camclub December Article
- Peace of mind - Nicolle Mitchell, MFHT, FHT
- CNHC reports back on its 2011 camexpo experience
- Antony Haynes - Seminar Slides from camexpo
- Natural Therapy Pages - How to Control Food Cravings
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Nicolle Mitchell, MFHT, FHT accredited training provider for massage and dementia, explains how a combination of time, touch and appropriate communication can help to improve the well-being of those affected by dementia.
Treating people affected by dementia involves multiple skills above and beyond massage and other therapy techniques – from sharpening listening and communication skills in order to build rapport with the client, to the ability to be adaptable and flexible during treatment.
What is dementia?
Dementia is an organic disease that results in damage to the brain cells, contributing to a progressive decline of the brain and its abilities. It is more than just forgetfulness; it can potentially affect the ability to reason, short and long-term memory, orientation, inhibition, sequencing, concentration, perception, communication and independence. Slightly more common in women than in men, dementia tends to occurs in people aged 65 or over, and the likelihood of developing the condition increases with age. Although there are more than 100 types of dementia, the following are those people tend to be most familiar with:
• Alzheimer’s disease, the most common form of dementia, tends to be progressive and involves proteins developing around the brain cells, disrupting the brain’s normal functioning;
• Dementia with Lewy bodies also involves proteins, known as Lewy bodies, which develop inside the brain and disrupt the brain cells;
• Vascular dementia occurs when blood circulation problems cause an insufficient amount of oxygen and nutrients to reach the brain; and
• Frontal lobe dementia, where the frontal and temporal lobes of the brain are damaged, can affect visual and verbal memory, appetite, sleep patterns, organising, sorting information, empathy and inhibitive behaviour. This type of dementia is more common in people under the age of 65.
Therapeutic touch
The National Dementia Strategy published by the Department of Health (February 2009) highlighted the need for early diagnosis, better treatment and support services, and offered advice on living well with dementia, including reducing medication where appropriate, and employing treatments such as cognitive stimulation therapy, reminiscence work, massage and aromatherapy.
People affected by dementia can benefit enormously from therapeutic touch and massage.1,2
For clients who live in nursing homes or in hospital, the therapist may be the only person regularly visiting them and touching them in a caring, therapeutic way. The average amount of time that people with dementia in care homes spend interacting with staff or other residents (excluding care tasks) is two minutes in every six hours (Alzheimer’s Society, 2007). Therapy sessions provide people with dementia an opportunity to both receive and express ‘affection’, and clients tend to respond well to therapeutic touch, often wanting to reciprocate the kindness. Many people with dementia become depressed, and massage can help improve clients’ mental and emotional state by promoting the release of dopamine and oxytocin; hormones that induce feelings of love and heighten sense of well-being.3-6
Some clients may relive past experiences or memories during their treatments, some of which can be uncomfortable or frightening, and therapy sessions involving reassuring touch with a trusted therapist can provide a space where they feel safe enough to face and deal with such feelings.
Massage can help improve or retain proprioception, which is our own perception of the location, movement and posture of our bodies in relation to the physical surrounding space. This can help clients retain independence for longer, maintain engagement in everyday activities, and improve overall quality of life. Other potential benefits may include helping to ease anxiety about symptoms and any side effects of medication; improve circulation and increase supply of blood and oxygen to the brain; and relieve oedema, stiffness, aches and pains caused by reduced mobility. It can also help improve disrupted sleep patterns, and provide comfort and peace to people at the end of their life.7
If you treat clients at home, the therapy session can provide respite for the carer, a time for themselves, while working within the nursing home or hospital environment can offer professional carers more time to spend with other residents or patients.
The treatment
As with all therapy practice, treating clients with regard, respect and dignity is of paramount importance. Consent is a key issue when treating this particular client group and it can be useful to be familiar with the Mental Capacity Act 2005 and the Mental Health Act 1983. Depending on the client’s capacity, written permission must be gained either directly or via a relevant caretaker with the capacity to authorise treatment, such as next of kin, GP, advocate, guardian, or medical professional in the care/nursing home. If clients are contraindicated for treatment, then written consent from their GP or doctor is required. A thorough consultation is essential and gaining information from carers, such as family members, community psychiatric nurses, GPs, dementia nurses, care staff and social workers, can help the therapist to build a rapport and meaningful connection with the client. Where appropriate, therapists should ask to be involved in the client’s care plan.
