There are over a 100 different types of dementia, all of which gradually destroy brain cells and lead to a progressive decline in mental function. The most common types of dementia are Alzheimer's disease, vascular dementia, and dementia with Lewy bodies, though conditions such as Huntington's disease, Parkinson's disease and MS may also include an irreversible dementia component. Symptoms of dementia typically include: short term memory loss; disorientation: problems with language: difficulty sleeping; impaired judgment; progressive forget-fullness; and rapid changes in mood or behaviour. In the final stages of severe dementia/ Alzheimer's disease, individuals often lose all ability to respond to their environment and need 24 hour care as the nervous system, starts to fail the entire body and not just the memory.

Massage

Not all elderly people enjoy touch, but for many with dementia, it is a means of connecting with the outside world and another human being at a time when they are feeling particularly vulnerable and all other forms of communication are starting to fail them. Simply touching, listening, and being with someone who has dementia can be extremely supportive and beneficial. Whilst a full body massage may be contra-indicated, inappropriate, or even impracticable for an elderly person with dementia, much can be achieved by very gently massaging the hands, feet, neck, shoulders, or back (for which derobing is not necessary), Not only does massage have the potential to improve circulation, ease stress, and relieve physical aches and pains, it can also be comforting and nurturing, and affords the client some unconditional, one-on-one attention.

In her book, From the Heart Through the Hands, author Dawn Nelson writes of a pilot study that took place in a care home in Chicago in 1996 which identified a correlation between certain kinds of touch (applied to specific parts of the body) and specific behaviour patterns. This study's findings, combined with her own experience, led Nelson to conclude that:

• Hand massage/ face stroking - generally works well for those who are anxious, worried, sad or fearful
• Foot massage - works well for those who are hyperactive, restless or have a tendency to 'wander'
• Temples/ scalp/ head - works well for those with tension or headaches
• Shoulder/ neck massage - works well for tiredness, irritability, and mild upset
• Back rubs - work well for people confined in wheelchairs/ in chronic pain/ exhibiting irritability or anger.

Massage should always be slow and relaxing, and never forced upon clients or exercised without their express or inferred permission.

Aromatherapy

People with dementia tend to lose their sense of smell (referred to as 'anosmia'), though this is not believed to interfere with the effects of essential oils, For those clients who do still have a sense of smell, it is important that therapists allow them to choose their own oils where possible. This is because some aromas may have negative connotations for the elderly, e.g. for many Europeans aged 70+, lavender may be associated with death or dying relatives, as this particular herb was often used to scent bed linen and night garments. Some aroma therapists, such as Patricia Davis, are also of the opinion that client's will often instinctively select those oils that are right for them at any given time.

Various studies and experienced practitioners have suggested that certain essential oils may be of particular benefit to some of the symptoms associated with dementia:

For memory loss/ cognitive function ...
Rosemary; geranium; mandarin; lemon balm; peppermint; lavender

For disturbed sleep/ insomnia ...
Lavender; marjoram; chamomile; neroli. Clinical studies have shown that small amounts of lavender: can be as effective as sedatives (or reduce the amount required); do not have the same undesirable side effects as some sedatives (e.g. constipation, confusion, incontinence due to abnormally deep sleep); is more cost-effective than sedatives or other medical interventions used to counteract the side effects of sedatives.

It is advised that only half the normal concentration of essential oils should be used when massaging the elderly, e.g. 1%. Drops on a pillow, in a bath, or in a vapouriser/ burner may be just as beneficial and preferable to elderly clients (though vapourised oils will obviously affect other people present in the room, which could present a problem in a nursing home or hospital environment).

Our thanks to International Therapist Magazine for allowing us to share past articles