Touch-Based Therapies in Dementia Care: A Systematic Review and Narrative Synthesis

Abstract

Touch-based therapies (massage, acupressure, reflexology/shiatsu, and therapeutic/healing touch) are used in dementia care, but effectiveness remains uncertain. The authors evaluated their impact on behavioural and psychological symptoms of dementia (BPSD) and pain, and extracted pragmatic “dose” and delivery parameters to inform a research blueprint. The authors searched major databases (MEDLINE, CINAHL, PsycINFO, Embase, CENTRAL) for studies from January 2005 to February 2023 involving people with any dementia aetiology/severity in community, residential, or inpatient settings. Eligible designs included randomised, quasi-experimental, and pre–post studies with a comparator (usual care, attention/quiet presence, or sham/light-touch). Data were extracted to a prespecified template; study quality was appraised using CASP tools. Owing to substantial clinical and methodological heterogeneity, the authors conducted a structured narrative synthesis as opposed to meta-analysis. Thirty-three studies met inclusion: 21 massage, 8 acupressure, 3 therapeutic/healing touch, and 2 reflexology/shiatsu. Most were in long-term care or inpatient settings. Interventions typically used brief, repeated sessions (5–20 minutes, several times per week for 2–6 weeks). The most consistent finding was short-term calming, particularly reductions in agitation immediately post-session or over brief treatment courses, with the clearest pattern for massage and acupressure. Effects on broader neuropsychiatric symptoms (e.g., NPI/NPI-NH domains) and pain were mixed. Where monitored, no serious adverse events were reported; minor transient issues (e.g., brief restlessness, skin sensitivity with aromatherapy oils) were infrequent and acceptability generally high. Risk of bias was mixed (≈49% low, 42% moderate, 9% high), and durability beyond 4–8 weeks was rarely assessed. Current evidence provides preliminary indications that brief, touch-based therapies may offer short-term calming effects when used alongside person-centred care, although certainty remains low and findings should be interpreted cautiously. The authors propose a pragmatic research blueprint that predefines session length, frequency, and course duration; uses attention/sham controls; adopts core outcomes (e.g., Cohen Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory/Neuropsychiatric Inventory adapted for Nursing Homes (NPI/NPI-NH); Pain Assessment in Advanced Dementia (PAINAD) where relevant); ensures blinded assessment; and extends follow-up. The authors recommend that future work should prioritise feasibility/pilot studies, followed by adequately powered trials to determine effectiveness, durability, and scalability for practice.

Keywords

dementia nonpharmacological agitiation pain massage accupressure alzheimers BPSD

Introduction

Background

Dementia is a term that encompasses a number of neurodegenerative conditions including a range of dementia specific conditions such as Alzheimer’s Disease, Frontotemporal Dementia, Young Onset Dementia and other Cerebrovascular diseases. Across these conditions, individuals can experience cognitive impairment that is considered severe enough to impact on their ability to manage everyday activities. Dementia tends to occur in later life but can impact younger populations too. For the purposes of this review, an all-encompassing definition of dementia is adopted with all types and severity levels of dementia being considered. This inclusive adoption of the term is necessary due to the growing concerns of the global increase in dementia prevalence which is estimated to increase from 57.4 million in 2019 to 152.8 million in 2050 (Nichols et al., 2022).

Dementia is commonly associated with behavioural and psychological symptoms which further impact the quality of life and wellbeing of those living with the condition (Nelis et al., 2018) and their loved ones (Gilhooly et al., 2016). Recent research has found that the prevalence of depression, anxiety and apathy remain relatively consistent across people living with mild, moderate and severe levels of dementia (Leung et al., 2021) with prevalence rates ranging from 37-55% across different types of dementia, and up to 97% of individuals experiencing at least one Behavioural and Psychological Symptom of Dementia (BPSD) as the condition progresses (2020). BPSD is a debated term, however, it remains the most commonly used construct in published studies (Soofi, 2025; Warren, 2023). It is used here to maintain authenticity and alignment with the terminology applied in the evidence base, while noting its conceptual limitations.

Pain is increasingly recognised as a contributing factor to BPSD with research evidence that inadequate pain management in people with dementia exacerbates and may even cause behavioural symptoms (Achterberg et al., 2013). For example, research has found that 65.5% of residents living with dementia in aged care facilities in Australia experience pain and out of these, 48.8% experience moderate to severe pain (Atee et al., 2021). When comparing those who were experiencing pain to those who did not experience pain, Atee et al. (2021) found that the pain group were 3.8 times more likely to experience aggressive and agitated behaviours compared to the non-pain group, suggesting that pain may be a key contributor to these types of behaviours.

Touch based therapies (including massage, reflexology, shiatsu and therapeutic touch) have been widely used within acute settings across a range of conditions in the management of pain and symptoms (Adams et al., 2010). However, their effectiveness in the alleviation of pain and management of symptoms such as depression, irritability and anxiety among people with dementia is underexplored and there is a need to develop the evidence base for the efficacy of these intervention(s).

To date, there are a limited number of reviews that have explored touch-based therapies for pain. Some reviews, such as Saragih et al. (2023) and Bao and Landers (2021), have considered touch-based therapies’ under the umbrella term of non-pharmacological interventions. Saragih et al. (2023) found evidence for massage being effective in managing pain. However, questions remain regarding the specific types of massage that are effective, as well as how effectiveness is impacted by patients’ age and frequency of the intervention. Bao and Landers (2021) explored massage and ear acupressure and reported mixed findings suggesting that non-interactive non-pharmacological interventions were not as effective for managing pain compared to interactive types. However, it should be noted that there were only 2 studies related to massage included in the review and these studies had contradictory findings resulting in the lack of confidence in the findings. By focusing more broadly on non-pharmacological interventions rather than touch-based therapies more specifically, it is challenging to establish firm conclusions regarding touch-based therapies effectiveness due to their limited presence within these reviews. Therefore, more work is required to explore developments in this research area and to revisit the possibility of more confident conclusions regarding the management of pain for people with dementia using touch-based therapies.

Greater attention has been focused on exploring the effectiveness of touch-based therapies for behaviours associated with dementia, and anxiety, agitation and aggression (Watt et al., 2019; Wu et al., 2017). Watt et al. (2019) reported massage and touch therapy with and without music were more effective than usual care for managing aggression and agitation, however, the concern within this review was the high risk of bias seen across 46% of the studies. Similar challenges in drawing firm conclusions due to the limitations number of studies, samples sizes and quality of research in the area have also been reported by Wu et al. (2017) who examined the effectiveness of massage and touch. With the potential of touch-based therapies and limitations of previous reviews, it is necessary to consider how the research has developed in this area by conducting a more up to date and comprehensive review of the literature.

