EFFECTS OF ACUPRESSURE ON AGITATION AND STRESS IN NURSING HOME RESIDENTS WITH DEMENTIA

Abstract

Agitation is prevalent in nursing home residents with dementia and has negative impacts on the PWD and their caregivers. Non-pharmacological interventions (NPI) offer promise for managing agitation. However, no NPIs have been proven to be effective across cultures. Acupressure is derived from Traditional Chinese Medicine. It has been used, particularly in Chinese communities, to manage agitation in PWD because it is safe and inexpensive. However, its effect on agitation and at the biochemical level is uncertain. The aim of this study was to examine the effect of acupressure on those with agitation and stress, and to test whether acupressure reduces agitation by mediating stress. This RCT was conducted in 12 nursing homes in Hong Kong. CMAI was used to measure the effect of acupressure on agitation, and salivary cortisol the effect on stress, measured at baseline (T0) and in the 3rd (T1), 5th (T2), and 8th (T3) weeks. The participants, who were agitated nursing home residents with dementia, were randomly allocated into three groups. In the acupressure group (n=39), acupressure was performed by trained laypeople for nine minutes per session; on five acupoints: Baihui (GV20), Shenman (HT7), Yingtang (EX-HN3), Fengchi (GB20), and Neiguan (PC6); for 10 minutes per session, for two sessions per day; and for 20 sessions within two weeks. In the sham group (n=41), the intervention was the same as in the acupressure group, except that five non-acupoints were employed. In the usual-care group (n=39), only the usual care was provided. Significant interaction effects between groups and time points were observed on the level of salivary cortisol (p=0.022) but not on agitation (p=0.052). The mediation effect of salivary cortisol between intervention and agitation was insignificant. Intervention fidelity was 100% and compliance was 91.9%. Acupressure can be accurately implemented by trained laypeople and complied with by agitated Chinese PWD. Its effect at reducing salivary cortisol in PWD merits further research on how acupressure works on the HPA axis. Its insignificant effect at reducing agitation may be related to the inadequate sample size. Physiological stress may not be the cause of agitation in PWD.