CONNECTING THROUGH TOUCH

            Touch seems to be the least appreciated of our senses, the sense we rarely think of.  Yet there is a significant impact on how we feel.  Unhappily, the Covid pandemic has so reduced our normal touching that we long for touch, reminding us of how significant touch is.  We touch to convey key feelings to another person; in most interactions these are positive emotions.  Of course, pushing, hitting, and other forms of attack are well known for expressing negative feelings, typically anger.  But mostly we convey our friendship, caring, and love through a range of touching, putting a hand on an arm, hand shaking and hand holding, hugging, rubbing and massage, even sensual touch.

            For many with Alzheimer’s, any form of positive touching can bring happiness to them and to us.   There are many possibilities.  The obvious is a simple touch to the hand, arm, or shoulder, even the neck. Handshakes can be positive if engaged with subtlety and a little longer time.  Holding hands.  Hand to the face or waist is somewhat more intimate, but sometimes allowable from the right person.  Brushing or combing hair involves touching that can be very positive as can arranging hair and makeup.  Massages of the neck, shoulder, and upper back can be very pleasurable for them, as can massages of hands or feet.

            There is research about the impact of positive touching on the dementia patient.  Even a few minutes each day can have considerable positive effect.  A few minutes twice a day of healing touch has resulted in reductions in several common problems with Alzheimer’s patients. It is not always clear from the summary reports available about the form of touch used in some of these studies.  Hand massage has demonstrated a clear effect.  Another study used contact with the neck and shoulders.   Agitation is reduced, so there is less wandering, pacing, and fidgeting.  Stress and anxiety appear to be lowered as well, which essentially means the patient is more relaxed.  There appears to be no effect on physical aggression.

            But there are some important cautions.  Some Alzheimer’s patients develop a hypersensitivity to touch, so that therapeutic touch interventions would be problematic and perhaps so would normal touching by a loved one.  We should be tuned into the issue of paranoia and delusions, as touching could precipitate a strong negative reaction.  Even so, a subtle touch that is not invasive or restraining will ordinarily be a positive intervention, especially in conjunction with gentle, kind talk about wanting to understand and help.  “You are upset.  Can I help with holding your hand (or a hug)?”

            The one time I saw someone aggress toward Beverly was when she approached a man (with dementia) sitting on a bench in her facility.  She put a hand gently on his shoulder.  He stood up and punched her, fortunately without any real harm to her, beyond her hurt feelings.  She was being friendly, but he did not want to be touched, as others told us.  But, of course, this was the rare exception.  Nearly all of the time her touching of others was welcomed.

Still, for most, therapeutic touch is something that has important positive effects.  As discussed above, there is likely to be calming and soothing and provide some please for our loved one.  The book by Mace & Rabins (The 36-Hour Day:  A Family Guide to caring for People Who Have Alzheimer Disease, Other Dementias, and Memory Loss) is a compendium of everything one might want to know about managing dementia.  They mention the significance of providing pleasure by touch for our loved one—from handholding, touching, hugging, and the like.  And there are so many ways that we can use touching to communicate our love for them.  Delivered tenderly, almost any touch tells them of our love.  The wonderful book The Spectrum of Hope by Devi discusses touch, stating “…I am a strong believer in the importance of touch and the healing power of the human hand.”  Her emphasis is that dementia patients need connections through touching, though many do not receive touches.

Mace & Rabins also indicate that this may be an important means of communication, such as touching the arm that he or she should put into the sleeve of a shirt.  And so many examples:  touching a shoulder and pointing is the communication that might be the most effective means of telling them how to get to the dining room.  The right touch to a hand can tell them to manipulate the fork or spoon needed for eating.  And, of course, the staff know how to move the person from one place to another—simply take their hand and start moving, though not too suddenly.  I previously told the story of the caregiver (CNA) who intervened with the angry man who had struck a woman; she simply took his hand and told him it was time to go to his room.  He walked off calmly with her; holding his hand was a significant part of that comforting.

Beverly has always been a touching person, needing hand holding, hugging, and massaging.  Prior to Covid, I could still get her to a massage therapist on a regular basis (every 2-3 weeks).  This worked well because she knew him and he understood her situation; he is a wonderful therapist with keen insight and fundamental caring.  

Now (Summer, 2021), her verbal communication is very limited, so touch is even more essential.  These days the facility has limited time visits available; sometimes when I am with her, a large part of that time is quietly holding hands.  There may be no talk from me for several minutes and she is silent too.  Yet this is communication that is more powerful than words!  She may rub my arm or hand and I may do the same to her. She appreciates gentle massage to her neck and shoulder area of her back, which are tighter than they should be.  And the hugs remind me that touch is significant for the caregiver, too.

Touch is fundamental to our relationship with the person with dementia.  We can convey our caring and love and create relaxation and calm, especially when they are upset.  We can even give subtle instructions.  I believe that touch will be powerfully effective (for her and for most) through all the changes with dementia, including the latest stages.