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Massage for Dementia - my personal journey Oct 20, 2024

A powerful and beautiful guest Blog by Nicolle Mitchell. As some aspects of communication fall away, the relational fundamentals remain expressed through a trusted caress, of a mother’s loving touch, whatever tender context it comes wrapped in.

"A Mother’s Touch"

by Nicolle Mitchell, Massage Practitioner and Trainer 

As a single parent of four mum certainly had a lot on her plate and very little support it being the late 1970s and all. In fact, she was spurned by neighbours, supposed friends and some family for not staying committed to a loveless marriage and an alcoholic husband. How very dare she! I’m grateful she took the brave decision to leave our father and raise us without him. I must have been about 10, 11 maybe when mum would ask me to give her shoulders a rub to ease the tension brought about by her many struggles in life. Happy to help and chuffed to spend quality time connecting with mum, I remember rubbing my thumbs into her shoulders and we’d both giggle to our toes as she lolled her head, loosened her bones, melting her muscles and pretended she was purring like one of our beloved cats. 

These were precious moments of love and connection, foundational in our relationship which helped us through inevitable relational mother-daughter ruptures. Mum could run hot and cold emotionally, so any affection was dependent on whether she was in the mood and whether we were “good” children – not necessarily unconditional. Looking back, those wee back rubs were times when we connected more deeply, spoke about the stuff of life, opened our hearts, and when we did fall out as is inevitable in all relationships, it was this trust and ability to reconnect that saw us through. Thing was I had no massage techniques and little stamina, so the massage would last a few minutes at best. What I know now though is it only takes seconds during a nurturing touch intervention for feelgood hormones such as oxytocin and dopamine to release for both giver and receiver and this I believe positively affected our biology, our relationship, our ability to trust each other better.

Fast forward to the late 90s and my partner Rob and I were making some life changing decisions. We left our jobs in the care profession in Reading and travelled round Devon and Cornwall in our camper van “Sonny Boy” enjoying a summer of love and some much-needed recharge time, after all caring is a super demanding role on so many levels. When our season of freedom and fun came to an end as all good things do, we settled on the north coast of Cornwall and I went back to college having obtained a place on an ITEC massage course due to a last-minute cancellation – woohoo! Little did I know the life changing trajectory this would set me on the path to! 

During these salty summer days as we settled into our new life, Mum used to revel in coming down to Cornwall where we’d spend time together enjoying the sun, sea and each other’s relaxed company. She really seemed to dial down her stress levels and we relished these golden moments. I think this was enhanced because mum became a willing volunteer (of course she did!) trusting me to practice my newly acquired massage techniques on her. I recall one time her softly saying as the massage was reaching its end, “I feel so selfish. When you’ve finished, I just want you to go back and start all over again.” It certainly made me think about how important nurturing touch was for her even if she hadn’t always found it easy and this gave her permission to receive nurturing touch in a boundaried way, something that would pave the way for later on.

Within a few years, having been wooed by the Cornish life we’d made for ourselves, mum followed suit fulfilling her new dream also moving to Cornwall with her husband. Sadly, not too long after, she was diagnosed with a mild cognitive impairment (MCI) meaning she had to leave her job working in accounts at a nursing home, where I also worked as a massage therapist treating people who lived with dementia. Mum had convinced the manager at the time that massage would benefit so many of the residents there. She was a big supporter of my work knowing first-hand the benefits she felt from receiving nurturing touch treatments.

Anyway, mum’s MCI developed into early onset Alzheimer’s, and she started to come and see me regularly for a massage in my clinic to help with her stress levels. One of the upsides for me was that she was a great advocate for massage and often spoke with people about how much she enjoyed her treatments. It was also a positive and structured way to see her regularly and was where she could confide, seek understanding and we could have sacrosanct space to continue to connect deeply with each other illustrating conclusions found by Kilstoff and Chenoweth in their study that massage provides connection and improves relationships.

I recall with clarity the moment with mum when I needed to change my approach to her massage to retain her trust. One day in the clinic, she could no longer lie face down with her face in the cradle and experienced an overwhelming sense of anxiety. I reassured mum that this was OK and encouraged her to lie on her back with her head end raised a little adjusting the treatment to suit. She was delighted and I think somewhat relieved that it still felt as wonderful as always. Mum felt happy and reassured that we changed how she experienced her massage to suit her changing needs, but more than that, she retained agency when so much control was being lost in other aspects of her life. 

