Acupressure can significantly reduce agitated behaviour in older patients with dementia, according to a study published in the February issue of the UK-based Journal of Clinical Nursing.

Researchers at the National Yang-Ming University in Taiwan found that providing 15-minute treatment sessions twice a day for five days a week yielded considerable benefits, including reductions in verbal and physical attacks and wandering.

But once the four-week treatment period ended, agitation levels started to rise again, suggesting that acupressure needs to be provided on an ongoing basis.

20 patients were studied over six weeks, including one week before the treatment started and one week after it finished. All lived in dementia special care units at a long-term care facility.

70 per cent of the patients suffered from severe behavioural disturbances, with a further five per cent suffering from extremely severe impairment. The remaining 25 per cent were classed as medium.

An average pre-treatment score of just over 79 was recorded on a specialist scale developed to measure agitation levels. After four weeks' treatment this had fallen to just under 60.

Pre-treatment agitation was highest in the 65-59 and 80 plus age groups (82 and 97 respectively) and in males (83).

"Agitated behaviour in people with dementia is a major concern for caregivers" says co-author Professor Li-Chan Lin from the Institute of Clinical Nursing at National Yang-Ming University, Taiwan. "It can endanger patients and others, make it necessary for them to be moved from familiar surroundings and demoralise and psychologically distress caregivers.

"People are living longer and, as a result, we face increased numbers of people with dementia. It is very important that we find interventions that enable us to provide more effective care for them, both in their own home and in long-term care facilities."

During the study, carried out with colleagues from the University, different types of agitation were measured on a specialist scale.

In week one, before the acupressure treatment began, physical attacks were given an average score of 5.53. These included pushing, beating, scratching and pinching.

Agitation levels were measured daily and by week two, when the treatment began, the physical attack score had fallen to 1.46. By week five, the last week of treatment, the score had fallen to 0.53. In week six, when the treatment had stopped, the figure rose to 2.17.

Verbal attacks, which included repeated questioning and shouting, showed a pre-treatment score of 2.81 in week one, 0.54 in week two and 0.29 in week five. By week six it had risen to 1.36.

Similar patterns were recorded for non-physical and non-verbal agitation, which included wandering, stealing, undressing and tearing things.

Wandering aimlessly was measured using pedometers. This reduced from an average of 5,368 steps a day in week one to 2,611 in week five. By week six it had risen again to 3,374.

Patients received acupressure based on five key pressure points - Fengchi (GB 20), Baihui (Du 20), Shenmen (He 7), Niguan (Pe 6) and Sanyinjiao (Sp 6) - after a short warm-up session which consisted of holding, rubbing and pressing the palms and finger joints on both hands.

Each acupressure point was pressed for two minutes using three to five kilograms of pressure.

"Our study showed that providing patients with acupressure twice-daily for five days a week significantly reduced agitated behaviour and wandering" says Professor Lin.

"This has important implications for the future care of dementia patients as it provides an effective option that, following training, can be carried out at home or in long-term care facilities."

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The efficacy of acupressure for decreasing agitated behaviour in dementia: a pilot study. Yang et al. Journal of Clinical Nursing. Volume 16, pages 308-315. (February 2007).

Founded in 1992, Journal of Clinical Nursing is a highly regarded peer reviewed Journal that has a truly international readership. The Journal embraces experienced clinical nurses, student nurses and health professionals, who support, inform and investigate nursing practice. It enlightens, educates, explores, debates and challenges the foundations of clinical health care knowledge and practice worldwide. Edited by Professor Roger Watson, it is published 10 times a year by Blackwell Publishing Ltd, part of the international Blackwell Publishing group. blackwellpublishing/jcn

Contact: Annette Whibley
Blackwell Publishing Ltd.