Working with Clients who have Alzheimer’s/Dementia


Working with Clients who have Alzheimer’s/Dementia
UPDATED:: Jan. 22, 2021 
Published  in Hebrew Sept. 2008 in "Reflexology Today"
Published in English Summer 2008 in the NCRA Newsletter
Persons diagnosed with Alzheimer’s or other types of dementia can benefit greatly from Reflexology and other complimentary or alternative treatments, but the practitioner needs to take into consideration some of the challenges when working with a client who has been diagnosed with dementia.  Sessions need to be attuned to the client’s stage of dementia, but there are some basic rules that can help make your session pleasant and comfortable for both you and your client.
1. Respect and Patience
Probably the most important way to have a positive relationship with clients that have Alzheimer’s or other types of dementia is to respect them and treat them as fellow adults. Although this seems obvious, I have found that many people who work with cliets with cognitive declien, tend to talk down to them like children.  This is terribly degrading and hurtful.
A person with who has dementia may forget who you are at each session.  Always introduce yourself as if it is the first time you are meeting.   Avoid putting your client into an uncomfortable position by asking him if he knows who you are; rather say your name and ask him if he would like a “massage” today.  Keep your questions simple, that is why I never ask if the client wants “reflexology.”  He most probably would not understand what this means.   
Never talk about your client in front of him. Obtain background information and permission from a family member prior to the first session.   Your client may not know the answers to your questions, which could cause feelings of confusion, frustration or incompetence.  
2. Make the session short and precise 
Have everything ready and in place before you begin the session. You do not want to lose you client’s attention because you have to search for hand cream, a pillow, proper chairs for both or you… etc.  Generally, my reflexology sessions are about 20 minutes. The attention span of a client with dementia can be limited.   It is best to begin with short sessions to see how your client responds.  In subsequent appointments, you may be able to increase the duration of the session. 
3.Treatment Environment 
It is extremely difficult for a person with Alzheimer's/Dementia to focus.   The session must take place where there are no distractions.  The room should be quiet; even playing soft music may be a distraction for someone with dementia.  As much as possible, avoid distractions such has people walking in and out or noise outside the window.  Speak slowly and clearly.
Hunger and thirst are other distractions to consider before providing a treatment.  Make sure the treatment is not set right before mealtime.
Finally, it is best to set appointments in the morning.  In the afternoon your client may be tired – an additional distraction.  Later in the afternoon  persons with dementia may be most agitated, with a drop in cognitive ability.  This time is known as sun downing since it occurs around sunset.  
4. Emotions
Many times, a Reflexology session can cause a flood of emotions. Life is already very confusing for a person who has cognitive decline.  Many will do their best to hide their condition from others and themselves.  They tend to find excuses to explain their memory loss and change, but the disease is scary and frustrating. These hidden emotions can come out during a session.   
As the disease progresses, a person may tend to remember more past than current events.   The person many times will relive their past and will actually think they are the younger person they once were.  If this person had a rich and happy youth and childhood this may be a lovely experience.  If the person was, for example, in the Holocaust, he may be reliving a bitter, sad and frightening experience.   Also, many people have kept emotions hidden deep all their lives, but as they becomes elderly, they are no longer able to conceal these emotions and they explode out after years of denial. 
When I first published this article, I suggested redirecting the client to another topic if he becomes emotional because I did not want to upset him.   Today, after studying and practicing Validation for 6 years, I now understand the importance of allowing my clients to express their emotions. Don’t judge, don’t give advice and don’t try to make your client feel better.  Simply be there for him.  Be the person who will finally listens. Allow your clients to express their emotions in order to feel better.    
5. The Benefits 
Reflexology cannot cure or stop Alzheimer’s or other types of dementia, but it can improve the quality of life. I have seen reflexology reduce stress, induce better and longer sleep, reduce cognitive decline due to stress, reduce meds, increase mobility, improve communication, reduce constipation and improve disposition and relationships with others. 
Giving reflexology to persons diagnosed wtih  Alzheimer’s and other types of dementia can be a most rewarding experience.   Complimentary treatments can have an important and calming effect on these clients, but they can do much more.  These clients normally lack private and personal time with others and can benefit from receiving the full attention from you, the practitioner during a session.   
Family members may have a very difficult time relating to their family member who has regressed due to the illness because they only see what their loved one is not capable of doing anymore.  As a practitioner you are meeting the person as he is now and can accept him as he is today.   By caring, touching and being there for him, your sessions can have a profound effect.  
Oran Aviv has been a reflexologist for 25 years and has worked with people who have dementia for the past 12.  During the last 6 years she has studied and incorporated Validation into her work.  Validation is a way of communicating with people who have cognitive decline.  Today Oran is a Certified Validation teacher and combines both the principles of hand reflexology and Validation to teach caregivers and senior facility staff around the world. Oran is also the recipient of the Geller Prize for her work helping people with who have been diagnosed with Alzheimer’s and other types of dementia.  
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Workshop info: 
Photo of eBook Beyond Words
Oran’s first book Beyond Words, Using Hand Reflexology to Help Your Loved One with Dementia, is soon coming out as an eBook workshop for family caregivers.  Please contact us at  oran@reflexandmore and asked to be notified of the book launch. 
To have Oran teach a workshop at your facility, email her at
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call or whatsapp at +972535533856   or 
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