Lack of touch can lead to poor health

During the Covid pandemic, I read a Facebook post where an elderly almost blind and deaf woman just longed for a hug or touch, but it was not possible to arrange. A caress with clean hands does not spread infection. During the Covid pandemic, many residents have felt the absence of physical touch. Many have expressed a longing for a hug or caress. Skin thirst affects health and quality of life for many elderly people.

Touch has a healing power: The need for touch remains as we age

Aging is a natural part of life, and it comes with many challenges and changes. An important and often overlooked aspect of our health and well-being as we age is the need for touch. Touch is a fundamental human experience that has a powerful impact on our physical and mental health, and it continues to be valuable throughout life, especially as we get older.

Touch is an essential part of people's lives, regardless of age. For older people, it can be particularly important for their physical and psychosocial well-being. Recognizing the need for touch and working to provide it can make a huge difference in the lives of older individuals as they navigate the challenges of aging. By promoting the healing power of touch, we can help the elderly age with dignity, comfort, and a sense of belonging.

Well-being and touch

1. Reduced stress and anxiety: Touch releases oxytocin, a hormone that reduces stress levels and anxiety. For older people who may experience worry and anxiety about aging, regular touch can be a soothing and comforting experience.
2. Improved sleep: Touch can help improve sleep quality by reducing sleep disturbances and promoting relaxation.
3. Feeling of community: For older people who may feel isolated or alone, touch, like a hug or holding hands, can create a sense of belonging with others.
4. Self-esteem and dignity: Being touched and cared for provides a sense of self-esteem and dignity that is crucial for psychosocial well-being.

Feel-good hormone

Touch releases Oxytocin and contributes to creating calm, relaxation and security. Research shows that the secretion of Oxytocin lowers blood pressure, relieves pain, reduces stress hormones, improves nutrient intake, and leads to improved wound healing and reduced fear. Oxytocin is the body's anti-stress hormone, which contributes to calm, relaxation and favors growth and healing. The production of the substance is stimulated by hugs, touch caresses, sex and closeness among other things.

Kerstin Uvnäs Moberg, a doctor and professor of physiology who researches Oxytocin, says that the hormone also has a positive effect on people's ability for social interaction. Not everyone has someone to experience physical closeness with, but then there are other ways to increase the amount of the hormone in the body. What you perceive as pleasant, mentally and physically, increases the amount. Warm, comfortable baths, music that you like and enjoy, sitting in the sun when it warms. In fact, we intuitively know what makes us relax. All types of soft massage are good for relaxation, but not hard muscle massage. Touch that makes us relax can also be to touch animals, to pat a dog or sit with a purring cat in your lap. Everything that brings us satisfaction and joy.

Touch in care

Care provides many opportunities for touch. Touch can be both pleasant and unpleasant and staff need to think about how they touch the residents. This is particularly important in situations when they are helping the resident with hygiene. It is possible to ensure that the moment in the shower is pleasant and that the drying feels pleasant. Many elderly people have dry skin and therefore need to be moisturized after they have been showered.

How massage should be offered must be adapted to the resident. For many, simple hand massage can feel soothing. A hug can be valuable. There are nursing homes that offer tactile massage. It is an approach consciously used to increase the well-being of the residents through touch.

Getting feet and hands moisturized or massaged can be nice. Some long for physical touch, others may find it more unpleasant. It is important to be alert to the resident's experience. Humans have a natural need for body contact to feel good.

One way to avoid negative stress is to do things that you yourself want, find fun, stimulating, that make you feel good and that give life content. Another is to enjoy, not least physically. This is knowledge that we can use in both our own lives and in the nursing home. What applies to us applies to those we give our care and attention to.
It is possible to work with other methods to give the residents a sense of well-being. Animals and robot animals can also provide stimulation.

Many elderly people do not get any natural touch in everyday life. Lack of touch can lead to depression and anxiety. Natural touch, on the other hand, makes us safer and healthier and plays a crucial role in our survival. The sense of touch stays with us even when dementia disease increases or other senses deteriorate.

Physical health and touch

1. Pain relief: Touch, such as massage or hugs, can reduce pain by releasing endorphins and reducing tensions in the body. This is particularly valuable for elderly people who may suffer from chronic pain.
2. Muscle function: Aging can lead to decreased muscle function and mobility. Touch in the form of soft massage or physiotherapy can help to preserve and improve muscle tone and mobility.
3. Circulation: Touch promotes circulation by stimulating blood flow to different parts of the body, which can be particularly valuable for elderly people with impaired blood circulation.
4. Skin health: Regular skin contact and massage can improve skin health by increasing blood flow to the skin and promoting the removal of dead skin cells.

Tactile massage leads to:

• Improved self-esteem and sleep
• Pain relief
• Reduced anxiety and worry
• Affirmation and visibility
• Joy and alertness
• Better body perception
• Improved concentration ability
• Facilitated communication
• Calm
• Improved gastrointestinal function

Touch done in the wrong way can have the opposite effect and may be perceived as uncomfortable by the individual. There are people with MS or depression who do not find tactile massage as pleasant.

A caress with clean hands does not spread infection. We must do what we can for our elderly to socialize with quality even when there is a risk of infection. The residents must be allowed to live, not just survive.

