Using mind-body techniques with the aged in care

M Phillips — Thu, 07 Apr 2011 05:16:00 GMT

Question:

Hello. I have just finished reading Healing the Divided Self. I found your work and approach very respectful and certainly inspiring, and I was keen to find out more, especially about the somatic links. I am a physiotherapist working in Melbourne Australia with clients who are in care, aged 80 and over with chronic pain and other disabling conditions. I use physiotherapy techniques for my people, but I also have a qualification in hypnotherapy and I have begun to use mind-body approaches to pain relief including mindfulness, EFT, modified ego-state work, meditation and Middendorf Breathwork. While I have had limited success using the latter methods, I would like to learn more so that I can be more effective.

My question is, whether working this way is perhaps too difficult for many in this age group, who have problems to some degree or another with cognition, concentration and short term memory. Dealing in an ongoing way with chronic pain which has not responded to other methods seems to rely on the client's possessing mental powers sufficient to employ self-hypnosis, for example. I would like to hear your thoughts on this Maggie, and whether there are particular techniques more suitable for this population than others. The other problem I am encountering is that working in ways other than the purely mechanistic ones employed in standard medical practice (including physiotherapy) is quite foreign to most of these folk, and I often encounter resistance, or simply complete lack of interest, in pursuing alternative approaches, even when one might think a client would be willing to experiment with new methods through sheer desperation! In my case, this might relate partly to the fact that I have been 'the physio' in the facility for some 7 years now, and have had the opportunity to expand my practice into the mind-body field in this setting only in the past year or so. I wonder if you can offer any advice in this regard? It has occurred to me that there may also be some form of block in myself -- something to do with my presentation of the suggested alternatives... Thank you!

-- Jenny Meyers, B. Phty.
Physiotherapist

Dr. Maggie Responds:

Dear Jenny,

Influencing people to consider alternative approaches to conventional medicine is often a difficult process. Most elderly patients have sought care through standard medical practice, and many have spent lifetimes becoming accustomed to this type of care for the treatment of pain. Even in situations where medical treatments have been shown to have little effect on pain, many people over the age of 80 want the “known” methods, rather than taking a chance on the unfamiliar.

When addressing the practice of mind-body therapy on cognitively impaired adults, my initial ideas agreed with your questions about short-term memory difficulties. Can we expect a resident in a long-term care facility, who is over the age of 80 and with potential cognitive decline, to remember how to use mind-body techniques on a regular basis? Additionally, when such residents are managing pain and difficulties with movement due to age anyway, my initial answer would be “no.”

On further research, a study in the Archives of Internal Medicine (Dechamps et al., 2010), uncovers a clinical trial that was performed with institutionalized patients using the techniques of tai chi and a training program referred to as cognition-action. The cognition-action activities consisted of warm-ups using lower and upper limb movements, and deep breathing and relaxation. The tai chi methods were administered by a trained instructor who modified the movements to adapt to an elderly population. The average age of the participants was 82 years, and the study took place over the course of 12 months.

The researchers found that these interventions slowed the deterioration of quality of life in these patients, even among those who showed severe decline in cognitive function. Over the course of 12 months, these interventions were beneficial for those involved, compared with the control group, who received no interventions. Upon reading this study, I would think that involving elderly patients within a training method adapted to their capabilities offers benefits. Because the study lasted for a year, we can say that participants were able to continually attend classes and perform the necessary maneuvers through tai chi, range of motion, relaxation and deep breathing.

So we can observe that a group of residents benefits from these interventions, but the next step is convincing them of its advantages. How do you persuade a person that using alternative therapy, while out of her comfort zone, can actually improve her quality of life? Historically, patients who sought treatments from medical doctors were not advised about alternative therapy options. Despite changes in practice, people remain skeptical, and that may be hard to modify. The School of Public Health at the University of California in Los Angeles affirms that therapy, such as therapeutic touch, shows benefits among aged populations. This method may provide a positive outcome that can prove that alternative therapies are valuable sources of pain control. With continued time and effort, particularly since your practice has expanded within the last year, you may start changing some minds as to the benefits of your work.

References:

Dechamps, A., et al. (2010). Effects of exercise programs to prevent decline in health-related quality of life in highly deconditioned institutionalized elderly persons. Archives in Internal Medicine. 170 (2), 162-169.

University of California Los Angeles School of Public Health. (n.d.). Complementary and alternative medicine: Expanded options for wellness also raise concerns. Retrieved March 27, 2011 from http://www.ph.ucla.edu/pdfs/SPHmag.Nov03.cam.pdf

Welcome to Ask Dr. Maggie!

M Phillips — Fri, 14 Jan 2011 19:02:00 GMT

I'm so excited to announce this new blog, created for you!

I hear from so many who have questions about physical pain, emotional distress and suffering, mindbody health problems and various types of healing approaches. What better way to answer your specific questions and share with everyone!

We're also having a contest of sorts - if we select your question to answer on this blog - you will receive a free gift!

Rather than place all the details on the blog - we've created a page for you to visit to get all the details.

http://reversingchronicpain.com/askdrmaggie.html  will provide you with all the details and an area in which to submit your question.

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If you have any questions about this blog, please contact my assistant Peggy via Peggy@ReversingChronicPain.com.   Peggy will likely be able to answer all our questions, and if not, she will let me know!

Warmly,

Dr. Maggie Phillips

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Using mind-body techniques with the aged in care

Welcome to Ask Dr. Maggie!