Rationale

The National Institute for Health and Care Excellence (NICE), and Scottish Intercollegiate Guidelines Network (SIGN) have increasingly emphasised the importance of non-pharmacological interventions in the management and support of people with dementia, particularly in the earlier stages of the disease (National Institute for Health and Care Excellence, 2018; Scottish intercollegiate guidelines Network, 2023Scottish Intercollegiate Guidelines Network, 2023). While pharmacological treatments are recommended for use to manage symptoms, NICE recommends that non-drug approaches be considered as a first-line treatment or alongside medication. NICE guidelines suggest a balanced approach incorporating pharmacological and non-pharmacological methods in the treatment of pain and behavioural symptoms in people with severe dementia (National Institute for Health and Care Excellence, 2018). Despite these recommendation, the evidence base for non-pharmacological interventions is relatively poor. This review aims to address this gap and synthesise the available evidence on the ongoing use of touch-based therapies within dementia care to strengthen the evidence base and clarify their role in in dementia care.

Review Objectives

The primary aim of this review is to assess the individual and overall efficacy of Touch Based Therapies in Dementia Care in the alleviation of Dementia Symptomology and Pain.

For dementia symptomatology, we summarised changes in symptom severity using validated measures such as the CMAI, NPI/NPI-NH, and Behave-AD. For pain, we summarised both the proportion of participants experiencing pain and any changes in pain severity over the course of the intervention.

A secondary aim of the review included providing a narrative synthesis on specific aspects of the intervention delivery to provide a blueprint for future research such as; Length, Frequency, and Duration of intervention; Dementia Stages (Early, Mid and Late); Product Type/Combined Therapies; Expertise/Level of Training of Practitioner. The authors initially planned a mixed-methods synthesis including meta-analysis, however, marked heterogeneity in interventions and outcomes and incomplete/non-comparable reporting precluded pooling, so the authors undertook a structured narrative synthesis.

As touch-based therapies are generally considered as low-risk interventions, there are no known typical areas of adverse event. However, to achieve a balanced perspective, the review adopted an exploratory approach when looking at adverse effects, aiming to review all recorded adverse events within returned articles and categorising them in relation to measured outcomes. i.e. increase in pain, increase in dementia symptomatology.

Methods

Literature searches were conducted in April 2023 and were carried out across a multitude of databases with publication dates restricted to January 2005 to February 2023. This builds upon previous reviews of a similar nature, and reduces the likelihood of causing duplication of previous published works. One study published prior to 2005 was identified during full-text screening through citation chasing of included articles. As this study met all other eligibility criteria (population, intervention, design, and outcomes), it was retained. No additional backward-citation searches yielded further eligible pre-2005 studies. The inclusion of this single earlier study does not reflect an extension of the formal search period but rather the standard practice of incorporating eligible studies identified through citation chaining. The review protocol was registered with PROSPERO (CRD42023401376): https://www.crd.york.ac.uk/PROSPERO/view/CRD42023401376. The search ended in February 2023, when the initial literature searches and screening were completed. The subsequent phases of data extraction, analysis, drafting, submission, and the current revision period, spanned several months. To maintain consistency with the protocol and avoid introducing bias part-way through the process, we did not extend the search during revisions. The author team recognise that new studies may now be available and encourage future updates to incorporate these.

Eligibility Criteria

The authors applied a single set of inclusion/exclusion criteria covering population (people with dementia), intervention (touch-based therapies), comparators, outcomes, study design, and timeframe. For each outcome synthesis (agitation, pain), only studies reporting the relevant validated measures were summarised. A summary table of the eligibility criteria (Population, Intervention, Comparator, Outcomes, Study Design, Setting, Time frame, Language) is provided in Supplemental Table 1.

Population/Participant/s

Individuals were described as having a diagnosis of dementia. This was determined to be of any type and severity where the following sufficed as formal diagnosis of dementia; The international Statistical Classification of Diseases and Related Health Problems (ICD-10) (World Health Organisation, 1992); the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (Lewis, 1994). Cognitive screening and professional clinical diagnosis of well validated assessment scales for cognitive function were also included such as; The Mini-Mental State Examination (MMSE) (Larner, 2012), and the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) (Kueper et al., 2018); Clock Drawing Test (Brodaty & Moore, 1997); Six-Item Cognitive Impairment Test (6-CIT) (Jefferies, 2012); general Practitioner Assessment of Cognition (GPCOG) (Brodaty et al., 2002); Test Your Memory (TYM) (Hancock & Larner, 2011); Montreal Cognitive Assessment (MoCA) (Nasreddine et al., 2005); Addenbrooke’s Cognitive Assessment- Revised (ACE-R) (Davies & Larner, 2012); Memory Impairment Screen (MIS) (Buschke et al., 1999).

All care settings were included both from within the community and long-term care facilities including care homes, nursing homes, residential homes, dementia specialist units, inclusive of international language.

Intervention Inclusion

The interventions that were included are listed below. A full breakdown of how each of these interventions is defined can be located in Appendix 1. All forms of massage (‘Swedish’, ‘Esalen’ ‘Lymphatic Drainage’ ‘Seated Massage’ ‘Sports Massage’ ‘Aromatherapy Massage’ ‘Indian Head Massage’ ‘Cranial Sacral Massage’ etc); Reflexology; Shiatsu; Accupressure; Bowen Therapy; Touch (Healing/Therapeutic).

The reason for including only these particular interventions is predominantly to do with governing bodies. The majority of the provided list with the exception of touch (healing/therapeutic), are considered as voluntary regulated since they do not have any statutory regulation. Other reasons include the need to physically place your hands upon the other person, and that the touch involved is part of a therapeutic intervention, and not that of in-the-moment care. In-the-moment care refers to spontaneous, informal physical contact that occurs naturally during routine interactions. For example, assisting with dressing or offering comfort, rather than touch that is delivered as a structured therapeutic intervention. Multi-component interventions were also included when touch formed a central therapeutic element, reflecting typical practice in dementia care (e.g., massage commonly delivered with aromatherapy). However, because these designs limit the ability to isolate the specific effect of touch, we interpreted their findings cautiously and reported when outcomes may reflect combined rather than touch-specific effects.

Database

With the support of a skilled academic librarian, the research team conducted a comprehensive database search and managed the retrieved articles using Zotero reference management software (Nikam, 2015).

CENTRAL (Cochrane Register of Controlled Trials); MEDLINE; Cummulative Index for Nursing and Allied Health Literature (CINAHL); PsycINFO; BioMed Central; Biosis Previews/Web of Science; British Medical Journal (BMJ Journals); Cambridge Core; Emerald; Health Source: Nursing Academic Edition; Taylor and Francis Online; Karger Journals; OVID; Oxford Academics; Sage Journals Online; Scopus; Wiley Online.

Some of these databases were grouped together based on the search engine, such as EBSCO Host. The choice to include these databases within the review was to ensure comprehensive coverage of the literature from diverse sources, enhancing the robustness of the findings (Bramer et al., 2017). Utilising both specialised and multidisciplinary databases, the review can minimise the risk of missing important evidence and provide a more complete and unbiased synthesis of available research on touch-based therapies in dementia care.

Search Strategy

The structure of the search strategy was fairly similar for each search where the authors wanted to capture as much literature as possible. To do this the authors followed a PIO format of Problem/Population, Intervention, and Outcome using varying words to both broaden and filter appropriate articles (Table 1).

Table 1.

Example PIO Search Strategy

	Problem/Population	Dementia ‘OR’ dem*	(inc. associated variation words such as Alzheimer’s, Lewy body, Cognitive Impairment etc)
‘AND’	Intervention	Massage ‘OR’ massage therapy	(inc. inclusion interventions and associated variations words such as reflexology/accupressure)
‘AND’	Outcome	Behavioural or psychological symptoms of dementia ‘OR’ BPSD	(inc. additional inclusion outcomes and variation words)

A full breakdown of the search strategy that was followed for each database search from our skilled academic librarian can be seen in Appendix 2.

Data Extraction and Management

A data extraction template was developed to extract all relevant information from each included study after screening. The extracted data included: Reviewer; Author(s); Objective(s); Sample characteristics; Method(s); Outcome(s)/Measure(s); Type of Therapy; Location of Intervention; Duration of Intervention; Country of Study; Summary of Results; and Critical Appraisal Skills Programme (CASP) Concerns. The CASP tool was used to support the data-extraction process, as it provided a structured and reliable method for assessing the quality and rigour of included studies and was attached to each included article within the Zotero software (Long et al., 2020). As there were three reviewers, the CASP checklists supported efforts to reduce bias, improve the accuracy of the findings, and enhance the overall reliability of the reviewers’ conclusions.

To begin the screening process, all records were exported into Zotero and underwent initial title/abstract screening by all three reviewers. Each record was independently double-screened using a traffic-light system (green = include, red = exclude, yellow = uncertain). The reviewing team met iteratively to discuss all yellow and discordant ratings, ensuring a shared interpretation of the eligibility criteria. During full-text screening, studies were divided among the three reviewers, and to maintain consistency, a second reviewer checked a proportion of each reviewer’s full-text decisions. Any disagreements were resolved through group discussion.

Data extraction was conducted using a standardised template covering study characteristics, intervention details, outcomes, and CASP concerns. CASP item-level assessments were then synthesised into an overall risk-of-bias rating: studies with all or nearly all criteria met and no major methodological concerns were classified as low risk; studies with some unclear or partially met criteria were classified as moderate risk; and studies with several unmet criteria or substantial methodological concerns were classified as high risk.

Results

The authors synthesised findings from 33 studies evaluating touch-based therapies for people with dementia across massage, acupressure, therapeutic/healing touch, and reflexology/shiatsu. Most studies were conducted in long-term care or inpatient settings, with relatively few based in community contexts. Study designs included randomised controlled trials, quasi-experimental approaches, and pre–post designs. When reviewing the data, the author team agreed that a meta-analysis would not be feasible; therefore, a structured narrative synthesis was undertaken. The review reports study selection and characteristics, risk of bias, modality-specific findings, adverse events, and an integrated synthesis of effects and implementation signals.

A meta-analysis was not conducted due to substantial clinical and methodological heterogeneity across the included studies. Interventions varied markedly in modality (e.g., hand massage, aromatherapy massage, foot massage, acupressure, therapeutic/healing touch, reflexology, shiatsu), dose (minutes per session, frequency, treatment duration), delivery personnel (trained staff vs. specialist practitioners), and setting (community, residential care, inpatient units). Comparator conditions also differed widely, including usual care, quiet presence, attention control, and sham/light-touch conditions. Outcomes were assessed using multiple non-comparable tools (e.g., CMAI, NPI/NPI-NH, BEHAVE-AD, various pain scales), with inconsistent timing of measurements (immediate post-session, daily, weekly, or end-of-treatment). These variations meant that even within individual modalities there were insufficient groups of studies with compatible designs, outcomes, and time points to support meaningful statistical pooling. In accordance with Cochrane guidance, when heterogeneity precludes valid aggregation, a structured narrative synthesis is the most appropriate approach. Accordingly, we synthesised findings narratively while highlighting patterns across lower-risk studies and identifying areas where standardisation is required to support future meta-analytic work.

Study Selection: (PRISMA Diagram)

Study Characteristics

Concluding the screening process, 33 studies met the inclusion criteria and were incorporated into this review. Of these, 21 studies were focussed on the intervention of massage, 8 Acupressure, 3 touch modalities (i.e healing touch), 1 Reflexology, and 1 Shiatsu. Data is discussed as per these intervention listings as a way to compare across interventions (Table 2).

Table 2.

Literature Search Prisma

Risk of Bias

To minimise bias, each study was appraised with the CASP checklist appropriate to its design, and an independent column in the extraction sheet captured specific CASP concerns flagged by the reviewers. Key domains assessed included study design and allocation processes, sampling and baseline balance, clarity and timing of outcome measurement, blinding of outcome assessors (where feasible), fidelity/adherence reporting, and completeness of data.

Of the 33 included studies, 16/33 (48.5%) were rated low risk, 14/33 (42.4%) moderate risk, and 3/33 (9.1%) high risk overall. High-risk ratings most commonly reflected limited blinding of outcome assessment, small samples with incomplete reporting, and/or unclear fidelity of the intervention; moderate-risk ratings frequently reflected imprecision or ambiguity in outcome timing/measurement, or incomplete detail on intervention dose and delivery.

Several small studies reported immediate post-session improvements (e.g., agitation reduction), but short treatment courses, heterogeneous protocols (modality, dose, comparator), and variable assessor blinding limit certainty. In integrating the evidence, the authors flagged high-risk studies within each modality summary and did not let single high-risk studies drive conclusions. Where apparent benefits were reported across multiple low- or moderate-risk studies using repeated brief sessions, The authors describe the direction of effect as promising but provisional pending larger, well-controlled trials with longer follow-up. Findings will now be reported as per intervention dataset.

Interpretation should consider the risk-of-bias profile and heterogeneous protocols described above where estimates are provisional pending larger, well-controlled trials with longer follow-up. Adverse events are summarised in a cross-cutting section at the end of the results.

Massage

Most massage studies were conducted in long-term care, nursing homes or inpatient geriatric/psychiatry units, with a smaller number in community or day-care settings (Dimitriou et al., 2022; Ellis et al., 2019; Fu et al., 2013; Holliday-Welsh et al., 2009; Kapoor & Orr, 2017; Kaymaz and Ozdemir, 2017; Moyle et al., 2014; Rodriguez-Mansilla et al., 2013; Schaub et al., 2018; Smallwood et al., 2001; Suzuki et al., 2010; Ting et al., 2023; Yang et al., 2016; Yoshiyama et al., 2015). Session formats were brief and repetitive: typically 5–20 minu per session, delivered several times per week over 2–8 weeks, often in calm resident rooms or lounges (Ellis et al., 2019; Fu et al., 2013; Hicks-Moor and Robinson, 2008; Kapoor & Orr, 2017; Kaymaz and Ozdemir, 2017; Moyle et al., 2011, 2014; Rodriguez-Mansilla, 2014; Ting et al., 2023). Protocols varied by body area (hand, foot, back/shoulder/neck) and by use of neutral versus aromatherapy oils, contributing to heterogeneity in dose and content (Hicks-Moore & Robinson, 2008; Kaymaz and Ozdemir, 2017; Rodriguez-Mansilla, 2014; Smallwood et al., 2001; Ting et al., 2023; Yoshiyama et al., 2015).

Agitation & BPSD

Several studies reported short-term reductions in agitation (often immediately post-session or across brief treatment courses), particularly with hand massage and aromatherapy-supported massage (Kaymaz and Ozdemir, 2017; Rodriguez-Mansilla et al., 2013; Schaub et al., 2018; Ting et al., 2023). Findings for broader neuropsychiatric symptoms (e.g., NPI/NPI-NH) were mixed, with improvements in some analyses but null effects elsewhere (Dimitriou et al., 2020, 2022; Kaymaz and Ozdemir, 2017). Null or modest effects on agitation were also common, especially when treatment duration was short, baseline symptoms were low, or comparators included attention/quiet presence (Dimitriou et al., 2020; Harris et al., 2012; Kapoor & Orr, 2017; Kaymaz and Ozdemir, 2017; Moyle et al., 2014; Schaub et al., 2018; Ting et al., 2023; Yang et al., 2016; Yoshiyama et al., 2015).

Pain and Related Outcomes

Where measured, some studies suggested reductions in observed or reported pain with repeated massage, while others found no clear between-group differences (Ellis et al., 2019; Kapoor & Orr, 2017; Rodriguez-Mansilla, 2014). Sleep and mood outcomes were inconsistently assessed, and results were broadly inconclusive across small samples (Harris et al., 2012; Smallwood et al., 2001).

Acupressure (Non-Needle)

Most studies were conducted in long-term care or nursing-home settings, with brief, repeated sessions delivered by trained staff or therapists (Kwan et al., 2016, 2017; Lin et al., 2009; Yang et al., 2007, 2015). Protocols commonly used a small, fixed set of points (e.g., Baihui/GV20, Fengchi/GB20, Shenmen/HT7, Neiguan/PC6, Hegu/LI4) applied for short durations per point within a 10–15-min session (Kwan et al., 2016, 2017; Lin et al., 2009; Yang et al., 2015). Frequency was typically daily or near-daily (e.g., 5–6 days/week), for 1–4 weeks overall (Kwan et al., 2016, 2017; Lin et al., 2009; Yang et al., 2015).

Agitation & BPSD

Several trials reported short-term reductions in agitation (immediately post-session or across 2–4 weeks), particularly when sessions were frequent and protocols were standardised (Kwan et al., 2016, 2017; Lin et al., 2009; Yang et al., 2015). However, null or mixed effects also occurred, especially in smaller pilots or where comparators included attention/presence, highlighting variability in findings across designs and settings (Bayram et al., 2021; Yang et al., 2007).

Pain and Related Outcomes

One study of auricular acupressure reported improvements in pain under routine pain management alongside acupoint stimulation, suggesting potential analgesic benefit in some contexts (Zhang et al., 2022).

Therapeutic/Healing Touch

Most studies were conducted in residential long-term care with brief, repeated sessions delivered by trained practitioners (Senderovich et al., 2022; Wang & Hermann, 2006; Woods et al., 2005). Protocols employed non-invasive, light touch techniques aimed at relaxation and behavioural calming, using structured sequences or standardised healing/therapeutic touch procedures (Senderovich et al., 2022; Wang & Hermann, 2006; Woods et al., 2005). Session “doses” were short and frequent. Examples included 5–7 minutes twice daily for 3 days, daily sessions up to 10 minutes over 4 weeks, and 5 consecutive treatment days (Senderovich et al., 2022; Wang & Hermann, 2006; Woods et al., 2005).

Agitation & BPSD

Across the three studies, short-term reductions in behavioural disturbance/agitation were reported during the active treatment periods, with effects generally small in magnitude and observed immediately post-session or over the short course (Senderovich et al., 2022; Wang & Hermann, 2006; Woods et al., 2005). In two studies, improvements were statistically significant versus control comparators but with small effect sizes, with authors noting limitations such as reliance on observer ratings and potential expectancy effects (Senderovich et al., 2022; Woods et al., 2005). One pilot reported positive responses on agitation indices alongside qualitative notes from practitioners/residents, but findings were described as anecdotal and at risk of bias (Wang & Hermann, 2006).

Reflexology/Shiatsu

The reflexology evidence base comprised two small studies conducted in residential/clinic contexts, with brief, repeated sessions delivered by trained practitioners (Hodgson & Andersen, 2008; Lanza et al., 2018). Protocols varied where one used reflexology delivered in 4-week blocks with 25-min sessions paired with quiet companionship controls, while another evaluated shiatsu combined with physical activity versus physical activity alone over a longer programme (Hodgson & Andersen, 2008; Lanza et al., 2018).

Other Outcomes

The reflexology study reported reductions in physiological stress markers and behavioural distress during/after sessions relative to control, although effects on some measures were marginal and sample sizes were small (Hodgson & Andersen, 2008). The shiatsu/activity pilot reported within-group improvements in global cognition (MMSE), activities of daily living, and depressive symptoms (GDS), with a statistically significant decrease in GDS observed only in the active group compared with comparator (Lanza et al., 2018).

Synthesis of Results

Due to substantial heterogeneity, including variation in intervention type, dosage, settings and outcome measures, a meta-analysis was not feasible. Across modalities, short, repeated sessions (typically 5–20 min, several times per week) were most often associated with short-term reductions in agitation, particularly for massage and acupressure. Effects on broader neuropsychiatric symptoms (NPI/NPI-NH) were mixed, and evidence for pain benefits was limited but suggestive in some protocols. Durability beyond 4–8 weeks remains uncertain, and heterogeneity in dose, comparators, and settings precluded pooling. Taken together with the risk-of-bias profile, these findings point to promising but provisional effects that warrant larger, well-controlled trials using core outcomes (e.g., CMAI/NPI, PAINAD) and longer follow-up.

Adverse Events

Reporting of adverse events (AE) was variable across studies and, in those where AE was explicitly monitored, no serious harms were identified. Minor, transient issues were occasionally noted. Most commonly brief restlessness or refusal/withdrawal during sessions, momentary discomfort with acupressure, and skin sensitivity/irritation when aromatherapy oils were used. Overall acceptability was high and adherence was generally good where recorded. Given small samples and short follow-up, rare or delayed events cannot be excluded. Future trials should predefine adverse-event capture and grading, conduct skin patch tests when oils are used, document contraindications (e.g., fragile skin, anticoagulation, acute illness), and ensure brief safety training and fidelity checks for all deliverers.

Discussion

Summary of Evidence

Across 33 studies, touch-based approaches delivered as brief, repeated sessions were consistently associated with short-term calming, most notably reductions in agitation observed immediately post-session or across brief treatment courses. The clearest and most reproducible positive signals came from massage and acupressure, while findings for therapeutic/healing touch and reflexology/shiatsu were fewer and more variable. Effects on broader neuropsychiatric symptoms (e.g., NPI/NPI-NH) were mixed, and evidence for pain relief was limited but suggestive in a subset of protocols. Formal harms were rarely reported where monitored, no serious adverse events were identified. Minor/transient issues were infrequent, and acceptability was generally high, especially when sessions were short, delivered in a quiet space, and embedded in routine care by trained staff.

Methodological heterogeneity (intervention content and dose, comparators, outcome timing/measures) and mixed study quality (about half low risk of bias, a substantial minority moderate, and a small number high) precluded meta-analysis and limit precision. Nonetheless, converging patterns across low-/moderate-risk studies suggest that dose matters. Short sessions (5–20 min), delivered several times per week over 2–6 weeks, in a low-stimulus environment and with simple, standardised protocols, were the conditions most often linked to positive agitation outcomes.

Taken together, the preliminary evidence suggests pragmatic use as an adjunct to person-centred care while underscoring key uncertainties, durability beyond 4–8 weeks, optimal dose, and which subgroups benefit most. These signals directly inform the blueprint the authors propose. Clear, testable dose parameters (minutes per session, sessions per week, course length), standard comparators, core outcomes (e.g., CMAI/NPI; PAINAD where appropriate), blinded assessment where feasible, and planned follow-up to evaluate maintenance of effect.

Strengths and Limitations

This review synthesised 33 studies across massage, acupressure, therapeutic/healing touch, and reflexology/shiatsu, most conducted in real-world long-term care or inpatient settings, which enhances practical relevance. The author team also recognise that as the search concluded in February 2023, more recent studies may not be captured. Beyond direction of effect, the authors extracted and compared dose and delivery parameters such as minutes per session, sessions per week, course length, setting, who delivered, and basic fidelity cues, so the discussion could offer a trial-ready blueprint rather than a purely descriptive summary. Study quality was appraised with CASP, concerns were logged study-by-study, and our narrative weighting highlighted high-risk evidence while emphasising areas of convergence across low- and moderate-risk studies. The authors also collated the safety signal across modalities; where adverse events were explicitly monitored, no serious harms were reported and acceptability was generally high.

At the same time, substantial heterogeneity in intervention content and dose, comparators (usual care, attention/quiet presence, sham/light-touch), settings, and outcome timing/measures precluded meta-analysis and limits precision. Many studies were small, follow-up was short, and assessor blinding and fidelity reporting were inconsistent. These factors can inflate apparent benefits or obscure null effects. Agitation was frequently assessed (often with CMAI), but broader BPSD (e.g., NPI/NPI-NH domains), pain, and sleep/mood outcomes were inconsistently collected, reducing cross-study comparability and hampering any assessment of dose–response. Few studies examined durability beyond 4–8 weeks, so maintenance of effect remains uncertain. The preliminary evidence is concentrated in care homes/inpatient units, making generalisability to community-dwelling populations or specific dementia aetiologies/severities less clear. Furthermore, because a narrative “direction-of-effect” synthesis relies on reported statistics without pooling, the authors could not formally assess small-study or publication bias.

Across outcomes, the overall certainty of evidence was low to very low. For agitation, the certainty was judged to be low: several studies demonstrated short-term calming effects, but heterogeneity in protocols, small samples, and variable comparators reduced confidence in the consistency and precision of these findings. For broader BPSD outcomes, certainty was very low due to mixed findings, inconsistent outcome measures, and underpowered analyses. For pain, certainty was also very low, as pain was infrequently and inconsistently measured, and studies often lacked adequate controls, resulting in imprecise and highly uncertain estimates.

A final limitation relates to the use of the term BPSD, which we acknowledge is contested; although it remains the predominant terminology in the research literature, its use may inadvertently reinforce biomedical framings that overlook the communicative or contextual nature of behaviours (Soofi, 2025; Warren, 2023).

These strengths and constraints directly shape our blueprint. It is recommended that future trials should pre-specify dose (minutes per session, frequency, course length), standardise core outcomes (e.g., CMAI/NPI for agitation/BPSD; PAINAD where appropriate), use concealed allocation and blinded outcome assessment where feasible, include routine fidelity checks, extend follow-up to test durability, and incorporate economic evaluation. Taken together, these steps will help the field move from suggestive signals to robust, comparable evidence that can be implemented and scaled with confidence.

Comparison with other Reviews

Our findings are consistent with earlier syntheses of non-pharmacological approaches for agitation/BPSD in dementia. Touch-based modalities show immediate, short-term calming, but overall certainty is limited by small samples, heterogeneous protocols, and inconsistent follow-up. In particular, a network meta-analysis found massage/touch (and music) more effective than usual care for aggression/agitation, while noting a high risk of bias in nearly half the included studies (Watt et al., 2019). This pattern, a signal of benefit with methodological caveats, is echoed in other reviews focused on touch modalities (Bao & Landers, 2021; Saragih et al., 2023).

Where this review extends prior work is by (i) separating modalities (massage, acupressure, therapeutic/healing touch, reflexology/shiatsu) while explicitly extracting dose parameters (minutes/session, sessions/week, course length); (ii) foregrounding implementation details (who delivers, setting, fidelity/acceptability) often mentioned only briefly elsewhere; and (iii) translating these into a recommended trial blueprint with standard comparators and core outcomes (e.g., CMAI/NPI; PAINAD where appropriate). This adds a practical scaffold that earlier broad reviews could not provide because touch-based interventions were typically pooled with other sensory or activity-based approaches (Bao & Landers, 2021; Saragih et al., 2023; Watt et al., 2019).

