Oh Bugger! Pete’s in a rage?

The strung out and overworked carers around him and the duty nurse Steve were all on high alert. You could see their chests rising as their breathing increased pace ready for the fight/flight response being channelled to intervene to keep Pete, the other residents and themselves safe. The next stop would be the reaching for the medicine trolley for some heavy duty “Calms” for Pete.

Pete lived with dementia and in my years of visiting his home he was usually a gentle soul and in recent years had become mostly non-verbal.

Pete wasn’t one of my clients, but I did massage his good friend Percy each week and Pete would often come and sit with us. We would sit together, quietly enjoying each other’s company. I sometimes brought in newspapers or a memory box to share. Both friends enjoyed a paper and Percy particularly used to enjoy going through the items, occasionally perching a hat on my head and feather boa round my neck. We had some giggles about that especially as I sat massaging Percy in my fancy garb.

Anyway, I digress, today Pete whirl-winded past me, shaking his fists in the air and headed straight to a locked door which led to the front foyer and started banging on it. I wondered if he wanted to get out. I kept a safe distance checking with him, “Pete, you seem angry.” I caught Steve’s expression, his eyebrows raised, looking slightly panicked as if to question my feeding into Pete’s outburst. I don’t think the Steve felt comfortable dealing with emotions. The way I saw it though, was that the proverbial can of worms was already open, spilt on the floor and was wiggling away in a frenzy in all directions.

Pete spun round to face me, raised his hands aloft and shook them. Maintaining my distance I asked, “Pete, is it your hands?” Pete, normally non-verbal remember, stated clearly in his anguish, “yes!”

“Oh Pete,” I say gently, “OK, I’ve got something for that,” and I ask if he wants to follow me. As we head to sit in the lounge area, I quickly ask Steve if he is happy for me to give Pete a cream to help with the pain in his hands and, at the end of his tether he agreed with a ‘whatever’ wave of his hand.

I asked Pete to come and sit by me. Percy was already sat down, he was next in line to be offered a massage that day, so we sat next to him. They shared a lovely quiet relationship of understanding and acceptance.

I quickly got to work mixing some chamomile essential oil into a mild calendula cream offering words of reassurance to Pete, explaining what I was doing and why. Once it was suitably mixed, I presented the blended cream to Pete and gestured that he should rub it into his hands to ease his pain. He did exactly that and I monitored his safety while readying to treat Percy. Pete rubbed the cream round and round massaging his own hands.

While he did that Percy had rolled up his trouser legs in anticipation of his treatment and I had got to work massaging his lower legs. After about 20 minutes or so of rubbing his hands together, Pete got up and went about his business calmly.

In a review of hospital patients living with dementia in China, Zhao, Gu and Zhang, (2020), concluded that “long-term massage therapy in combination with aromatherapy, was more significant than other combinations of therapies in controlling behavioural abnormalities.” Now, although I’m not keen on the language in this quote, because I don’t think we should control behaviour but enable needs to be met, I think you get the picture, that massage and essential oil use wrapped up in a compassionate approach is a kinder therapeutic intervention.

Studies by Zhao, Gu and Zhang, (2020); Fung and Tsang; (2017) and Liu, Liao and Song (2022) illustrate how massage can calm a person and reduce carer stress, and that includes professional carers. Feedback I have received constantly over the years is that when I go to work with people, the room calms, quietens and this makes life easier for the carers working there, especially because the effects of the massage last long after the treatment has ended. I think there is a valuable role of therapeutic touch interventions within health and social care settings. These studies also show that a qualified massage therapist could quickly and easily work with teams of health and social care professionals to pass on skills so that we can all be working in more therapeutic ways weaving positive touch into our daily lives.

Acknowledging Pete’s distress and pain was key, as was addressing his pain. Enabling Pete to have agency in alleviating his own distress I think was hugely important given that dementia can strip us of so much control in our lives. Co-regulating then giving Pete space to self-regulate meant he retained his dignity. It also affirmed the power of massage (albeit self-administered) and essential oils and how they can be used to ease pain with their mildly analgesic and anti-inflammatory properties. There are other things we can reach for before we reach for the medicine trolley, or as Kirsty (@Justacarehomeg1) coined it recently, “reach for people not medicines”.

As always, names have been changed to protect people’s identity.

References:

Fung, J.K.K. and Tsang, H.W. (2017). Management of Behavioural and Psychological Symptoms of Dementia by an aroma-massage with Acupressure Treatment protocol: a Randomised Clinical Trial. Journal of Clinical Nursing, 27(9-10), pp.1812–1825. doi: https://doi.org/10.1111/jocn.14101

Liu, Y.-C., Liao, C.-N. and Song, C.-Y. (2022). Effects of Manual Massage Given by Family Caregivers for Patients with dementia: a Preliminary Investigation. Geriatric Nursing. [online] Available at: https://www-sciencedirect-com.plymouth.idm.oclc.org/science/article/pii/S0197457222001185 [Accessed 2 Jun. 2022].

Zhao, H., Gu, W. and Zhang, M. (2020). Massage Therapy in Nursing as Nonpharmacological Intervention to Control Agitation and Stress in Patients with Dementia. Alternative Therapies in Health and Medicine, [online] 26(6), pp.29–33. Available at: https://pubmed.ncbi.nlm.nih.gov/32088672/