When Your Massage Client Has Dementia https://medium.com/@everflowing"
Providing massage for dying persons presents multi level challenges to me as a practitioner. One of these special challenges is working with persons experiencing dementia. One of the blog posts that has been archived earlier is titled The Lost Pause. https://medium.com/@everflowing" Please read that post as well, as it is the preparation for the following guidelines for working with clients with varying degrees of dementia.
The following guidelines will assist you in remaining sensitive in your communications:
*Always approach the person with dementia from the front and tell the person who you are. Communicate at eye level. This may indicate that you sit to say hello.
*Use short simple words and sentences.
*Speak slowly and clearly. Breathe between thoughts.
*Give one step directions. (Ex) “Hold my hand” rather than, “Reach over and take my hand.”
*Patiently wait for a response. Verbal response may be faster than body response. Allow time.
*If the body does not respond, repeat the request again exactly the same way as the first time. If there is no body response, add a touch cue. If action does not follow then say, “That’s ok” and state what you are going to do next. “I am going to hold your hand.”
*Be willing to repeat information or questions. Use the same words each time.
*Your client may forget who you are and what you are doing several times during a session. Be willing to repeat these very basic details as often as needed. This will require you to acquire permission over and over again in regards to touching your client. Permission and trust building are ongoing with the client experiencing dementia.
*The client may also suggest that you attend to an area of the body to which you have already attended. Be willing to touch the area again before moving on or simply repeat the actions.
*Clearly define what you are saying. (Ex) “I am using lotion,” instead of “I am using this.”
Cueing
*Cueing is talking the client through a request in specific terms. (Ex) Instead of asking a client to lift this leg, You will touch the area of the body affected, to guide the client through the action while giving the verbal instruction. You would say, “can you lift the leg that I am touching.” Once again you will touch the areas of the body affected by the request.
*Turn questions into answers. (Ex) “I am going to touch your shoulder” instead of, “Do you want me to start with your shoulder.”
Communicating with Family
Family members of those suffering with dementia are in a deep state of loss. They are watching their loved one lose every aspect of their identity in the world. They are in constant fear that their loved one will one day no longer know who they are. Family are many times relating to what they have lost rather than what is present. I learned this the hard way when I took a photo of one of my clients that I thought was radiant. He was beaming and so comfortable. I showed this photo to the family. It brought immediate pain to the mother who explained to me that the person in that photo was a mere shadow of who had been her son and never to do that to her again.
As a member of a health care team I have the opportunity to meet the person in the bed. I have no past experience to grieve. I only know who I see and feel in that moment. The full experience is much broader than that. I must stay gentle and aware of the larger picture. I have learned to hold my excitement and awe of my touch experiences and share them with the larger picture in mind and heart.
Don’t Take It Personally
*With short term memory loss there may be a sudden change in the relationship. You may be asked to leave or the client may simply say, “That’s enough.” Try and make each touch as complete as possible as the session may end at any time.
*Feedback and gratitude at the end of a session may not be possible with more advanced symptoms of dementia because the session is not retained consciously. Be alert to the feedback expressed through the body and in facial animation as you facilitate the session.
Over Stimulating
Stimulation is needed; however, overstimulation can be frustrating. Remember your client is integrating in slow motion. Perform bodywork for short periods of time. Work slowly so you can observe the body’s response. After the initial trust building and set up for your touch session, ten minutes of touching physically may be enough.
Remember that you will be returning the room to its previous arrangement. Rearranging the room is more stimulation and is still part of your touch session.
Reporting
Grandiose ideas such as having lunch in Paris or having intimate relations with the body worker may be a symptom of dementia. Always report any out of the ordinary behavior to a staff member on-site. Make written reports on your sessions and note any irregular behavior or accusations.
Always Remember Your Client’s Safety
Short-term memory loss and loss of motor control may indicate that your client can forget their physical limitations, such as not being able to walk. They may also not be able to clearly assess the edge of the bed. Stay alert to your client’s limitations, the equipment you are using, your surroundings, and the directions you are giving. Be alert, as well as compassionate.
Irene Smith www,everflowing.org
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