Foot massage versus quiet presence on agitation and mood in people with dementia: a randomised controlled trial.

BACKGROUND: There is increasing interest in using complementary and alternative treatments to manage behavioural and psychological symptoms of dementia such as agitation, aggression and depressed mood. OBJECTIVE: To compare the effect of foot massage (intervention) and quiet presence (control) on agitation and mood in people with dementia. DESIGN: A randomised controlled trial using a within-subjects, crossover design. SETTINGS: Five long-term care facilities in Brisbane, Australia. The primary outcome was the Cohen-Mansfield Agitation Inventory (CMAI) and the secondary outcome was the Observed Emotion Rating Scale (OERS). The screening and data collection research assistants, families, and care staff were blinded to participant allocation. PARTICIPANTS: Participants of the study were 55 long-term care residents aged 74-103 years (mean age 86.5), with moderate to severe dementia and a history of agitated behaviour according to the Pittsburgh Agitation Scale. A computer-program randomised participants to 10-min foot massage (intervention) or quiet presence (control), every weekday for 3 weeks. RESULTS: A carry-over effect was identified in the data, and so the data was treated as a parallel groups RCT. The mean total CMAI increased in both groups (reflecting an increase in agitation) with this increase greater in the quiet presence group than the foot massage group (p=0.03). There was a trend towards a difference on OERS General Alertness, with a positive change in alertness for participants in the foot massage group (indicating reduced alertness) and a negative change for participants in the quiet presence group (indicating increased alertness) (F(1,51)=3.88, p=0.05, partial ή(2)=0.07). CONCLUSIONS: The findings highlight the need for further research on the specific conditions under which massage might promote relaxation and improve mood for people with dementia. The unfamiliar research assistants and variations in usual activity may have contributed to the increase in agitation and this needs further research. TRIAL REGISTRATION: ACTRN12612000658819.

Foot massage and physiological stress in people with dementia: a randomized controlled trial.

BACKGROUND: The anxiety associated with unfamiliar surroundings, the disorientation and mental confusion, and the social isolation that accompanies dementia can often create increased stress for people living in long-term care settings. Such a response is thought to affect the autonomic nervous system and result in emotional and physical symptoms of distress that may be manifested as agitation. There is the potential for such distress to influence the physiological response and in particular Blood Pressure and Heart Rate. A relaxation intervention such as massage may influence the physiological stress response. METHODS: This randomized controlled trial aimed to compare the effect of foot massage (FM) versus a control activity (quiet presence, QP) on physiological stress response (i.e., blood pressure [BP] and heart rate [HR]) in people living with moderate-to-severe dementia in long-term-care settings. RESULTS: Fifty-three residents were randomized to intervention (10-minute FM) or control group (QP). While the FM group experienced a greater reduction in HR than the control group, these reductions were not significantly different between groups (p=0.83; see Table 1 ), or across time (p=0.46). Both groups experienced a reduction in systolic BP and diastolic BP, while the mean reduction in systolic BP was greater for those in the FM group. CONCLUSIONS: While the findings do not provide strong support for FM, the finding that both conditions allowed the person with dementia to rest in the presence of another human being is of importance in the care of people with dementia. The close presence of another person may in fact promote relaxation and therefore improve BP and HR measures.

Interviewing techniques for the Asian-American population.

The cultures of racial and ethnic minorities influence many aspects of mental illness, including communication styles, symptoms, coping strategies, family and community support, and willingness to seek treatment. This article presents the effects of Asian American/Pacific Islanders' beliefs and behaviors related to mental health. Strategies to enhance the process and outcomes of the psychiatric interview with members of this populatior are addressed.

Potential effects of antidepressant agents on the growth and development of children and adolescents.

The regulatory bodies of both the United States and United Kingdom have issued cautionary statements about prescribing antidepressant medications to treat major depressive disorder (MDD) in children younger than age 18. Despite these cautions, antidepressant agents, particularly SSRIs and serotonin activators, are regularly used to treat MDD in this age group, and increasingly so in very young children. This article considers the possible effects of antidepressant agents on the growth and development of children younger than age 18 and provides recommendations for the use and careful monitoring of these medications, including screening for physiological effects, selfinjurious behavior, and suicidal ideation. Guidelines for use of antidepressant agents with these populations include incorporating medications into comprehensive, holistic treatment, assessing for onset of severe akathesia as a marker of increased risk for self-harm, and advocating for more clinical trials of these medications in different childhood age groupings.