by David Siever, Edmonton, ALberta, Canada

As the majority of the North American population continues to age, cognitive decline in older adults is becoming an ever-growing concern. With the increase in age comes a decrease in cerebral blood flow, slowing of the brain's alpha rhythm and increased theta activity. These changes correlate with reduced cognition, spanning memory, problem solving ability, difficulty with language and speech, and locomotion. Chronic stress impairs hippocampal function leading to a host of disorders including Alzheimer's disease. The left hemisphere of the brain has a tendency to loose functionality before the right side, which may enhance spatial creativity and when coupled with fears and feelings of helplessness, may also bring forth depression. Preliminary studies of Audio-visual entrainment (AVE) have shown this technique to be promising in the treatment of age-related issues common with our senior citizens. AVE is proving to rehabilitate cognitive function in seniors and the best application of AVE may be that as a prophylactic against cognitive decline.

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This was a prospective study designed to examine the potential of massage to reduce agitation in cognitively impaired nursing home residents. Subjects were identified as susceptible to agitation by nursing home staff or by Minimum Data Set (MDS) report. Data was collected during baseline (3 days), intervention (6 days), and at follow-up. Five aspects of agitation were assessed: Wandering, Verbally Agitated/Abusive, Physically Agitated/Abusive, Socially Inappropriate/Disruptive, and Resists Care. At each observation, agitation was scored 5 times during the 1-hour window of observation. Subjects' agitation was lower during the massage intervention than at baseline (2.05 vs. 1.22, P < .001), and remained lower at follow-up. Of the 5 agitated behaviors examined in this study, massage was associated with significant improvement for 4: Wandering (0.38 vs. 0.16, P < .001), Verbally Agitated/Abusive (0.59 vs. 0.49, P = .002), Physically Agitated/Abusive (0.82 vs. 0.40, P < .001), and Resists Care (0.10 vs. 0.09, P = .022). When analysis was restricted to residents with significant levels of agitation at baseline, the observed effects of massage on agitation increased. Massage is an accessible, easily learned intervention that is effective in controlling some types of agitation in elders with cognitive impairment. Massage should be studied further as a nonpharmacological intervention in such patients.

Geriatr Nurs. 2009 Mar-Apr;30(2):108-17. Holliday-Welsh DM, Gessert CE, Renier CM. Holliday Welsh & Associates, Duluth, MN, USA.