Treating people with dementia involves a combination of communication, intuition and flexibility. This starts even before the therapist enters the client’s space – a genuine smile and positive attitude is essential as people with dementia are often experts at reading facial expressions, body language and speech tone. Clients should be spoken to about the treatment in a way they can understand and sufficient time allowed for any information to be understood. Where appropriate, clients can be encouraged to make decisions for themselves, although advocates should be involved if necessary. At the first treatment – and, if necessary at subsequent sessions - the therapist should explain why they are there, reassuring the client that it is a time and space purely for them, before slowly introducing touch to discover what they find acceptable and are comfortable with. Intuition is key – always work with your client’s interests at heart above those of the carer; even people with advanced dementia can pull away if they do not like a massage move or touch.
Repetition can be reassuring whether that is flowing, repetitive massage strokes; gentle pressure to stimulate muscles and enhance proprioception; or gentle, prolonged touch to relax and nurture. Gentle pressure point work may help to relieve oedema, joint pain, and muscle spasms, as well as promote mental clarity and ease depression.
The therapist often needs to treat clients in a bed or wheelchair, therefore massage techniques and movements may need to be adjusted, and extra towels and pillows positioned to ensure clients remain comfortable and dignified.
When working in a care/nursing home, it can be a good idea for therapists to create a special client record card in addition to their own personal ones, which is available for staff to access, monitor treatments, and record any changes in clients’ health, well-being and medication. Therapists may need to diplomatically address any presenting issues with carers, for example with regards to clothing or posture; if a client is wearing socks that are too tight, exacerbating or causing discomfort and circulation or oedema problems, or advising that the client is encouraged to sit with their feet in contact with the floor, which helps to send feedback to the brain for better posture, improving digestion, breathing and circulation.
Challenges of treating people who live with dementia
Working with clients with dementia can be both challenging and rewarding; attending forums, training and conferences and undertaking training in sensory work and dementia awareness can help therapists build on their existing therapy skills and become a reputable professional in this field.
Conducting a risk assessment helps to anticipate safety issues and highlight areas to address, such as the safe storage of massage and essential oils, which should never be left unattended in case clients drink these. Clients’ hands and feet should be patted dry after treatments so there is no remaining oil residue that could increase the risk of falls.
Clients with dementia often present challenging and aggressive behaviours that tend to be caused by unmet needs, and should be assessed for both your safety and that of your clients. Communicating with family members and staff can reveal how they best manage certain behaviours, which will help minimise risk to yourself and your client – from postponing treatment until later when they are calmer, having a carer present during treatment, or adopting a different approach. As treatments progress, trust is built, unmet needs may be addressed, and the dementia may advance to a stage where the client no longer poses the same risks.
Working in this field involves a degree of keeping expectations of client engagement and response low; sometimes a smile or a slight responsive grip will be a profound sign of a privileged connection, but at other times, there may be nothing. Although this can be disappointing or frustrating, the therapist needs to accept that this is rarely a reflection upon their work. Treating people at the end of their life can also be deeply moving and upsetting, but also very rewarding, as it can facilitate a more peaceful transition and comfortable end to someone’s life. Therapists may gain from additional support, such as counselling, supervision or therapy to ensure their ability to cope.
Through a combination of therapeutic touch and time, it is possibly to connect with clients affected by dementia in order to nurture their inner core and help improve their well-being and quality of life.
Case study
Doris* is in her late 80s and has vascular dementia. I have been treating her for five years in a nursing home where she was admitted when her husband died. Doris suffers with constipation, circulatory problems and other health complications (epilepsy, muscular atrophy in the legs, and occasional urinary tract infections (UTIs)), which make her restless and twitchy, especially in her legs.
I treat Doris once a week with integrated massage, incorporating techniques from a variety of different therapies I practise (aromatherapy, massage and Chinese foot massage) and using the following essential oils:
• Black pepper, to improve circulation and ease constipation
• Melissa, to reduce anxiety
• Rose, to nurture and lift mood
• Benzoin, to warm circulation, boost immunity and ease feelings of isolation
• Bergamot, to address UTI symptoms and boost mood 8
Within two months of first starting Doris’ weekly massage treatments, there was a marked reduction in her leg twitching, which shortly after stopped, and Doris’ feet began to lose their white pallor and became a healthier colour. I tend to concentrate on Doris’ feet, in particular working the reflexes that correspond to the digestive system to help relieve constipation. I use many repetitive movements, including gentle holds and stretches, lymphatic drainage, and pressure point work to ease tense calf muscles and any joint issues presenting in her ankles and knees. Over time, despite a reduction in mobility due to the progressive nature of her dementia, there has been a consistent improvement in Doris’ circulation.
At first, during some sessions, Doris chattered away, laughed, and was engaged; in others, she was very peaceful and slept. As her dementia has progressed, Doris has become less engaged and quieter but I still understand her cooing, and she is very serene during and after her massage sessions. Staff often comment on how happy she is after treatments and that the massage helps her bowel movements. Doris responds well to music, and if she is upset I will sometimes sing her a lullaby to calm her or play classical music, which may make her animated and excited.
