Children act out in the days leading up to holidays and parents shake their heads and say ” he has had too much sugar.” That may very well be true, yet children are certainly impacted by the hustle and bustle of holidays. And just as children are overwhelmed by the activities and anticipation, even more so is the elder with dementia.

However when the elder with dementia becomes angry and uncooperative, no one says “he has just had too much sugar.” And very often the solution proposed is some form of isolation, where what the elder may need is just the opposite. The elder with dementia may push family away with angry behaviors such as yelling, screaming, even pushing and at times throwing things.

There are also behaviors that are not as physical but equally as troubling such as, pacing, complaining, repeating themselves and general restlessness. What is important to remember is that the elder with dementia is not acting this way on purpose. The elder with dementia is always trying to understand his environment. Where he is, who is there, what is going on and most of all what might be expected of him.

While holidays are great is so many ways for the person with dementia, the music, colors, food, smells and decorations reinforce what is happening. The increase in  people, excitement, noise can push an already stressed elder over the edge. This is a good time for old fashion remedies. Activities that are calm, quiet and one on one.

  • a hand massage helps with anxiety, worry, sadness, and fearfulness
  • the old fashion back rub works wonderfully for those  in chronic pain or exhibiting irritability and anger
  • a foot massage provides calming for those with hyperactive behaviors, restlessness and pacing
  • massaging the forehead, temples and scalp help with tension and headaches

Added to the calming effect of the physical-therapeutic touch, some light smelling aroma, and you might be giving the best gift.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing




The time for a back rub is, any time. For the caregiver of a potentially difficult elderly man, a good time could be right before getting ready for bed. The back rub can be given over clothes, making it a good transitional activity. Just saying “here, I have a few minutes, let me give you a back rub,” takes it from a procedure, to a gift from a friend.

Many of the confused elderly have increased agitation in the evening. A back rub can reassure the elder; that they are not alone, provide feelings of trust in the caregiver, bring the elder to the present moment, reduce resistance in the elder at bedtime or bath time, increase the sense of wellbeing and calmness in the elder, and then will help the elder fall asleep more easily while providing a better quality of sleep.

The back rub guidelines:

  • Beginning the backrub at the shoulders is a good idea, always avoiding the neck area of any individual of any age. The neck should be manipulated only by a trained professional because of the sensitive nerves located in the neck.
  • Caregivers should have short finger nails as a precaution. You will be massaging with the flat of your hand, however long fingernails can pose a hazard.
  • If the backrub is given directly to the elder’s skin, warm up the lotion rubbing it between the palms of your hands. (a back rub given in bed, directly to the elder’s skin can be located on this site Archived at September 13, 2010)
  • If the elder has any open areas of the skin, use gloves.
  • For the elder in clothes and in a seated position, use small circular strokes. Begin the strokes at the shoulder blades, right circles to the right and left handed circles to the left over the shoulder blades.
  • Continue those small circular movements down the elder’s sides and then across the lower back and moving up the sides of the spine. This can be repeated several times.
  • The circular strokes increase circulation and the back rub can end with long flowing, relaxing strokes.

Taking the time to give something as simple as a massage may reduce the need for pain medication or a behavioral medication, improve joint flexibility as well as skin condition, decrease the chance of bed sores, and make the elder happier, more flexible and easier to care for.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


Part II

The hand massage is an easy skill for anyone to acquire and yet it provides so much to the elder in the way of comfort, reassurance, communication, and caring.

Hand massage guidelines:

  • Some elderly people should not have hand massage; if they have any broken or irritated areas of their skin, if they have inflammation of their joints, if in any way the massage seems to be causing pain, or they have very thin and fragile skin that appears bruised.
  • Beginning a hand massage with clean hands (for both elder and caregiver) is very important and can be part of the event. A small basin of warm water with a small amount of soap can be a great way for the elder to relax and warm up those stiff joints.
  • Clean towels should be handy and a clean towel placed under the elder’s hand for support during the massage.
  • A hand massage is performed in a very slow, rhythmic pace. This is an opportunity to communicate to the elder, through your touch, I am with you.
  • A hand massage, while done with a light touch, is done totally encompassing of the elder’s hand, providing full contact with the caregiver’s hands.
  • Provide a quiet and calm environment – TV and talk radio always off. Soft music is fine and can make the event even more relaxing.
  • A light lotion is used with hand massage (not oils) either unscented or lightly scented with lemon but not perfumed.

The Hand Massage:

  1. If the person is in a wheelchair you can support the hand and arm with a bed pillow, if the person is able to sit with a small bedside table in front of them the hand can rest on a small towel on the table.
  2. The stroke is similar to the stroke used for applying a lotion, smooth, light and flowing.
  3. The caregiver’s fingers are relaxed and use the gentlest of pressure.
  4. Small circular motions can be made with the flat portion of the fingers and palm of the hand, alternating with times of sandwiching the elder’s hand between the caregivers and giving reassuring pressure.
  5. The hand massage can be effective in as little as 3-5 minutes, alternating the flowing stroke, circular stroke and moments of gentle pressure.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



Zelda has lived here for several months, but when I gave her a hand massage, I felt like I got to know her for the first time” said Zelda’s caregiver.

Providing human touch improves the quality of life for those who are ill or in their later life stages. Touch in the form of a massage gives an opportunity for one-on-one attention from the caregiver. Instead of casual touch during times of providing care or completing a task, this touch is intentional and focused.

Each of us has within us the power of a healing presence that we can give another person through a smile, our focused attention and most of all by putting our hands on another person. Touch is a very real and strong form of communication.

There are several types of touch used in healthcare as well as by the person caregiving in the home. Caring touch is used to comfort or encourage another person. Putting your arm around the elder’s shoulders, or stroking the head of a person in pain is caring touch. The task touch is used in bathing, dressing and general care of the person. There is also a protective touch that is used when you take the elder’s arm to support him walking.

Many times the caregiver just doesn’t think they have the time or the skill and training to do compassionate touch. They may think this is just something a professional, or someone in hospice care does, but just the opposite is true. This is a caregiver tool for everyone, which provides as much satisfaction for the caregiver as for the individual receiving care.

The very simple hand massage can calm a restless elder, bring focus to the elder suffering from delirium following surgery, and provide comfort for the dying. And like Zelda, give the gift of a warm memory, for the caregiver.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing