A Randomized Controlled Trial Examining the Effect of Acupressure on Agitation and Salivary Cortisol in Nursing Home Residents with Dementia

Abstract

Background: Acupressure has been used to manage agitation in people with dementia because it is safe and inexpensive. However, its effect on agitation and at the biochemical level is uncertain. Methods: This randomized controlled trial examined the effect of acupressure on agitation, as measured by the Cohen-Mansfield Agitation Inventory (CMAI); and on salivary cortisol, as measured at baseline (T0) and in the 3rd (T1), 5th (T2), and 8th (T3) weeks. There were 119 agitated residents with dementia randomized into 3 groups: acupressure (n = 39), sham (n = 41), and usual-care group (n = 39). Results: A downward trend in agitation over time was noted in the acupressure group, which almost reached a level of significance in interaction effects between groups and time points (p = 0.052). Post hoc pairwise tests in the acupressure group showed that acupressure significantly reduced agitation at T2 (mean difference -6.84, 95% CI -10.60, -3.08) compared to baseline. Significant interaction effects between groups and time points were observed on the level of salivary cortisol (p = 0.022). Conclusion: Acupressure is a multicomponent intervention that can reduce agitation. Acupoint activation may not be a significant component in reducing agitation, although this result may have been limited by the inadequate sample size. Acupressure is effective in reducing salivary cortisol in people with dementia.

An integrative review of acupressure interventions for older people: A focus on sleep quality, depression, anxiety, and agitation

“…Of the 19 studies included, nine studies measured sleep outcomes . Four studies measured depression, three studies measured anxiety, and five studies measured agitation . One study measured both sleep quality and depression, and one other study measured sleep quality and anxiety .…”

“…As shown in Table , the various types of control and comparison groups were used. Three studies compared acupressure with sham acupressure and control groups, and three studies compared with sham acupressure . Eight studies compared acupressure with a control group receiving different types of care: routine care, blood pressure measure, massage and handholding, light touch on acupoints, sleep health instruction, a wait listed control group, guidance of mental health and education on sleep knowledge, and regular care and visits .…”

“…In RCTs and experimental studies, all reported that randomization was used for participants' assignment, but only eight studies reported the method of randomization, and six studies did not report the randomization method leaving unclear information about true random assignment. Allocation concealment was reported in three studies, and the remaining studies did not report concealment. Ten studies reported participants in acupressure and comparison group were similar at the baseline level, three studies show differences at the baseline, and one study did not report clearly about baseline information.…”

“…Blinding of participants was present in three studies that compared acupressure with sham acupressure in two studies, and control group receiving light touch in one study . Two studies reported that participants were blinded for treatment allocation, but it was unclear because the researchers compared three groups: acupressure, sham acupressure, and control group receiving routine care . Therefore, the participants in the control group would be aware of their group allocation.…”

“…Five studies did not blind the participants, and four studies did not report whether the participants were blinded for treatment allocation. Blinding of acupressure practitioners was applied in one study, in which trained interventionists were blinded for the nature of intervention, and they did not know which protocol was therapeutic or sham . The remaining studies did not blind the personnel who performed acupressure.…”