When Doris started to exhibit head shaking, I checked with staff that she would soon be receiving a medication review. We felt that she was looking for her mother’s breast and sensory stimulation, so the carers and I wondered whether she might have regressed due to the stage of her dementia. I advised the staff to provide as much physical contact to nurture and reassure her, and Doris’ head shaking reduced and now she only displays this occasionally.
Doris later developed difficulties eating and drinking. The speech therapist visited and recommended the use of essential oils immediately before mealtimes to remind her when it is time to eat. I created an aperitif essential oil blend with sweet orange, mandarin and may chang, which the staff massage gently around her mouth just before meals, to encourage the proprioception connected with chewing and masticating. Family members approved the aromatherapy blend as one that Doris liked, and over a four week period, there was an improvement in Doris’s appetite and eating.
Overall, a combination of communication, massage, creativity, and aromatherapy helps to stimulate Doris’ senses and promote a better quality of life, and it is humbling and gratifying to work with the wider network of healthcare professionals to contribute to her improved well-being.
*The client’s name has been changed.
About the author
Nicolle Mitchell has a successful holistic therapy practice in Porthtowan, North Cornwall. She has combined her own training, research and experience to develop an FHT-accredited short course, Massaging People who have Dementia. Nicolle is also part of a team that facilitates training sessions around Cornwall to carers of people living with dementia with Outlook Southwest on behalf of the Cornish PCT. www.lifenlimb.co.uk T. 01209 711686
References
Alzheimer’s Society (2007). Home from Home report. Source: http://www.alzheimers.org.uk/site/scripts/download_info.php?fileID=270
Department of Health (February 2009). The National Dementia Strategy. Source: http://www.dh.gov.uk/en/SocialCare/NationalDementiaStrategy/index.htm
1) Ballard C et al (2002). Aromatherapy as a Safe and Effective Treatment for the Management of Agitation in Severe Dementia: The Results of a Double-Blind, Placebo-Controlled Trial with Melissa. Journal of Clinical Psychiatry, 2002;63:553-558.
2) Burns A (2002). Dementia. British Medical Journal, BMJ 2009; 338:b75 doi:10.1136/bmj.b75.
3) Teri L (2003). Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. JAMA. 290(15): 2015-22. Source: Alzheimer’s Society (www.alzheimers.org.uk).
4) Teri L (1997). Behavioral treatment of depression in dementia patients: a controlled clinical trial. Journals of Gerontology Series B: Psychological Sciences & Social Sciences. 52(4): 159-66. Source: Alzheimer’s Society (www.alzheimers.org.uk).
5) Brizendine L (2007). The Female Brain. Published by Three Rivers Press.
6) Zeisel J (2009). I’m Still Here: A Breakthrough Approach to Understanding Someone Living with Alzheimer’s. Published by Avery.
7) Hansen N Dr et al (2006). Massage and touch for dementia. The Cochrane Database of Systematic Reviews; 2006: Issue 4. Source: www.raysahelian.com/massage.html
8)Holmes C et al (2004). Aromatherapy in dementia. Advances in Psychiatric Treatment; 2004, 10:296-300. Source: The Royal College of Psychiatrists (http://apt.rcpsych.org/cgi/content/full/10/4/296)
For more information
Dementia Care Matters is an inspiring and pioneering company in this field who offer expert and compassionate training in dementia care (www.dementiacarematters.com)
The Alzheimer’s Society (www.alzheimers.org.uk)
Dementia UK (www.dementiauk.org)
NHS Direct (http://www.nhs.uk/conditions/Dementia/Pages/Introduction.aspx)
This article was first published in International Therapist (July 2011, issue 97), the membership journal of the Federation of Holistic Therapists (www.fht.org.uk). Reprinted with permission of the FHT and Nicolle Mitchell.
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CNHC reports back on its 2011 camexpo experience
CNHC staff were delighted with the amount of interest shown in regulatory issues at camexpo this year. There were a significant number of visitors to the CNHC stand throughout the two days, with most enquiring about the process of CNHC registration. The level of knowledge of CNHC’s activities and the advantages of registration were very obvious and we were delighted to have the opportunity to meet so many practitioners and answer the questions they raised.
Maggy Wallace and Margaret Coats (CNHC Chair and Chief Executive) also held a busy interactive seminar with between 60-70 delegates to look at some of the issues affecting practitioners. One key area was advertising and the recent complaints to the Advertising Standards Authority (ASA). CNHC is working with colleagues at the ASA to try and resolve these issues and is aware of the concern being generated amongst the professions. We recognise that this will take some time but advise all our registrants to adhere to the CNHC Guidance on Advertising and to also be aware of the ASA’s Code of Conduct. The Committee of Advertising Practice (CAP) unit of ASA will provide advice and help through their copy advice team if requested (see www.cap.org.uk for more details).