As mum’s dementia progressed, she required more care and for a few years I stepped in to provide respite so her husband could take much-needed holidays or visit family. I would weave nurturing touch techniques into her daily care routines whether I was assisting her with washing, medication or reassuring her in moments of distress especially in the wee small hours when she was particularly disorientated. Much later on in my career, Fung and Tsang’s clinical trial confirmed what I knew in my heart many years before, that by validating mum’s needs through therapeutic touch helped reduce agitation and improved communication.

Mum’s health inevitably continued to decline and by now I was treating her at home. I continued to turn my visits into opportunities to connect with foot massages which incorporated wee pedicures, painting her toenails in the scarlets and golds she always loved. Sometimes depending on where mum was at, I gave her gentle hand massages where she would reciprocate the touch rubbing my hands whispering to me, “that’s better,” fulfilling her need to “mum” and nurture me still. This is underpinned by the Nicholls et al. study, where it emerged that when touch was initiated by carers and family members reciprocity occurred which in turn created positive relational experiences for both people connecting through touch. It really takes the pressure off having to speak when we let our hands do the talking.

In April 2023, mum finally needed full time nursing care and she moved to a nursing home on the coast. During that time my interventions have become increasingly subtle especially as I wish to be her daughter first rather than her therapist. She doesn’t always recognise me, but she recognises the gentle nurturing touch and trusts me as I talk through any activity we enjoy together. I’ll let my hands gently define her face with a trace of my fingers before using a warm flannel to freshen her skin. My anchor hand gently holds, reassures and conveys love while the other hand applies specialist parental touch techniques we have both come to know so well. It was these techniques that I asked a support worker caring for mum in hospital during the pandemic in April 2020 to employ to enable her to feel cared for in a way she understood. The hospital environment had become so alien and scary in pandemic times that using an iPad to coach the person caring for mum was I believe fundamental in her recovery, but that’s another story! 

The other week, mum and I enjoyed some golden time with laughs, giggles and chatter and she voiced a very clear, "mum". I said, "yes, you are my mum." She looked perplexed so I wondered if maybe she thought I was her mum as grandma and I look quite alike so I said, "mum always, love, love, love," using parental touch on her face much as a mother would her child. Cue smiles, nods and vocal approval as I fulfilled mum’s need to feel a mother’s love. 

These feelings last, changing our biochemistry affecting the very essence and core of our being. This was still evident when the time came for me to leave, and I asked if she wanted a hug. Mum smiled as I leant in both of us enjoying the moment so much we had another. This makes me smile as in mum’s earlier days of her living with dementia she used to hug everyone goodbye at the end of any social gathering, and by the time we went to leave she’d say, “c’mere you,” and we’d hug again her having gotten caught up in the flurry of goodbyes and forgotten we’d hugged already. Typical mum, so greedy for touch. Lucky me, getting twice the hugs!

How powerful that the sense of touch can lower heart rates and cortisol, engendering feelings of calm and safety. We humans are positively wired for it. Our neuro-chemistry drives us to connect through touch to create attachment without words, to build trust and fulfil the most important of human needs, to belong. As some aspects of communication fall away, the relational fundamentals remain expressed through a trusted caress, of a mother’s loving touch, whatever tender context it comes wrapped in.

Nicolle Mitchell
Massage Practitioner and Trainer
Innovator of Massaging Persons Living with Dementia, UK

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.

Kilstoff, K. and Chenoweth, L. (1998). New Approaches to Health and Well‐being for Dementia Day‐care clients, Family Carers Day‐care Staff. International Journal of Nursing Practice, 4(2), pp.70–83. doi:https://doi.org/10.1046/j.1440- 172x.1998.00059.x.

Nicholls, D., Chang, E., Johnson, A. and Edenborough, M. (2013). Touch, the Essence of Caring for People with end-stage dementia: a Mental Health Perspective in Namaste Care. Aging & Mental Health, 17(5), pp.571–578. doi:https://doi.org/10.1080/13607863.2012.751581.