Sleep

Sleep habits affect quality of life. The need for sleep changes and many have a lesser need for sleep. Disturbed night sleep can engage both the resident and the staff due to increased fall risk and disturbed neighbors.

A biological clock tells us when it's time to sleep. The body temperature drops, you become sleepy. The need for sleep is between seven and eight hours for most people, while some get by with six hours of sleep or less. The need for sleep decreases with increasing age. By the age of 75, most people lack deep sleep. This leads to the elderly often waking up at night. It is not a condition that should be medicated. To prevent the elderly from getting up and injuring themselves, night alarms can be used that go off if the elderly get up.

Regular sleep times should be individually adapted. It used to be common for the elderly to be put to bed routinely so that everyone would be lying down when the night staff arrived. It seems to still occur today. To reduce the need for nocturnal toilet visits, the resident should be helped just before going to bed. Many can sit up in their night clothes and dressing gown and may go to bed later. The teeth should be freshly brushed and any incontinence protection changed in connection with bedtime.

Always map sleep problems. Use a "sleep and activity schedule". Use pain assessment scales like the VAS scale or Abbey Pain Scale if the elderly person cannot communicate what is wrong themselves. Many sleep poorly due to pain and need pain treatment. Others cannot turn themselves and then a turning schedule and interventions and help from the staff may be measures that are required. To lie comfortably in bed, the mattress and pillow should be comfortable and the blanket should be just warm.

With a good range of activities and outdoor stays, most people sleep well at night. Walks, exercise, physical activity and daylight make sleep better. Physical activity can also improve sleep. Good sleep habits increase resistance to stress. Too much stimulation, especially negative, means that you are constantly on high alert. Then meditation can help. Meditation is good for counteracting stress.

Avoid giving sleeping pills to the elderly. Sleep medication does not cure the cause of sleep problems and in some cases gives serious side effects such as daytime fatigue, dizziness, forgetfulness and confusion and an increased risk of falling. There are studies suggesting an increased suicide risk in the elderly who take sleeping medication.
Studies show that sleeping pills have a limited effect on the elderly. The desired effect decreases quickly as a result of habituation. The treatment often needs to be phased out to avoid causing continued sleep problems.

If someone is sedentary, for example in a wheelchair, it is important to ensure regular rest to avoid pressure sores. Toilet visits and changing of any incontinence protection should take place at least every four hours during the day. Many residents need several short rest breaks during a day as well as position changes in between. Rest time should not exceed 20 - 30 minutes as it can affect night sleep.

In nursing homes, the staff's supervision visits can become a disruptive element. Try to minimize the need for disruptive elements at night. Using motion alarms and well-functioning incontinence protection can reduce the risk of disturbed night sleep. Also, there may be reason to review medication if the elderly have large amounts of urine just at night.
In home healthcare, a peephole camera is often used where supervision visits are made via webcam at certain times during the night.

Sexuality and aging

Sexuality is a taboo subject for many. It can become even more noticeable when it comes to older people. Many people have both feelings of desire and sexual drive left well into their years. Incipient dementia can affect the judgment of some individuals. When we don't talk about it, there is a risk that it becomes difficult to handle in everyday life.

Care staff need to consider the individual's integrity and learn that when the elderly person is in their room, it is not just a matter of stepping into the room. Knocking and waiting a while is part of respectful treatment.

Caregivers who meet the elderly must understand that love, desire and sexuality do not end with age. It is taboo to talk to the elderly about sexuality, and caregivers should learn more about the subject to be able to handle it more easily.

Many elderly people who have a desire for sex still refrain. Lack of a partner, lack of desire for the existing partner or pains can be reasons. Also, own, adult children's or the surroundings' prejudices can hinder. Many of those who are older today have grown up in a society where you do not talk about sexuality. Staff who do not knock before entering the apartment can be a hindering factor.

There are cases where residents grope care staff. This is not acceptable and staff may need to set boundaries. Often it may be enough for the manager or responsible nurse to have a conversation with the resident in question. When it comes to people with dementia, the staff must work together to come up with an approach. This becomes particularly important if other residents are subjected to courtship against their will.

Another situation that may arise is that residents turn to each other without being married. Perhaps one of them has a wife or husband who does not live in the nursing home.
Many medications can lead to decreased sexual desire or contribute to erection problems such as antidepressant treatment, blood pressure medications, and drugs that lower blood cholesterol. Incontinence protection and urinary catheter can be limiting and cause a lot of problems for some men. It can happen that they cut off the hose or try to pull it out. Women can get treatment with estrogen for fragile mucous membranes.

Reflection - need for rest, relaxation and touch
Care personnel:
• Do you consider your touch to be pleasant in connection with care measures?
• Are aspects of good night's sleep included in your implementation plan?
• Do you discuss elderly and sexuality in the group?

Manager, nurse, occupational therapist and physiotherapist:
• Is tactile massage used in the operation?
• Is skin thirst discussed?
• Do you have health plans related to someone having difficulty sleeping at night?
• Do you have a common value base regarding elderly sexuality?

Resident and relative:
• Does your loved one get closeness?
• What are your thoughts on aging and sexuality?

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day