Those attending the seminar were also updated on the changes proposed in the current draft Health Bill. These include a proposal to expand the role of the Council for Healthcare Regulatory Excellence (CHRE), which currently oversees the work of the statutory regulators such as the General Medical Council (GMC) and the Nursing & Midwifery Council (NMC). CHRE is to be renamed as the Professional Standards Authority (PSA) and is to be responsible for the establishment of an ‘approval’ system for assured voluntary registers, thus gathering both statutory and voluntary regulation under its wing. CNHC is involved in discussions with CHRE and looks forward to continuing to update practitioners as this issue progresses.
We were delighted to have the opportunity to talk to so many delegates about matters of mutual interest and look forward to continuing the debate throughout the year and meeting even more people at camexpo next year.
For more information about CNHC and how to register visit: www.cnhc.org.uk or call 020 3178 2199
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Hormones & Neurotransmitters - Antony Haynes
Imbalances involved in anxiety depression and trauma; benefits of dietary support and specific nutritional supplementation.
Click here to down load the slides from camexpo.
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How to Control Food Cravings
What is a Food Craving?
A food craving may be described as the intense urge to eat a specific food, rather than a general hunger of any kind.
What Causes a Food Craving?
Food cravings are generally caused by hormonal imbalances in the body, or a poor diet that does not provide the body with adequate nutrition. They are especially common in women, whose monthly cycle and consequent hormonal fluctuations play a big part. The main causes for food cravings include:
• Post-diet food cravings
• Meal skipping
• Pregnancy
• Pre-menstrual syndrome
• Fatigue
• Hangovers
• Depression
• Stress
• Boredom
• Comfort
Common Food Cravings
The most common foods that people crave include:
• Chocolate and other cocoa products
• Coffee
• Sugar, which may indicate you are lacking in nutrients such as Chromium, Carbon, Phosphorus, Sulfur and Tryptophan in your diet
• Alcohol, which may indicate you are lacking in nutrients such as protein, avenin, calcium, glutamine and potassium
• Salt, which may indicate a mineral deficiency. A salt craving can be quenched by foods high in chloride
• Fatty foods, whose cravings may be suppressed with foods high in calcium and essential fatty acids
• Breads, which may indicate you are lacking in nutrients such as protein and nitrogen
How to Control Your Food Cravings
There are many natural remedies that may help you control food cravings. Some of these include:
1. Avoiding triggers. If you crave something that you regularly eat, you may like to consider substituting the food for something else. For example, if its caffeine you are craving, try substituting your morning coffee with a hot of herbal tea instead. It won’t quite feel the same initially but in time your cravings will subside and your body will thank you for it
2. Destroy any temptations, clean out your pantry and throw out any trigger foods that you may crave and binge on in times of weakness.
3. Since stress is a common trigger for food cravings, practice mindfulness regularly and let go. Meditation, mindful walking and breath work are three easy techniques with which can distract yourself from a craving and prevent its reoccurrence in the future.
4. Make sure you to get adequate sleep, as fatigue often leads to intense sugar cravings as the body tries to stay awake.
5. Eating at regular intervals throughout the day. This stablises blood sugar levels and keeps your metabolism burning kilojoules at an efficient rate.
6. Eat enough kilojoules, which is often not the case when on a strict, set diet.
7. Eating low GI/GL foods to control blood sugar levels. This will ensure your body is provided with a steady flow of energy, as well as prevent a spike in blood sugar that may cause mood and appetite swings that influence food cravings.
8. Limiting added sugar and salt to foods, which when overly consumed can aggravate cravings.
9. Distract yourself with a book, pet, film, phone call or anything else non-food related that you enjoy.
10. Stimulants such as caffeine are thought to affect blood sugar levels, and should therefore be avoided when trying to control food cravings.
11. Avoid artificial sweeteners that are often hundreds of times as sweet as natural sugar. Their super sweet taste can trigger a serious sweet tooth craving later on in the day, as well as causing a build-up in insulin resistance.
12. When craving sweet foods, opt for a piece of fruit instead.
13. Shake up your exercise routine. Exercise has been scientifically proven in positively influencing mood as well as supporting blood sugar level regulation. It does so by stimulating a release of feel-good endorphins, which leave you on a natural high without the food cravings you usually desire. Upping the exercise around hormonal and emotional periods will prove especially beneficial in reducing food cravings.
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