Complementary and alternative therapies
The difference between a complementary and alternative therapy is a little difficult to define. Simply put, a complementary therapy is one that you have alongside conventional medical treatment (the kind you get from your doctor or hospital). The therapist generally won’t claim to be able to cure or treat your medical condition. So this includes therapies like massage and aromatherapy.
An alternative therapy generally claims to be able to cure or treat you instead of conventional medicine, often without the evidence to back that claim up.
But it’s not always that straightforward. Acupuncture is often called an ‘alternative therapy’ but does have proven benefits for some illnesses, and quite a few ‘medical’ doctors are trained in its use.
The National Institute for Health and Care Excellence (NICE) is the body that decides what treatments the NHS should fund in the UK. They do recommend some complementary therapies, including some of those listed here.
Aromatherapists use essential oils from fragrant plants to improve your sense of wellbeing and help you relax. You may have a massage with the oils the therapist has chosen for you. Or the therapist may give you small bottles so you can put a few drops in your bath, or on to a fragrance diffuser or vaporiser.
Aromatherapy is said to help promote sleep and relaxation and help with depression. Trials have been carried out trying aromatherapy for agitation, behaviour problems and to improve overall quality of life. The results were not consistent but NICE recommends that aromatherapy is one possible approach for treating agitation in dementia.
Acupuncture uses very fine needles, which the practitioner puts through the skin in specific places and leaves in place for a short time. Sometimes, acupuncturists connect a small electric current that makes the needles tingle. Acupressure is similar, but uses pressure on acupuncture points, rather than needles. You normally have a course of these treatments.
We don’t know exactly how acupuncture works. It is thought to have a number of different actions, on the nervous system, including encouraging the release of ‘natural painkillers’, endorphin and serotonin. In conventional medicine, it is mostly used to treat sickness (nausea and pain).
Research into acupuncture as a treatment for mild cognitive impairment (which causes symptoms similar to dementia) has suggested it may help with thinking and memory. Other early research has suggested it might help in vascular dementia. It’s early days and we need more rigorous research as well as more research with patients with dementia. There is also research showing that acupressure can be helpful in controlling anxiety, although this research didn’t involve people with dementia.
Massage means manipulation of the soft tissues (eg muscles) with the hands. Even though the evidence for it is not strong, massage is another complementary therapy that NICE recommends trying for someone with dementia who is agitated.
There are many different types of massage. Hand massage was found in two clinical trials to reduce agitation in people with dementia. Gentle touch may also be helpful. Another study found that people with dementia ate more when their carers stroked their forearm gently while encouraging them to eat.
There are various theories about why massage and touch may help people with dementia. One is that it releases oxytocin, a hormone that is calming and reassuring and so reduces agitation. Experts generally agree that the short-term benefits of massage are likely to be in improving behaviour and mood, and promoting wellbeing. More research is needed to form any strong evidence about the benefits of massage.
Light therapy is a recognised treatment for a form of depression called ‘seasonal affective disorder’ (SAD). Light is thought to affect mood, behaviour and our internal biological clocks. Because of this, light therapy has been tried for people with dementia, mainly to try and correct sleep disorders, such as night-time waking and length of sleep at night.
Unfortunately, a review of all the research didn’t show any benefit. However, if a person with dementia has always had low moods during the winter months, it may be beneficial. Light therapy is known to help around two-thirds of those with SAD. There are no real side effects, though in one study it may have caused agitation in some people with dementia.
Light therapy involves sitting for 30–60 minutes in bright light once a day. This is brighter than normal light and special ‘SAD’ lamps are available.
There are a lot of herbal therapies on the market these days. Several have been researched in dementia, including gingko biloba, vitamin E and a traditional Chinese medicine (TCM) called yizhi. None so far proved beneficial. St John’s Wort has been shown to be helpful for some people with mild or moderate depression, which can be common in dementia.
Trying herbal medicines or TCM is not the same as trying something like music therapy. Most drugs come from plants originally and taking a herbal medicine is a bit like taking a drug in its raw form. Different brands can vary hugely in the amount of active ingredient they contain. They can also have side effects and may interact with other medicines you’re taking to produce very unpleasant effects. It’s very to check with the GP before a person with dementia starts to take any herbal or vitamin-based therapy.
Some other approaches for agitation in dementia suggested by NICE are multi-sensory therapy and music or dance therapy.
Multi-sensory therapy uses lighting, touch, calming music and essential oils. A review of the research didn’t show that it helped in the long term, but it may have a short-term benefit on mood for people with dementia. The review said we needed better research in assessing this type of therapy.
Some researchers say that listening to music either on your own or in a group can help with behavioural problems. Music therapy also hasn’t been proved to be helpful in dementia, although there is a need for better research. Whether proven or not, it’s unlikely to do any harm and is worth a try, especially if the person with dementia is a music lover.
Some people with dementia have access to pet or animal therapy. It may be arranged through residential care. This works on the idea that spending time with animals has a therapeutic effect.
Professor Graham Stokes, Bupa Global Director of Dementia Care, says, ‘It’s hard to scientifically demonstrate the lasting benefits of these kinds of therapy. But often for people with dementia who have memory difficulties, the “here and now” is what’s important. So if these therapies offer pleasure in the moment then they’re worth exploring.’
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Produced by Nick Ridgman, Lead Health Editor, Bupa UK Health Content Team, November 2016
Reviewed by Professor Graham Stokes, Bupa Global Director of Dementia Care
Next review due December 2019
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