For pain, broader non-pharmacological overviews report mixed findings for touch-based therapies. Massage sometimes appears beneficial, but evidence is sparse and heterogeneous; conclusions are cautious given few eligible trials and contradictory results across small samples (Bao & Landers, 2021; Saragih et al., 2023). These conclusions align with our interpretation that dose clarity, outcome standardisation, and longer follow-up are prerequisites for firmer inferences.

Finally, current guidelines endorse non-pharmacological approaches as first-line or co-interventions for behavioural symptoms in dementia, but highlight the need for better-designed trials, a gap which our blueprint aims to directly target (National Institute for Health and Care Excellence, 2018; Scottish Intercollegiate Guidelines Network, 2023).

It should be noted that with wider contextual issues such as COVID-19, recruitment and delivery of close-contact, touch-based interventions were substantially constrained during 2020–2021, particularly in care homes, due to infection-control restrictions and redeployment of research staff. In the UK, the NIHR paused set-up/recruitment for non-COVID studies in March 2020 and only later issued restart frameworks, while care homes limited visitor access and staff movement to reduce transmission (Department of Health and Social Care, 2020; National Institute for Health and Care Research, 2020a, National Institute for Health and Care Research, 2020b). This context likely contributed to the relative paucity of post-2019 trials in our corpus and may have biased the evidence base toward pre-pandemic, small, short-duration designs. Interpretation should consider that feasibility, acceptability, and implementation logistics observed pre-pandemic may differ under current practices.

Implications for Practice

The evidence base for touch-based therapies in dementia is limited, heterogeneous, and mostly short-term where effect estimates are provisional. The parameters below are pragmatic suggestions to implement or test as adjuncts to person-centred care. Services should consider applying local clinical judgement, obtain consent/assent, use safety screening (e.g., skin integrity, anticoagulation, acute illness), and monitor outcomes and adverse events.

Minimum Viable Package (Deliverable by Trained Staff)

The following session structures are derived from patterns observed across the included studies and are intended as pragmatic parameters to guide future feasibility work, rather than evidence-based practice recommendations.

• Hand/foot massage: 10–20 min, 3–5 times/week for 4–6 weeks; neutral oil; seated, low-stimulus environment.

• Acupressure (non-needle): 5–10 min, 5–6 times/week for 2–4 weeks, using a small predefined point set with a one-page guide.

• Therapeutic/healing touch/Reflexology/Shiatsu: 20–30 min, 1–2 times/week for 4–8 weeks where trained practitioners are available.

Interventions should be delivered by trained care staff in massage/acupressure after a short skills session and return-demonstration. Use specialist practitioners where required for reflexology/shiatsu/therapeutic touch.

It is suggested that practitioners should use a quiet space, log minutes delivered, a brief pre/post agitation rating (e.g., CMAI-SF or NPI), and any refusals or adverse events. Re-evaluate at 4 weeks, continue, modify, or stop based on response and tolerance. Safety, patch-test oils, screen for fragile skin, wounds, or acute illness and pause if agitation escalates.

Implications for Research

Given the small, heterogeneous, short-term evidence base, the next step should be feasibility/pilot RCTs (or small cluster RCTs) that prioritise clear dose specification, blinded outcome assessment, and standard comparators, rather than large efficacy trials.

What to test first (where the signal is clearest):

• Massage (incl. hand/foot): 10–20 min/session, 3–5 times/week, for 4–6 weeks.

• Acupressure (non-needle): 5–10 min/session, 5–6 times/week, for 2–4 weeks, using a predefined 3–5-point set (name/location, target pressure, seconds per point). (For therapeutic/healing touch, reflexology/shiatsu, start with small feasibility studies before RCTs.).

Researchers should aim to randomise against attention control (quiet conversation/handholding without technique) on top of usual care, and conceal allocation and blind outcome assessors. A single primary outcome measure should be pre-specified such as the CMAI (agitation) or NPI/NPI-NH with assessment conducted at baseline, 2 weeks, end of treatment (4–8 weeks), and 12-week follow-up. If feasible, a brief pre/post session agitation rating should be captured to test immediate effects.

Researchers should also aim to use a one page protocol and return-demonstration where they should log minutes delivered, missed sessions, interruptions, and predefined adverse events categories (skin irritation, transient agitation increase, dizziness) and simple stopping rules.

If and where possible, researchers should pre-register, use CONSORT/TIDieR, and adopt a core outcome set so results are comparable and poolable later.

Conclusion

Touch-based therapies for people living with dementia show short-term calming effects, with the most consistent signals for reductions in agitation from massage and acupressure. These interventions were most effective in reducing agitation, particularly when delivered as brief, repeated sessions in low-stimulus environments. Evidence for therapeutic/healing touch and reflexology/shiatsu was limited and more variable, and findings related to effects on broader neuropsychiatric symptoms and pain remain mixed. Serious adverse events were not reported where monitoring occurred, but safety reporting was limited. These interventions are best considered adjuncts to person-centred care with routine monitoring.

Due to the small evidence base and largely short-term nature of interventions, a meta-analysis was not feasible and firm conclusions about durability or comparative effectiveness cannot yet be drawn. To move the field forward, the authors provide a concise blueprint specifying dose parameters, comparators, and core outcomes as recommendations to consider. Adopting these shared parameters in feasibility and pilot RCTs, followed by adequately powered trials with concealed allocation, blinded outcome assessment, fidelity checks, and planned follow-up, will allow studies to align prospectively, generate robust and comparable evidence, and clarify when, how, and for whom touch-based therapies meaningfully improve outcomes.

Beyond these priorities, future trials should capture dementia subtype and baseline severity to enable stratified or adjusted analyses and to test whether effects differ by aetiology or stage. Trials should also incorporate basic economic evaluation (e.g., training time, delivery minutes, materials, supervision, and simple cost-per-unit change on the primary outcome), alongside feasibility/acceptability metrics, to inform real-world resource implications. Finally, evidence is highly concentrated in care homes and inpatient units; extending research to community settings (home care, day services, memory clinics) is important for scalability and equity, including diverse cultural and linguistic contexts.

