Progressive Relaxation Therapy and Older Adults

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1 Megan Sadler Undergraduate Longwood University Student Kirsten L. Whitely MA, C.T.R.S. Longwood University Department of Health, Athletic Training, Recreation & Kinesiology Therapeutic Recreation Program Progressive Relaxation Therapy and Older Adults Pico Statement: Does progressive relaxation therapy reduce anxiety in older adults with Alzheimer s and dementia as opposed to sensory stimulation? Search terms: (Alzheimer s OR dementia) AND ( muscle relaxation ) AND (stress) AND (apprehension) AND ( altered state of consciousness ) Years: Databases: EBSCO, CINAHL, Journal of Community Health Nursing Number of Articles: 8 Summary of Research Findings: Does progressive relaxation therapy reduce anxiety in older adults with Alzheimer s and dementia as opposed to sensory stimulation? The question is answered by many case studies, research and trial interventions. While both progressive relaxation therapy and multi-sensory stimulation are used in hopes of reducing anxiety in older adults, the latter is not as successful in this aspect. Multi-sensory stimulation, such as an intervention therapists like to call the Snoezelen room, can improve cognitive abilities and memory in patients with Alzheimer s and dementia, but only for a short period of time. There is no proof of it having positive effects on the long-term rehabilitation or of it reducing anxiety or anxious behaviors. On the other hand, progressive relaxation therapy is effective in the reduction of anxiety with older adults. There is research and evidence present that state progressive relaxation therapy can help reduce stress and not just for a short period of time. As stated above, it has been proven to improve cognitive abilities, which results in the prolonged improvement. This intervention is the better choice when it comes to reducing anxiety in older adults with Alzheimer s and dementia. Both of the interventions mentioned can be effective, but Multi-sensory stimulation is not as effective when it comes to reducing anxiety, as stated in the research above. Alzheimer s disease is the most destructive and progressive disorder among diseases of aging. It is the most common form of dementia (Safavi, Yahyavi, Farahani, Mahmoudi & Mahboubinia, 2013). The prevalence is 65% to 75% in all cases. After age 65, Alzheimer s occurs in 4% of people (Safavi, Yahyavi, Farahani, Mahmoudi & Mahboubinia, 2013). Researchers have found intricate information on several interventions when it comes to treating Alzheimer s and dementia. While there are numerous interventions practiced in the field of Therapeutic Recreation to improve the quality of life for a person suffering from Alzheimer s and dementia, some of these have been known to be more beneficial than others. Progressive relaxation therapy can be described as a type of sequential tension and muscle relaxation in various muscle groups in the body in chronological order (Suhr, Anderson, & Tranel, 1999). It will provide a state of relaxation within ten to twenty minutes and can be easily learned by anyone (Suhr, Anderson, & Tranel, 1999). There are several types of Progressive relaxation therapy. One of these types consists of Progressive Muscle relaxation.

2 This intervention works to reduce the tension in an individual s muscle that seems to be causing them stress physically, mentally and emotionally. Older adults participating in progressive relaxation therapy, or specifically progressive muscle relaxation, are encouraged to wear comfortable clothes that are not fitting on their body and causing physical distractions. Participants are placed in comfortable chairs in a quiet setting where distractions are limited to none. Preparing the room or area for progressive muscle relaxation is so important. There should be minimal lights and participants are given the option to close their eyes. The instructor, or the person conducting the intervention, goes down the list of major muscle groups in chronological order from head to toe, asking the participants to tense the said muscles. This allows a feeling of tightness and slight discomfort. Next the participants are asked to relax, loosening those particular muscles. The tensing and relaxing each last from about ten-fifteen seconds each. The main muscle groups being targeted are: forehead, eyes, mouth and lips, neck, shoulders, chest, biceps and triceps, stomach, thighs, calves, feet and toes (Bell, 2015). Progressive muscle relaxation has been proven to be beneficial to patients with Alzheimer s and dementia by providing an escape from anxiety and relaxing the brain. Results have shown that patients who used and learned progressive muscle relaxation showed a reduction in behavioral disturbance, regarding their anxiety. The findings show that Progressive Relaxation Therapy or Progressive Muscle Relaxation, also known as PMR, is effective to people with mild to moderate dementia (Suhr, Anderson, & Tranel, 1999). Since there are several different types of multi-sensory stimulation, researchers can conclude that some are more effective than others. Multi-sensory stimulation, such as Snoezelen, can sometimes be placed in the category of over stimulation for older adults suffering from Alzheimer s and Dementia. Multi-sensory stimulation such as Music Therapy, Reminiscence Therapy using the five senses, and other types of multi-sensory stimulation can be more relaxing and more beneficial in controlling anxiety. In regards to alerting the cognitive abilities and awakening sensory aspects in an older adult with Alzheimer s and dementia, Snoezelen may be the perfect choice. However, when it comes to the reduction of anxiety, it may cause accidental arousal and increased anxious behaviors. Barriers and Limitations: In older adults with Alzheimer s and dementia, there is not a lot of research on interventions such as Progressive Relaxation in regards to anxiety. There are, however, more specific research studies that indicate how progressive muscle relaxation can benefit older adults with Alzheimer s and dementia. These research studies that are more specific can lead us to know that progressive relaxation does reduce anxiety in this population. The reduction of anxiety is a broad topic and a great amount of reading needs to be done to learn about it. Also, data shows no difference in age, education, performance or use of medications (Suhr, Anderson, & Tranel, 1999). Therefore, we only know that progressive relaxation therapy is beneficial in the older adult population. One major barrier or limitation is that further research on this intervention is needed with systematic long-term follow-up as well as larger sample sizes (Devier et al., 2009). Knowledge Translation Plan In order for the Progressive Relaxation therapy technique to be successful in the reduction of anxiety in older adults with Alzheimer s and dementia, Certified Therapeutic Recreation Specialists should first 1) consider establishing a strong rapport with the client or clients he or she is working with. It is essential to have a trusting relationship with the client in every population but especially in older adults suffering from Alzheimer s. The client must learn

