of massage per week, each comprising 30 minutes, during a 6-month period, for a total 51 sessions. The researchers observed positive effects during the session as well as at 15 minutes after the session. They observed significant changes in the patients, including physical relaxation, better sleep, and better communication together with a decrease or stoppage of abnormal behavior. Kilstoff and Chenoweth performed a study in a multicultural health care center treating dementia and found that gentle massage on the hands of patients with dementia in the course of a period of 18 months produced a significant effect: the development of a positive relationship between patients and caretakers, a decrease in agitation, less distress, more alertness, a better sleeping pattern, and fewer incidences of withdrawal and wandering.5 The importance of slow-stroke massage in reducing physical expressions of agitation, including wandering and resistiveness, has also been described in individuals with Alzheimer’s disease. However, Rowe and Alfred found that slow-stroke massage was not successful in attenuating verbal forms of agitation such as shouting.11 Sansone and Schmitt’s 1-year demonstration project explored the effectiveness of gentle massage in older adults with dementia living in a nursing home.6 The researchers found that massage given by trained nurses could attenuate anxiety and lower agitation in the patients. Massage was given in three 12-week phases, and beneficial effects were evident from the second phase. In addition to reducing patients’agitation, nursing staff indicated that the patients enjoyed the tender touch of massage, which led to an improvement in communication between patients and health care staff. A short-duration pilot study reported the efficacy of foot massage therapy in reducing agitated behavior in older patients (N = 17) who were suffering from dementia and had a history of clinically significant agitation.7 These patients received foot massage for 10 minutes daily for 14 days. A behavioral checklist analysis showed a decrease in agitation and related behavioral abnormalities immediately after massage therapy and at a 2-week follow-up. Reducing Stress and Anxiety. Some studies have also shown that massage therapy can reduce stress and anxiety in patients with dementia. A randomized controlled trial evaluated the effects of foot massage on the parameters of the physiological stress response —reduction in blood pressure and heart rate—in patients (N = 53) suffering from moderateto-severe dementia.12 The researchers divided the participants into 2 groups, one receiving foot massage for 10 minutes and a control group receiving no intervention. Participants in the intervention group showed a greater reduction in heart rate and systolic blood pressure than those in the control group, suggesting the significance of massage therapy in attenuating stress response in patients with dementia. This article is protected by copyright. To share or copy this article, please visit copyright.com. Use ISSN#1078-6791. To subscribe, visit alternative-therapies.com 32 ALTERNATIVE THERAPIES, NOV/DEC 2020 VOL. 26 NO. 6 Zhao—Massage Rherapy and Agitation in Patients With Dementia salivary alpha-amylase. Moreover, it also decreased pain perception for these patients with dementia, suggesting the utility of reflexology in reducing stress in patients with mildto-moderate dementia. Massage Therapy for Health Care Personnel Taking care of patients with dementia is a demanding job and often leads to caregivers developing stress and mood variations. A pilot study has been conducted to explore the effectiveness of massage therapy on reducing the stress and elevating the mood levels of nurses taking care of patients with dementia.25 In a parallel, randomized controlled trial, 19 nurses involved in taking care of patients with dementia were recruited and divided into 2 groups, one receiving a footmassage intervention (n = 9) and a control group resting silently (n = 10). The intervention group underwent 3 sessions of massage in a week for a period of 4 weeks, each session lasting for 10 minutes. The results showed a trend toward improvement in mood together with a significant decrease in diastolic blood pressure and anxiety, suggesting the efficacy of short-duration massage in alleviating anxiety and reducing stress in health care caregivers. Lack of Beneficial Effects for Massage Therapy In contrast to the aforementioned studies showing the effectiveness of massage therapy, a few studies have shown no beneficial effects for aromatherapy and massage therapy on agitation in patients with dementia.26 In a single-blinded, randomized controlled trial, 67 patients with dementia with a history of clinically diagnosed disruptive behavior were exposed to either aromatherapy or aromatherapy in conjunction with hand massage therapy twice daily for 6 weeks.27 However, the study documented no significant differences between the placebo and the massage therapy for the patients. Another randomized, controlled, crossover study that was conducted in the course of 3 weeks in Australia compared the effects of 10 minutes of foot massage—the intervention— with a quiet presence of nurse (but not doing any massage)— no intervention as the control—on controlling agitation and