Massage Therapy, Dementia, and the Care Partner

Massage can still be appropriate and meaningful for someone living with dementia. The key is adapting the session to the person’s cognition, communication, mobility, nervous system, and safety needs.

Massage does not treat dementia itself. It may, however, support comfort, relaxation, connection, and short-term calming. Research suggests massage and touch can reduce agitation in some people living with dementia, although the evidence is still developing and individual responses vary. 

Dementia is not one-size-fits-all

Two people with the same diagnosis can have very different needs. Diagnosis gives us useful background, but the massage therapist still has to respond to the person in front of them.

Alzheimer’s disease

People with Alzheimer’s may have increasing difficulty with memory, language, processing new information, and following multiple steps.

Massage therapists can help by:

• Giving one instruction at a time
• Using simple choices, such as “blanket on or off?”
• Explaining what they are about to do before touching
• Demonstrating instead of giving complicated directions
• Allowing extra time for a response
• Avoiding unnecessary correction or arguing
• Reintroducing themselves or explaining the massage as often as needed
• Watching for nonverbal signs that the person wants touch to stop

Consent should remain ongoing. A client may initially agree to massage and later communicate “no” through words, guarding, pulling away, facial expression, or agitation.

Vascular dementia

Vascular dementia can look different depending on which areas of the brain have been affected.

Some people may experience:

• Slower processing
• Difficulty planning or sequencing tasks
• Balance problems
• Weakness
• Changes in judgment or attention
• Aphasia or other communication changes
• Changes related to previous strokes

For massage therapists, this may mean:

• Breaking transfers into individual steps
• Allowing much more time to answer
• Asking about stroke history and one-sided weakness
• Watching closely for fall risk
• Adapting communication for aphasia
• Being cautious with areas where sensation has changed
• Considering whether the person has difficulty noticing one side of the body

Some people who have experienced certain strokes can develop unilateral neglect, meaning they may not fully attend to one side of their body or surroundings.

Mixed dementia

Mixed dementia commonly involves more than one disease process, such as Alzheimer’s disease combined with vascular brain injury.

A massage therapist might see a combination of:

• Memory impairment
• Slow processing
• Difficulty sequencing tasks
• Word-finding difficulty
• Mobility changes
• Balance problems
• Emotional changes
• Significant differences between good days and difficult days

Rather than trying to determine which disease process is causing a particular behavior, a more useful question may be:

What does this person need from me right now to feel safe and comfortable?

Lewy body dementia

Lewy body dementia can involve cognitive fluctuations, visual hallucinations, Parkinson-like movement problems, sleep disturbances, and changes in blood pressure.

Massage therapists may need to accommodate:

• Major changes in alertness from one appointment to another
• Rigidity or slow movement
• Difficulty turning or transferring
• Visual-perceptual changes
• Hallucinations
• Dizziness or blood-pressure changes when sitting or standing

If a client reports seeing something the therapist does not see, arguing about whether it is real may increase distress.

A calmer response might be:

“That sounds unsettling. You’re safe here with me.”

Parkinson’s disease and dementia

Parkinson’s disease can overlap with cognitive impairment or dementia in some people.

Massage therapists may encounter:

• Rigidity
• Slowed movement
• Freezing
• Pain
• Fatigue
• Changes in balance
• Slowed thinking
• Difficulty with attention
• Visual-perceptual changes
• Hallucinations
• Blood-pressure changes

The therapist should consider the whole person, not just muscle tightness.

A systematic review found some evidence that massage may help certain motor and nonmotor symptoms associated with Parkinson’s disease, while also noting limitations in the available research.

Massage can support the caregiver, too

Care partners often experience significant physical and emotional fatigue. One practical problem is that they may not be able to leave the person they care for alone long enough to receive massage themselves.

Massage practices can become more accessible by offering options such as:

• Allowing the person with dementia to remain in the treatment room when appropriate
• Providing familiar music, headphones, a tablet, photo book, snack, or simple activity
• Offering clothed massage so the caregiver can respond quickly if needed
• Using chair massage or shorter sessions
• Allowing a spouse, adult child, aide, or other care partner to remain in the room during the client’s massage
• Scheduling during the person’s best time of day
• Keeping the therapist, room, music, and routine as consistent as possible
• Allowing extra time for transitions

The important distinction is that the person with dementia should not automatically become the massage therapist’s responsibility while the caregiver receives treatment.

If someone has significant wandering, fall risk, behavioral concerns, or medical needs, there should be a realistic supervision plan.

Touch can also become part of caregiving

There is some research suggesting that caregivers can use simple massage or therapeutic touch techniques at home.

In one randomized trial, family caregivers were taught to provide massage several times each week. Researchers reported improvements in some measures of agitation and depression in people with dementia, along with reduced caregiver stress.

The study was relatively small, so these findings should not be overstated, but it offers an interesting example of touch being used as a shared caregiving tool.

Behavior is communication

If someone suddenly becomes restless, angry, fearful, withdrawn, or resistant during massage, the behavior may be communicating something.

