother, father, brothers, sisters, aunts, uncles, and grandparents;
  •  As an adolescent and as an adult;
  •  As a parent to your child;
  •  As an adult child to your parent;
  •  As a spouse to your spouse.

Now reflect on your touch as a caregiver. Become aware that as you touch that person’s body, you are also touching his or her life. You invoke long forgotten memories of what once was and no longer is.

Throughout your caregiving, your touch conveys a variety of messages. Some of these messages include: your loved one is important; they are lovable; they do not need to be afraid; you are present with them on their journey.

Now, reflect on the possibility that the last touch in this person’s life may come from your hands. What would you like this last touch to convey, as you bid goodbye to your loved one who is transitioning to another realm?

Finally, take a look at your hands – the hands that will convey what words cannot. Feel your appreciation for your hands and the blessed gift of touch. Make a note in your journal of the value of this experience and how it can continue to enrich your life.

 hands-holding-together

Our experiences of bonding often center on the sense of touch and communicate much more than words ever could. The British-American anthropologist Ashley Montagu sums it up in his 1971 landmark book, Touching: The Human Significance of the Skin: “Touch conveys fondness, security, closeness, warmth, concern, and encouragement, and makes [older persons] feel an increased sense of trust and well-being.

I wish you peace, patience, and joy in your caregiving today and every day!

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Sincere thanks go to Merle Stern, my friend and mentor, who composed this reflection. Feel free to pass it on to family and friends, but please give credit to Merle and this website.

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Dave Otis, a licensed massage therapist, wrote easy directions for healthy self-massage exercises for hands, face, and neck. Check these out by going to: http://www.unh.edu/health-services/sites/unh.edu.health-services/files/media/PDF/Stress/SelfMassage.pdf.

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For a comprehensive article on “How Skilled Human Touch Can Transform Person-centered Dementia Care,” go here: https://www.nhqualitycampaign.org/files/Compassionate_Touch_White_Paper.pdf.

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My sister Marcia and I published a journal called My Blessings Journal. It can be a useful tool to introduce you to the joys of journal-keeping. To order a copy through my website click here: http://caregiverfamilies.com/book/.

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Alzheimer’s and the Senses Part Five: Touch

“To touch can be to give life,” said Renaissance painter, sculptor, architect and poet Michelangelo. I was privileged in 2014 to visit the Sistine Chapel in Rome and view Michelangelo’s fresco painting of “The Creation of Adam.” You may have seen this classic painting of God’s near-touching finger reaching out to bring “life” to Adam.

The scene is unforgettable! I wonder if Michelangelo knew that touch is the first sense developed by the body.

Michelangelo's "Creation of Adam"

Michelangelo’s “Creation of Adam”

Our sense of touch is a basic human need, a lifeline that can communicate love, safety, care, reassurance, and trust. Touch is not an emotion, but emotions are formed through the physical, psychological and spiritual effects that we experience through this unique sense. Persons with Alzheimer’s or other forms of dementia do not lose their capacity for human emotion or their recognition of a caring touch.

Compared to our scientific knowledge of the other senses, our understanding of the sense of touch, and in particular how it is processed in the brain, is limited. According to neurobiologist Dr. David Linden, “genes, cells and neural circuits involved in the sense of touch have been crucial to creating our unique human experience.” Yet, writes Dr. Linden, the body’s touch circuits are “a weird, complex and often counterintuitive system.”

How the Brain Processes Touch

Our sense of touch does not have a specific place on the body where it is located, for it is found all over the body in our skin. Our skin is the largest organ in the somatic sensory system. The somatic sensory system has nerve endings and receptors that help us feel when something comes into contact with our skin.

Chart of skin

Chart of skin

When the touch, pain or heat sensors in our skin are stimulated, they send electrical impulses to our neurons. The neurons then act as a relay team, passing the electrical pulse from neuron to neuron until it reaches our spinal cord. Our spinal cord then takes the signal and sends it to our brain to translate it.

Neuroscientists have discovered that there are two distinct but parallel pathways in the brain for processing “touch” information. The first pathway is in the region of the brain called the primary somatosensory cortex. This is the region that analyzes and processes information about the “facts” of a touch, such as vibration, pressure, texture, temperature and location.

The second pathway processes social and emotional information and activates brain regions associated with social bonding and our pleasure and pain centers.

Aging and Touch

Humans crave touch. Just as babies thrive and respond to being held, as we age our need for touch remains. Unfortunately, our sense of touch steadily deteriorates as we get older. Every year, starting at around age eighteen, we lose about one percent of our tactile sense. Some researchers explain that this could be the reason elderly people are so prone to falls – they get less tactile information from the soles of their feet when wearing shoes.