Supplemental Material

Supplemental Material - Touch-Based Therapies in Dementia Care: A Systematic Review and Narrative Synthesis

Supplemental Material for Touch-Based Therapies in Dementia Care: A Systematic Review and Narrative Synthesis by Bryan Mitchell, Eileen Harkess-Murphy, Nicola Douglas-Smith and Joshua Cheyne in Dementia

Supplemental Material

Supplemental Material - Touch-Based Therapies in Dementia Care: A Systematic Review and Narrative Synthesis

Supplemental Material

Supplemental Material - Touch-Based Therapies in Dementia Care: A Systematic Review and Narrative Synthesis

Footnotes

ORCID iDs

Bryan Mitchell

Eileen Harkess-Murphy

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by school-funded research from the University of the West of Scotland; no external funding was allocated.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Dr Bryan Mitchell: Bryan Mitchell, (PhD) is a Lecturer and Programme Leader in the School of Health & Life Sciences at the University of the West of Scotland and a member of the Alzheimer Scotland Centre for Policy and Practice. His teaching and scholarship focus on integrated health and social care, with research spanning advanced dementia care, complementary/touch-based therapies, palliation in nursing homes, and meaningful activity. Bryan has contributed to work on trauma-informed carer education, co-developed the award-winning “Understanding Dementia: Class in a Bag” resource, and has published on complementary therapy for advanced dementia palliation and meaningful activity in dementia services. He is accepting PhD enquiries and supervises student research across these areas. His contributions align with the UN Sustainable Development Goals on Good Health and Well-Being (SDG3), Quality Education (SDG4), and Reduced Inequalities (SDG10).

Dr Eileen Harkess-Murphy: Eileen Harkess-Murphy, (PhD) is a Lecturer in Health & Life Sciences at the University of the West of Scotland. A psychologist by background, her work focuses on health improvement, mental health and wellbeing, with particular expertise in psychological trauma and trauma-informed approaches in dementia care. She leads and collaborates on multi-centre projects exploring carers’ and people with dementia’s experiences through a trauma-informed lens, and has methodological strengths in medical statistics and data analysis. Eileen teaches on the BA (Hons) Integrated Health & Social Care programme and supervises postgraduate research. Her contributions align with the UN Sustainable Development Goals on Good Health and Well-Being (SDG3), Quality Education (SDG4) and Reduced Inequalities (SDG10). PURE Profile: .

Dr Nicola Douglas-Smith: Nicola Douglas-Smith, (PhD) is a Senior Lecturer in the School of Education and Social Sciences at the University of the West of Scotland. Her work sits at the intersection of health, social and environmental psychology, with projects spanning learning environments in higher education and care-home environments for people living with dementia. Nicola’s current research examines post-COVID teaching and learning workspaces and supports studies on caregivers’ experiences, vaccine hesitancy, learning for sustainability, and nature-/animal-assisted approaches to student wellbeing. Methodologically, she is committed to creative methods for both data collection and dissemination. She supervises undergraduate and doctoral research and is open to PhD enquiries. Her contributions align with the UN Sustainable Development Goals on Good Health and Well-Being (SDG3), Quality Education (SDG4) and Reduced Inequalities (SDG10). PURE Profile: .

Mr Joshua Cheyne: Joshua Cheyne, (MSc) is an Academic Support Librarian at the University of the West of Scotland, specialising in systematic review methods, advanced literature searching, and research support. He has 14+ years’ experience in libraries and evidence synthesis and previously served as an Information Specialist and Editor with the Cochrane Stroke Group, where he developed and peer-reviewed search strategies and supported editorial workflows. He delivers training on search methods and research skills for staff and students and has presented on the evolving role of information specialists in systematic reviews.

References

Achterberg

W. P.

Pieper

M. J.

van Dalen-Kok

A. H.

de Waal

M. W.

Husebø

B. S.

Lautenbacher

Kunz

Scherder

E. J. A.

Corbett

(2013). Pain management in patients with dementia. Clinical Interventions in Aging, 8, 1471–1482. https://doi.org/10.2147/CIA.S36739

Adams

White

Beckett

(2010). The effects of massage therapy on pain management in the acute care setting. International Journal of Therapeutic Massage & Bodywork, 3(1), 4–11. https://doi.org/10.3822/ijtmb.v3i1.54

Atee

Morris

Macfarlane

Cunningham

(2021). Pain in dementia: Prevalence and association with neuropsychiatric behaviors. Journal of Pain and Symptom Management, 61(6), 1215–1226. https://doi.org/10.1016/j.jpainsymman.2020.10.011

Bao

Landers

(2021). Non-pharmacological interventions for pain management in patients with dementia: A mixed-methods systematic review. Journal of Clinical Nursing, 31(7–8), 1030–1040. https://doi.org/10.1111/jocn.15959

Bayram

Altınbaş Akkaş

Ö.

Usta

(2021). Effect of acupressure on agitation in the elderly with dementia who receive institutional care: A pilot study. Perspectives in Psychiatric Care, 57(3), 980–988. https://doi.org/10.1111/ppc.12642

Bramer

W. M.

Rethlefsen

M. L.

Kleijnen

Franco

O. H.

(2017). Optimal database combinations for literature searches in systematic reviews: A prospective exploratory study. Systematic Reviews, 6(1), 245. https://doi.org/10.1186/s13643-017-0644-y

Brodaty

Moore

C. M.

(1997). The clock drawing test for dementia of the Alzheimer’s type: A comparison of three scoring methods in a memory disorders clinic. International Journal of Geriatric Psychiatry, 12(6), 619–627.

Brodaty

Pond

Kemp

N. M.

Luscombe

Harding

Berman

Huppert

F. A.

(2002). The GPCOG: A new screening test for dementia designed for general practice. Journal of the American Geriatrics Society, 50(3), 530–534. https://doi.org/10.1046/j.1532-5415.2002.50122.x

Buschke

Kuslansky

Katz

Stewart

W. F.

Sliwinski

M. J.

Eckholdt

H. M.

Lipton

R. B.

(1999). Screening for dementia with the memory impairment screen. Neurology, 52(2), 231–238. https://doi.org/10.1212/wnl.52.2.231

10.

Cloak

Al Khalili

(2020). Behavioral and psychological symptoms in dementia (BPSD). In StatPearls. StatPearls Publishing.

11.

Davies

R. R.

Larner

A. J.

(2012). Addenbrooke’s cognitive examination (ACE) and its revision (ACE-R). In Cognitive screening instruments: A practical approach (pp. 61–77). Springer.

12.

Department of Health and Social Care . (2020). Visiting arrangements in care homes. (updated April 1, 2022). https://www.gov.uk/government/publications/visiting-care-homes-during-coronavirus

13.

Dimitriou

T. D.

Verykouki

Papatriantafyllou

Konsta

Kazis

Tsolaki

(2020). Non-pharmacological interventions for anxiety in patients with dementia: A crossover randomized controlled trial. Behavioural Brain Research, 390(4), 112617. https://doi.org/10.1016/j.bbr.2020.112617

14.