They may be saying:

• This hurts.
• I’m cold.
• I need the bathroom.
• I don’t understand what is happening.
• You are moving too quickly.
• I don’t recognize you.
• I’m tired.
• I’m scared.
• I need to move.
• I simply do not want massage right now.

Pain, hunger, thirst, constipation, a full bladder, fatigue, medication effects, infection, illness, or overstimulation can all contribute to behavioral changes.

Sometimes the most therapeutic massage decision is simply:

Stop.

Using the CPI Crisis Development Model

The CPI Crisis Development Model offers a useful framework for thinking about escalating behavior.

The basic idea is that our response should change as the person’s behavior changes.

1. Anxiety: Be supportive

The client may start:

• Fidgeting
• Repeatedly asking when they are leaving
• Looking frightened
• Trying to sit up
• Becoming restless

The therapist can:

• Slow down
• Reduce stimulation
• Listen
• Speak calmly
• Determine what the person needs

2. Defensive behavior: Be clear and simple

The client may say:

• “Don’t touch me.”
• “Leave me alone.”
• “I’m getting out of here.”

The therapist should:

• Stop touching
• Give the person space
• Avoid arguing
• Use short, simple language

For example:

“Okay. I’ll stop.”

Being directive does not mean becoming authoritarian.

3. Risk behavior: Safety becomes the priority

If someone attempts to hit, kick, grab, flee unsafely, or creates another immediate safety risk, massage should stop.

The therapist should:

• Create space
• Keep access to an exit
• Avoid escalating the confrontation
• Involve the caregiver when appropriate
• Seek emergency assistance if necessary

Massage therapists should not attempt physical restraint or crisis techniques they have not been specifically trained to perform.

4. Tension reduction: Rebuild rapport

Once the person begins to settle, avoid shaming them or demanding an explanation.

A simple response may be:

“You’re okay. We don’t have to do any more massage today.”

Afterward, the therapist and caregiver can consider what may have triggered the situation and what could make a future visit easier.

Protecting the massage therapist matters, too

Person-centered dementia care does not mean accepting unsafe working conditions.

Before the first appointment, it can help to ask the caregiver about:

• Wandering or exit-seeking
• Fall history
• Transfer assistance
• Aggression or resistance during personal care
• Hallucinations or delusions
• Known triggers
• Best communication strategies
• Best time of day
• Whether the person can safely be separated from their caregiver
• What usually helps calm them
• Recent sudden changes in cognition or behavior

The physical environment matters too.

Whenever possible:

• Keep exits accessible
• Avoid positioning yourself where you could become trapped
• Minimize unnecessary noise and clutter
• Make transfers simple
• Allow extra time
• Stop the session when safety becomes uncertain

A sudden major change in behavior or cognition should not automatically be blamed on dementia. Pain, illness, infection, medication effects, or delirium may be involved and may require medical attention.

What should care partners look for in a massage therapist?

Not every massage therapist needs to be a dementia specialist. What matters is whether the therapist has relevant training, understands the needs of older adults, and is willing to adapt care to the person in front of them.

Here are some questions worth asking before booking.

Do they offer a complimentary consultation call?

A brief conversation before the first appointment can be extremely helpful.

It gives the care partner an opportunity to discuss:

• The type and stage of dementia
• Communication changes
• Mobility and transfer needs
• Known triggers
• Fatigue
• Agitation or anxiety
• Sensory preferences
• Goals for massage
• What usually helps the person feel comfortable

It also gives both the care partner and massage therapist a chance to decide whether the therapist, setting, and proposed approach seem like a good fit.

What dementia-care training have they completed?

Dementia-specific massage training can be valuable, but the training does not necessarily have to be massage-specific.

Education in dementia care can teach therapists important skills involving communication, behavior, sensory changes, person-centered care, and responding to distress.

For example, in my own continuing education I am currently completing coursework toward dementia-care specialist credentials through Insight Memory Care Center and training through CPI, the Crisis Prevention Institute.

Ask your massage therapist what dementia, memory-care, caregiving, or crisis-prevention education they have completed.

What continuing education have they taken related to older adults?

Training related to aging can be particularly useful.

Ask about continuing education in areas such as:

• Geriatric massage
• Aging skin
• Fall prevention
• Positioning and transfers
• Osteoporosis
• Joint replacements
• Neuropathy
• Cardiovascular conditions
• Edema
• Medications commonly used by older adults
• Cognitive impairment

Do they understand how pressure may need to change with age?

Older adults may have thinner, more fragile skin and may bruise more easily. They may also have osteoporosis, neuropathy, altered sensation, edema, vascular conditions, or medications that affect bleeding, blood pressure, or balance.

A therapist should not automatically use the same pressure they would use with a younger, healthy client.

They should be comfortable adapting:

• Pressure
• Stretching
• Positioning
• Session length
• Temperature
• Bolstering
• Pace of movement

Have they trained in oncology massage?

Oncology massage education can be surprisingly useful when working with older adults and people living with dementia.

It does not make someone a dementia specialist, but many of the principles translate well, including:

• Person-centered care
• Gentle pressure when appropriate
• Medical screening
• Adapting massage around health conditions
• Changing positioning based on comfort and function
• Paying attention to fatigue
• Recognizing when a standard massage routine is inappropriate

Rather than asking only, “Do you work with seniors?”, ask what education has prepared the therapist to adapt massage safely.

Have they trained in Manual Lymphatic Drainage?

Training in Manual Lymphatic Drainage, or MLD, can also be useful, even when the client is not receiving MLD specifically for a lymphatic condition.

MLD is characteristically light, slow, and rhythmic rather than aggressive or deeply pressured. That style of touch may be more comfortable for some older adults or people who become overwhelmed by stronger sensory input.

There is some research examining MLD and autonomic nervous system activity. Small studies in healthy adults have reported changes consistent with reduced sympathetic activity or other autonomic effects following lymphatic drainage techniques. However, this research has not established that MLD treats agitation, dementia, or nervous-system dysregulation in people living with dementia, so those claims should not be made. 

The practical value is simpler: a therapist trained in MLD has experience using very light, slow, repetitive, rhythmic touch, which can provide another option when deeper or more stimulating massage is not appropriate.

In my own practice, I hold a C-MLD Manual Lymphatic Drainage specialty credential, which adds another set of gentle techniques I can draw from when adapting a session to the individual.

Are they flexible if the person is having a difficult day?

Dementia can be unpredictable.

A person who enjoyed an hour-long massage last month may arrive today feeling:

• Exhausted
• Confused
• Anxious
• Agitated
• Withdrawn
• Apathetic
• Overstimulated
• Simply uninterested in massage

Ask what happens if the client needs to stop early.

A massage therapist working comfortably with dementia should understand that finishing the scheduled 60 or 90 minutes is not the goal.

If the person has had enough after 20 minutes, stopping at 20 minutes may be the most successful session possible that day.

What is their cancellation policy?

Care partners know that plans can change quickly.

Someone may wake up after a difficult night, become ill, experience increased confusion, have transportation problems, or simply be unable to tolerate an appointment that day.

Ask in advance:

• How are same-day cancellations handled?
• Is there any flexibility for dementia-related changes?
• What happens if a session has to end significantly early?

Policies still matter for a small business, but having the conversation beforehand prevents surprises for both the therapist and family.

Can the care partner stay in the room?

For some people, having a familiar person nearby makes the entire experience possible.

Ask whether the therapist is comfortable with:

• A spouse remaining in the treatment room
• An adult child staying nearby
• A professional caregiver attending the session
• The care partner assisting with communication or transfers when appropriate

The massage therapist should still speak directly to the client and include them in choices whenever possible.

Do they listen to the caregiver without talking over the person with dementia?

Care partners often hold essential information.

They may know:

• How the person communicates discomfort
• Which instructions work
• Which words cause confusion
• What behaviors signal fear or fatigue
• How transfers usually work
• What helps someone calm down

That information matters.

At the same time, the person with dementia is still the client. They should be spoken to directly, included in decisions to the extent possible, and treated as an adult.

Are they willing to stop?

This may be one of the most important questions.

Massage is not something that needs to be “completed.”

If the person becomes tired, agitated, distressed, resistant, withdrawn, or simply indicates they are finished, the therapist should be willing to stop.

A useful question during the initial consultation is:

“What would you do if my family member became tired, confused, resistant, or agitated during the massage?”

Listen for answers involving slowing down, simplifying communication, reducing stimulation, changing positioning, involving the care partner, shortening the session, or stopping altogether.

Be cautious of anyone whose answer essentially amounts to, “Don’t worry, I know how to handle them.”

The goal is not to find someone who can “handle dementia.”

The goal is to find a massage therapist who understands that:

The person comes before the massage plan.

What does the research actually say?

There is good reason to continue studying massage in dementia, but massage therapists should be careful not to overstate what is known.

A 2019 systematic review and meta-analysis included 11 randomized controlled trials and 825 people living with dementia. Researchers found improvements in measures of agitation and depression with manual massage, while some other outcomes did not significantly improve. The authors also emphasized the need for more research to determine the most effective types and frequency of massage. 

A more recent meta-analysis, which reviewed randomized trials through January 2024, also found evidence that massage and touch interventions may reduce agitation in people living with dementia, although results across the research have not always been consistent. 

A large network meta-analysis of 163 studies evaluating treatments for aggression and agitation in dementia also found favorable results for massage and touch therapy, while noting substantial limitations in the underlying research, including a high risk of bias in many studies. 

So the most responsible description is:

Massage is not a treatment for dementia. It can be one person-centered, non-drug strategy for comfort, connection, relaxation, and possibly short-term reduction in agitation. As dementia changes, the massage session should change too.

That may mean changing the pressure, positioning, communication, environment, length of the session, who stays in the room, or deciding that massage is simply not appropriate that day.

Evidence to explore

Manual Massage for Persons Living With Dementia: Systematic Review and Meta-analysis⁠

Effect of Massage and Touch on Agitation in Dementia: Meta-analysis⁠

Comparative Efficacy of Interventions for Aggression and Agitation in Dementia⁠

Effects of Lymphatic Drainage Therapy on Autonomic Nervous System Responses⁠

Effects of Manual Lymph Drainage on Cardiac Autonomic Tone⁠