The Physical and Emotional Benefits of Touch

Research studies document physical and emotional health benefits of using “touch” in caring for a person with dementia. The physical benefits include:

  • Lowering of blood pressure
  • A decrease in pain
  • An improvement in mood
  • A decrease in stress-related cortisol
  • A decrease in heart rate
  • An increase in sensory awareness.

As to the emotional benefits, touch can communicate multiple positive emotions such as love, safety, care, reassurance, trust.  Hugs, holding hands, a caress, or other physical gestures of affection can ease your loved one’s mind, help them feel less isolated, decrease their anxiety. Studies have shown that a person giving a hug gets just as much benefit as the person being hugged. For a person with Alzheimer’s, compassionate touch is a language of the human heart.

How You Can Help

1.  Active Tactile Stimulation

The brain “feels,” so tactile stimuli is brain stimulation. The most sensitive parts of our body and those with the most nerve endings are our fingertips and mouth. Each of our fingertips has about 3,000 nerve receptors.

A person with dementia naturally gravitates toward tactile stimulation when they explore the fabric of their clothing or the smoothness of an object in front of them. Every solid object has texture, temperature, and shape. They can benefit from activities that involve handling a variety of objects to experience texture. These could include: squeezable balls, sensory “blankets,” activity muffs, finger painting, “clay” work with Play-Doh.

Go for a walk in a garden or woods and let your loved one touch leaves, tree bark, and flowers. Bring the feel of the outdoors inside by filling a tray or basket with similar objects like shells and coral to replicate the seashore, or acorns, pine cones, and various branches.

Incorporate “touch” into their daily routine, like folding warm laundry, sweeping the floor, arranging flowers in a vase, drying dishes, brushing a dog’s fur coat, knitting or crocheting.

2. Passive Tactile Stimulation

My Mom always seemed to want a handkerchief in her hand. She told me it gave her a feeling of reassurance. She also enjoyed carrying around a small purse that had a few items tucked in it like a comb and coin purse.

One of the ways I found to calm and comfort Mom when I visited her in the assisted living facility was to give her a weekly manicure. A pedicure and combing/brushing hair are other forms of passive tactile stimulation.

Giving a hand, foot, neck, or upper back massage is also a way to connect and communicate. Make sure your loved one gives you permission to do so. Do not surprise them. hands-holding-togetherUse a little massage oil like lavender or lemon balm to add to the sensory experience.

When temperatures change in the fall and winter months, make sure your loved one is kept warm both inside and outdoors. They may not be able to tell you when they are hot or cold. Sitting wrapped in a soft blanket can provide comfort and warmth to an anxious person. Cover sofas or an armchair with fake fur or sheepskin.

3. Pain

Be on the alert to pain in your loved one at all stages of the disease. Pain often goes undetected, under-recognized, and under-treated in persons with dementia. Most studies suggest that the experience of pain is elevated in persons with mild to moderate Alzheimer’s disease. However, pain sensitivity in the late stages is unclear, according to Sciencedaily.com.

Beside facial expressions like grimacing or frowning, some signs that your loved one is in pain include: guarding, bracing, moaning, sighing, aggressive behavior.

The bathroom and kitchen are places where scalding and burns happen. Adjust the water heater to 120 degrees Fahrenheit, and/or install anti-scald devices for water taps. Check into automatic shut-off devices for stoves and ovens. Unplug appliances when not in use.

Michelangelo symbolized the power of touch in his magnificent painting of the act of creation.  Create opportunities each day to “give life” to your loved one. The sense of touch is truly fundamental to human communication, bonding and health.

I wish you peace, joy, courage, and patience in your caregiving today and every day!

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Read more about touch and the elderly at: http://www.comfortkeepers.com/home/info-center/senior-care/the-power-of-touch-and-what-it-means-for-the-elder#sthash.f1NaePg5.dpuf.

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Dacher Keltner, UC Berkeley psychology professor and faculty director at the Greater Good Science Center, shares insights into touch therapies in this eight-minute YouTube video: https://youtu.be/GW5p8xOVwRo.

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The Alzheimer’s Association of Australia has a “Help Sheet on Pain.” You can find it here:

https://www.fightdementia.org.au/files/helpsheets/Helpsheet-CaringForSomeone11-Pain_english.pdf.

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For easy directions about giving a hand massage, check out: http://www.wikihow.com/Massage-Someone’s-Hand.

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If you found this blog beneficial, please share it and “like” us on Facebook: https://www.facebook.com/CaregiverFamilies/. Sign up for my free newsletter that accompanies each new blog with extra tips and resources for my subscribers.