Calming Agitation without Medicine: Music and Hand Massage

There are two things you should know about me. First, I’m an academic. Second, my mother had Alzheimer’s. I’ll get to how these are related in a moment.

As my mother’s disease progressed, she often felt anxious or agitated, especially in situations that were unfamiliar or over-stimulating, such as rooms with a great deal of noise or activity. As evening approached, she frequently exhibited signs of “sundowning,” negative behavior or agitation that increased as sunset approached. We knew medication was an option, but we sought alternatives first. Mom was already taking a slew of pills everyday so we wanted to consider other alternatives before adding yet another medicine to her regime.

Here is where the academic part comes into play. When I seek answers, I typically turn to academic and/or clinical research. I like the scientific approach to determining the effectiveness of various treatments, and I particularly like controlled experiments. Fortunately, there is quite a cottage industry of scholars and clinicians studying how to reduce agitation in dementia patients, so the literature offers some helpful suggestions.

Today’s blog focuses on one of those studies “Calming Music and Hand Massage with Agitated Elderly” by Ruth Remington published in Nursing Research (2002) 51(5):317-323. The gist of the study is this: Remington ran an experiment to test whether hand massage, calming music, or both, influenced agitated behavior among nursing home residents with dementia (mostly moderate to severe dementia). The 68 subjects in the study were divided into four groups, one that received 10 minutes of calming music, one that received 10 minutes of hand massage, one that received 10 minutes of both hand massage and calming musing, and one that received neither hand massage nor calming music. She then assessed the effects of the four different “treatments” on the level of agitation in the patient.

Interestingly, the music selected for the calming music treatment was a “New Age arrangement Pachelbel’s Canon in D” one of my favorite pieces of music. Calming music is defined as one that has a slow tempo, non-vocal, repetitive musical themes, and soft dynamics (Remington 2002: 320). The hand massage treatment consisted of “slow strokes, even rhythm and light pressure to the back of the hand, palm and fingers,” applied for 5 minutes to each hand (Remington 2002: 320). The group assigned to receive calming music and hand massage received both simultaneously during a 10 minute period. The results of the study show that both music and hand massage significantly reduced verbal and non-verbal agitated behavior, but not physically aggressive behavior. However, the combined administration of music and a hand massage was no more effective than administering either one alone. For both hand massage and calming music, the reduction in agitation persisted for at least an hour after the treatment (the last time point assessed). The bottom line? The evidence from this study suggests that hand massage and calming music might help address issues of sundowning among Alzheimer’s patients.

My father didn’t need an academic study to tell him this. He knew that massage worked great for my mother! He would offer not only hand massages, but also foot massages. You could see her relax in just a few minutes. We kept a bottle of lotion nearby to combine hand or foot massages because her skin was often chapped and dry from the soaps used at the nursing home. We suspect that the scent of the lotion we used was calming as well. At least, the scent was calming to us!

For Elderbridge Gifts, we selected a number of lotions that we think work great for soothing hand and foot massages. The scent of lavender is well known for its calming properties so we offer Camille Beckman’s English Lavendar line. We love the scent of the Tuscan Honey line for its rich, slightly spicy, slightly sweet fragrance. For those who might be sensitive to smells or perfumes, we offer Camille Beckman’s Unscented Vitamin E line. All of these lotions are easily absorbed without leaving a greasy feel.

Here are some additional resources that address agitation and sundowning among Alzheimer’s patients.

Edyth Ann Knox. “Tips on Sundowning in Alzheimer’s Patients” ElderCare Online

Alzheimer’s Association “Sleeplessness and Sundowning”

Alzheimer’s Association “Agitation”