3 to be comfortable with the CTRS or whoever may be facilitating the intervention. It is important to establish a rapport because different types of Progressive Relaxation therapy work for various individuals. It also depends on the level of anxiety or discomfort in a client. If a CTRS knows what specific interventions, assessments or activities relax a client, he or she can then use those in the Progressive Relaxation therapy. For example, if a client gains relaxation from images, sounds and smells of the beach, the Progressive Relaxation therapy that might be most beneficial to that client is the sound of the waves, while the facilitator reads a script of being at the beach in the warm sun with sand in between the toes and smelling the salt water. If a client were deathly afraid of water, this type of Progressive Relaxation would not be successful with this particular client. Once a CTRS has learned what specific relaxation techniques should be used on a client, he or she can then 2) move ahead to develop an intervention with this client. The CTRS will need to decide whether it will be most beneficial for the client to participate in a group or oneon-one Progressive Relaxation therapy intervention. The client will be encouraged to participate in Progressive Relaxation therapy, whatever the type may be, at least three times a week for thirty-five minutes each session. This intervention should last over the duration of one month to determine if it is helping or hurting the client. Overall, the 3) CTRS will use the APIE (Assess, Plan, Implement, Evaluate) process to complete this plan. Assessing the client will allow the CTRS to establish a strong rapport with the client. It is in this area where the CTRS will learn more about the client and learn to fit his or her needs into the intervention. It is essential to treat each and every client as an individual who requires individual needs. During the planning section, the CTRS will develop an individualized plan that he or she thinks will be more successful in the reduction of anxiety in this client. The CTRS will then implement the plan by facilitating a Progressive Relaxation intervention with the client and lastly, evaluate the process and the intervention. Did the facilitation go as planned? Did the client seem intrigued or uncomfortable? Was there a noticeable difference in the levels of anxiety of the individual who participated? These are the questions the CTRS should ask himself during evaluation, once the intervention and implementation is complete. This intervention should also improve sleep patterns in older adults with Alzheimer s and dementia, as well as improve cognitive abilities and reduce behavioral disturbances, which all correlate with anxiety in older adults with Alzheimer s and dementia. One specific type of Progressive Relaxation therapy that CTRS s can implement is Progressive Muscle Relaxation. During this intervention, the CTRS, or whoever may be facilitating the group, will ask participants to tense muscles for five seconds and release muscles for 30 seconds. This intervention starts with the muscles at one end of the body and works its way down or up the skeleton. Music may be played in the background or the intervention can be completed with no music at all, depending on what is most beneficial for the clients present in the group. Overall, relaxation techniques such as Progressive Muscle Relaxation, consist of refocusing one s attention onto something calming and relaxing, instead of stimulating. It also increases awareness in the body without increasing anxiety or tension.

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5 References Bell, P. P. (2015). Progressive muscle relaxation. Salem Press Encyclopedia Of Health) Bauer, M., Rayner, J., Koch, S., & Chenco, C. (2012). The use of multi-sensory interventions to manage dementia-related behaviours in the residential aged care setting: a survey of one Australian state. Journal Of Clinical Nursing, 21(21/22), p. doi: /j x Devier, D. J., Pelton, G. H., Tabert, M. H., Liu, X., Cuasay, K., Eisenstadt, R., &... Devanand, D. P. (2009). The impact of anxiety on conversion from mild cognitive impairment to Alzheimer's disease. International Journal Of Geriatric Psychiatry, 24(12), doi: /gps.2263 Johnson, J. E. (1993). Progressive Relaxation and the Sleep of Older Men and Women. Journal Of Community Health Nursing, 10(1), 31 Kayser, C., & Shams, L. (2015). Multisensory Casual Inference in the Brain. Plos Biology, 13(2), 1-7. Doi: /journal.pbio Maseda, A., Sanchez A., Pilar Marante, M., Gonzalez Abraldes, I., Bujan, A., Millan Calenti, J. (2015). Effects of Multisensory Stimulation on A Sample of Instituionalized Elderly People With Dementia Diagnosis. A Controlled Longitudinal Trial. Safavi, M., Yahyavi S., H., Farahani, H., Mahmoudi, N., & Mahboubinia, M. (2013). The effect of multi-sensory stimulation (MSS) on cognitive status of women with Alzheimer's disease in Fereshtegan elderly care center. Journal Of Jahrom University Of Medical Sciences, 11(2), Suhr, J., Anderson, S., & Tranel, D. (1999). Progressive Muscle Relaxation in the Management of Behavioural Disturbance in Alzheimer's Disease. Neuropsychological Rehabilitation, 9(1), doi: /