Rehabilitation Interventions for the Institutionalized Elderly

Ellen D Taira

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781317940913
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Gerontology professionals offer suggestions to enrich the quality of rehabilitation services offered to the institutionalized elderly. This exciting volume examines up-to-the-minute ideas--some that would have been unlikely even a few years ago--that focus exclusively on rehabilitation services for the institutionalized elderly. Despite the strong move toward more community health services in the last decade, the essential role of the nursing home in the long term care continuum is continuing to expand. Perspectives on the response of elderly persons to therapeutic interventions are addressed--including the positive effects of such techniques as touch in therapy, group psychotherapy, and verbal and activity interventions. A significant exploration of the use of technological applications to promote independent living adds a new dimension to the use of technology in the field of gerontology--often a mixed blessing to chronically ill persons.

The Effects of Touch in the Geriatric Population

Deborah M. Howard

Research submitted by Deborah M. Howard has been approved and accepted in partial fulfillment of the requirements for the degree of Master of Occupational Therapy from the University of Puget Sound.

The author would like to thank the following people for their individual contributions toward making this paper a reality: Juli Evans, MS, OTR/L, Steven Morelan, PhD, OTR/L, Ron Stone, MS, OTR/L, and Thomas Sharon, Administrator, Sharon Guest Home.

SUMMARY. The current study investigated the effects of touch in a population of nursing home residents. Thirty individuals were randomly chosen to participate in a craft session. Sixteen participants were touched while fourteen were not touched. Participants completed a questionnaire immediately after the craft session. Responses to the questionnaire were statistically analyzed by means of chi square. Results found that tactile stimulation positively impacts attitude and motivation in the elderly. The touch group participants indicated strong, positive responses regarding attitude toward the task and the instructor. The touch group showed greater willingness to work for the instructor and complete a task. Touching is a positive influence on the geriatric person’s attitudes and behaviors toward both a task and therapist. More sensitive instruments are needed to determine the relationship between touch and mood since it was not significant in this study.

INTRODUCTION

The effects of a simple touch are considered vital to human function. Yet, little empirical exploration has been conducted in the area of occupational therapy with respect to touch. The current study was designed to examine, in the aged population, the effect of touch on patients’ behaviors and attitudes regarding both a task and the treating therapist.

The issue of touch has been controversial in the therapeutic setting. Twenty-five years ago, it was considered taboo for a therapist to touch a client, while today a casual touch is considered appropriate and helpful (Cohen, Lotyczewski, & Weissberg, 1982). “Clinical literature points to therapeutic potential of touch in nearly every branch of medicine from psychiatry to gerontology” (Older, 1984, p. 931). Modern day health professionals may choose to use touch as a powerful tool for communicating their caring (Pertillo, 1978) as touch can affect an individual’s behavior and affective state.

Touch is the giving and receiving of tactile stimulation. A touch on the shoulder or hand is universal, common, and non-sexual in connotation (Anderton & Heckel, 1985; Fisher & Whitcher, 1979; Rosenfield & Sussman, 1978). Three conditions can make a touch positive: (a) appropriateness to the situation, (b) appropriate degree of intimacy as perceived by the recipient, and (c) lack of a negative or condescending message (Fisher & Whitcher, 1979). As stated by Heslin and Patterson (1982), “… a casual touch by a stranger can be more positive than negative, and it has the power to influence a person’s general sense of well-being” (p. 36). An appropriate touch can convey a positive message to the recipient.

Patients are often more aware of a health professional’s concern, caring, and confidence than the touch itself (Farber, 1982; Huss, 1977; & Montagu, 1978). “The fact we are not aware of most tactile input does not mean that is not important. … If the brain is deprived of touch stimulation, it very quickly becomes disorganized” (Ayres, 1979, p. 96). Increased awareness of touch by the occupational therapist can help decrease the psychological barriers between the patient and therapist and improve therapist-client relationships in general.

Traditionally, touch has been acknowledged as a tool to enhance communication (Frith & Lindsey, 1983). Communication through touch has increased compliance levels of petition signing, retrieving dropped pamphlets, returning dimes left in telephone booths, and even eating free grocery store food (Fordyce & Goldman, 1983 & Kleinke, 1977). Fordyce and Goldman (1983) justified the compliance phenomenon by saying,

Having eye contact from or being touched by a requester may lead to more compliance because the requester is viewed as psychologically closer to the target person, or is more individualized, or because the target person is more aware of the requester’s needs. (p. 126)

Communication is an essential component of occupational therapy. Verbal, visual, and tactile communication increase the potential for patient response and compliance. A casual touch may increase compliance levels in patients who are unmotivated by or uninterested in projects presented to them.

Tactile stimulation increases compliance as well as other positive behaviors and attitudes during therapy. Individuals touched during counseling sessions readily talked about themselves and evaluated the interview and the interviewer as being more positive (Alagna, Fisher, Whitcher, & Wicas, 1979 & Pattison, 1973). Using touch as the basic technique in treating geriatric patients with chronic brain syndrome, Burnside (1973) found the group behaved more amiably and reached out to touch one another more frequently. Within the realm of occupational therapy, Eyler (1983), found touch had a positive effect on participant attitudes toward individual performance, the activity, and the instructor.

The elderly are often deprived of human contact. Pertillo (1978) offers two explanations for this phenomenon. First, many people refrain from touching older individuals because they may possess unpleasant physical characteristics (Pertillo, 1978). Second, the elderly population displays more inhibitions about touching due to limitations dictated to them by society (Pertillo, 1978).

Personal space, body language, and dialogue are clues contributing to the therapist’s perceptual awareness of each gerontic client’s need for tactile stimulation. Some clues are louder than others.

As I held her hand with its tissue paper skin, she pulled my head down to her and kissed me tenderly on the cheek…. This was the best example of “touch hunger” I had seen in a long while. (Burnside, 1973 p. 2060)

Often, as individuals reach “old age,” they begin to rely on the non-verbal behaviors they learned during younger years (Huss, 1977 & Preston, 1973). Huss (1977) found many elderly persons handle sentimental material objects, such as a wedding ring or picture of a deceased spouse. Although little research has been done in the gerontic setting, touch could be an important tool in therapeutically maintaining the health of the aged.

Fisher and Whitcher (1979) implied that touch may have consequences for behavior and affective state. Behaviorally, touch seems to facilitate compliance. Compliance is needed for adequate client response and, possibly, motivation. Affective response has been found to be positive if a touch is considered appropriate by the recipient. Touch in the gerontic setting has not been investigated. Presumably, both behavior and affective states would be altered as with other populations studied.

Awareness of the implications and advantages of touch used in the gerontic setting may be helpful to all allied health professionals. Specific awareness of touch and its effects on the elderly individual may be crucial to occupational therapy treatment. This study examined the effect of touch on the elderly person’s attitude and the resultant motivation toward an activity and the therapist. Finally, the effect of touch on mood state was examined.

METHOD

Subjects

Thirty females age 65 and over were selected using the following specific criteria: the capacity to follow written or verbal instructions and to attend to the task, and the absence of any upper extremity deficit which would interfere with completion of the task. The subjects were randomly selected from an all female nursing home population, then randomly divided into six groups. Members of three groups r...