dementia. Keywords tactile massage, severe dementia, physical and psychological effects, behavioral and psychological symptoms of dementia Introduction Japan’s society is aging at an unprecedented rate. In 2009, the elderly population represented 22.8% of the Japanese population, and it is expected that the proportion1 of elderly individuals will increase to 30% by 2025 and 40.5% by 2050. In addition, in 2005, approximately 1.9 million elderly individuals in Japan had dementia, and this number2 is expected to steadily increase to 3.3 million by 2020 and 4.9 million by 2050. Currently, the field of dementia care in Japan is facing the challenge of providing continuity in the lives of the elderly to allow patients to maintain their dignity. The Japanese government has tried to establish a community social support system for elderly people with dementia and their families, wherein nurses and social care workers provide various types of individual-based care. In 1996, the International Geriatric Psychiatry Society labeled peripheral symptoms or behavioral disorders of dementia ‘‘behavioral and psychological symptoms of dementia’’ (BPSD).3 Behavioral and psychological symptoms of dementia are classified into 2 types: behavioral symptoms such as physical aggressiveness, unrest, and irritation; and psychological symptoms, such as anxiety, hallucinations, and delusions.3 Patients with BPSD often resist care and may show physical aggressiveness, which makes it difficult to provide them with nursing care and places additional stress on nurses. This problem adds a major burden to providing medical care to patients with dementia and may affect their quality of life (QOL). Psychiatrists often use psychotropic or antipsychotic drugs for patients with BPSD, but these drugs often lead to side effects such as accidental falls or delirium. To address this concern, we have conducted several studies on music therapy4,5 and animal-assisted therapy6 as nonpharmacologic techniques reduce the symptoms of BPSD. 1 Hamamatsu University, School of Medicine, Faculty of Nursing, Hamamatsu, Shizuoka, Japan 2 Japan Sweden Care Institute, Tokyo, Japan 3Wakeikai Memorial Hospital, Hamamatsu, Shizuoka, Japan 4Mie Prefectural College of Nursing, Tsu, Mie, Japan Corresponding Author: Mizue Suzuki, Hamamatsu University, School of Medicine, Faculty of Nursing, 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3192, Japan E-mail: m*suzuki@hama-med.ac.jp American Journal of Alzheimer’s Disease & Other Dementias® 25(8) 680-686 ª The Author(s) 2010 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1533317510386215 http://aja.sagepub.com Tactile massage, developed by a Swedish nurse named Ardeby7 and referred to as taktil massage in Swedish, is a complementary care method used successfully not only in palliative and geriatric care but also in other health fields to reduce stress. Taylor defines tactile massage as a series of slow massage strokes applied with firm pressure, mainly using the flat of the hand and fingers.8 Andersson reported that among participants, 18 years of age or older, who were living at home and who underwent tactile massage for pain, sleep disorders, inability to move, headache, and body tension, 7 items assessing vitality, Mood of Health Index, pain score on the Borg scale, and sense of coherence were improved after massage.7 Andersson also reported that blood glucose and HbA1c levels were improved in patients with type 2 diabetes after 60 minutes weekly sessions of whole-body tactile massage over 10 weeks.9 Agren reported that tactile massage is a good alternative and complement to traditional therapy for severe nausea and vomiting during pregnancy.10 Henricson showed that tactile massage led to significantly lower levels of anxiety in patients who had undergone heart disease surgery or intestinal surgery in the intensive care unit, and tactile touch seemed to reduce the activity of the sympatric nervous system.11 In all these studies, tactile massage was reported to reduce anxiety or stress and related symptoms when provided as complementary or alternative therapy. Snyder showed that hand massage and therapeutic touching did not significantly reduce agitation in elderly patients with dementia in an Alzheimer’s care unit during 5 days of observation, after hand massage and therapeutic touching had been provided once a day in the late afternoon for 10 days.12 Kim and colleagues reported that dysfunctional behavior associated with BPSD decreased with physical massage.13 Remington reported that calming music and hand massage after exposure to an agitating environment enabled nursing home residents to feel calm within a structured surrounding, thus offsetting disturbing stimuli. However, no additive benefit was found by combining interventions.14 Hicks-Moore reported that playing a patient’s favorite music and providing a hand massage, both alone and in combination, significantly decreased agitation immediately following the intervention as well as 1 hour after intervention.15 Hall and Buckwalter hypothesized that an increase in agitation occurs when a person with dementia experiences high levels of stress.16 There are several reports on the effects of hand massage and touch during periods of agitation in elderly patients with dementia. However, there