Dimitriou

T. D.

Verykouki

Papatriantafyllou

Konsta

Kazis

Tsolaki

Koutsouraki

Tegos

(2022). Assessing combinations of non-pharmacological interventions for the reduction of irritability in patients with dementia and their caregivers: A crossover RCT. Brain Sciences, 12(6), 691. https://doi.org/10.3390/brainsci12060691

15.

Ellis

J. M.

Wells

Ong

J. S. M.

(2019). Non-pharmacological approaches to pain management in residential aged care: A pre-post test study. Clinical Gerontologist, 42(3), 286–296. https://doi.org/10.1080/07317115.2017.1399189

16.

Ernst

Lee

M. S.

(2010). Acupressure: An overview of systematic reviews. Journal of Pain and Symptom Management, 40(4), e3–e7. https://doi.org/10.1016/j.jpainsymman.2010.07.003

17.

C.-Y.

Moyle

Cooke

(2013). A randomized controlled trial of the use of aromatherapy and hand massage to reduce disruptive behaviour in people with dementia. BMC Complementary and Alternative Medicine, 13, 165. https://doi.org/10.1186/1472-6882-13-165

18.

Gilhooly

K. J.

Gilhooly

M. L. M.

Sullivan

M. P.

McIntyre

Wilson

Harding

Woodbridge

Crutch

(2016). A meta-review of stress, coping and interventions in dementia and dementia caregiving. Bio Med Central Geriatrics, 16(1), 106. https://doi.org/10.1186/s12877-016-0280-8

19.

Hicks-Moore

S. L.

Robinson

B. A.

(2008). Favorite music and hand massage: Two interventions to decrease agitation in residents with dementia. Dementia, 7(1), 95–108. https://doi.org/10.1177/1471301207085369

20.

Hancock

Larner

A. J.

(2011). Test your memory test: Diagnostic utility in a memory clinic population. International Journal of Geriatric Psychiatry, 26(9), 976–980. https://doi.org/10.1002/gps.2639

21.

Harris

Titler

Strathe

Van Houten

Russell

Jones

(2012). The effects of slow-stroke back massage on nighttime sleep in persons with dementia and sleep disturbances in the nursing home: A pilot study. Journal of Holistic Nursing, 30(4), 255–263. https://doi.org/10.1177/0898010112455948

22.

Hodgson

N. A.

Andersen

(2008). The clinical efficacy of reflexology in nursing home residents with dementia. Journal of Alternative and Complementary Medicine, 14(3), 269–275. https://doi.org/10.1089/acm.2007.0577

23.

Holliday-Welsh

D. M.

Gessert

C. E.

Renier

C. M.

(2009). Jukebox music and hand massage: Effects on agitation in residents with dementia. Geriatric Nursing, 30(2), 108–113.

24.

Ingram

Domagala

Yates

(2005). The effects of shiatsu on post-term pregnancy. Complementary Therapies in Medicine, 13(1), 11–15. https://doi.org/10.1016/j.ctim.2004.12.004

25.

Jefferies

Gale

T. M.

(2012). 6-CIT: Six-item cognitive impairment test. In Cognitive screening instruments: A practical approach (pp. 209–218). Springer.

26.

Kapoor

Orr

(2017). The effect of therapeutic massage on pain in patients with dementia: A prospective observational pilot study. Dementia, 16(1), 119–125. https://doi.org/10.1177/1471301216631095

27.

Kaymaz

T. T.

Özdemir

(2017). The effects of aromatherapy on agitation and related caregiver distress in individuals with dementia: A randomized controlled study. Geriatric Nursing, 38(3), 231–237. https://doi.org/10.1016/j.gerinurse.2016.10.014

28.

Kueper

J. K.

Speechley

Montero-Odasso

(2018). The Alzheimer’s disease assessment scale–cognitive subscale (ADAS-Cog): Modifications and responsiveness in pre-dementia populations. Journal of Alzheimer’s Disease, 63(2), 423–444. https://doi.org/10.3233/JAD-170991

29.

Kwan

R. Y. C.

Leung

M. C. P.

Lai

C. K. Y.

(2016). The effect of acupressure on agitation and salivary cortisol in people with dementia: A pilot study. Journal of Alternative and Complementary Medicine, 22(11), 903–910. https://doi.org/10.1089/acm.2016.0062

30.

Kwan

R. Y. C.

Leung

M. C. P.

Lai

C. K. Y.

(2017). A randomized controlled trial examining the effect of acupressure on agitation and salivary cortisol in nursing home residents with dementia. Dementia and Geriatric Cognitive Disorders, 44(1–2), 92–104. https://doi.org/10.1159/000478739

31.

Lanza

Centonze

S. S.

Destro

Vella

Bellomo

Pennisi

Bella

Ciavardelli

(2018). Shiatsu as an adjuvant therapy for depression in patients with Alzheimer’s disease: A pilot study. Complementary Therapies in Medicine, 38, 74–78. https://doi.org/10.1016/j.ctim.2018.04.013

32.

Larner

A. J.

(2012). Mini-mental Parkinson (MMP) as a dementia screening test: Comparison with the mini-mental state examination. Current Aging Science, 5(2), 136–139. https://doi.org/10.2174/1874609811205020136

33.

Lee

Lewis

G. N.

(2020). Short-term relief of multisite chronic pain with Bowen therapy: A double-blind, randomized controlled trial. Journal of Bodywork and Movement Therapies, 25(4), 271–279. https://doi.org/10.1016/j.jbmt.2020.06.025

34.

Leung

D. K. Y.

Chan

W. C.

Spector

Wong

G. H. Y.

(2021). Prevalence of depression, anxiety and apathy across dementia stages: A systematic review and meta-analysis. International Journal of Geriatric Psychiatry, 36(9), 1330–1344. https://doi.org/10.1002/gps.5534

35.

Lewis

(1994). Diagnostic and statistical manual of mental disorders (4th ed.). American Psychiatric Association.

36.

Lin

L.-C.

Yang

M.-H.

Kao

C.-C.

S.-C.

Tang

S.-H.

Lin

J.-G.

(2009). Using acupressure and Montessori-based activities to decrease agitation for residents with dementia: A crossover trial. Journal of the American Geriatrics Society, 57(6), 1022–1029. https://doi.org/10.1111/j.1532-5415.2009.02271.x

37.

Long

H. A.

French

D. P.

Brooks

J. M.

(2020). Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Research Methods in Medicine and Health Sciences, 1(1), 31–42. https://doi.org/10.1177/2632084320947559

38.

Mackereth

P. A.

Tiran

(2002). Clinical reflexology: A guide for health professionals. Churchill Livingstone.

39.

Moyle

Cooke

M. L.

Beattie

Shum

O’Dwyer

Barrett

(2014). Foot massage versus quiet presence on agitation and mood in people with dementia: A randomized controlled trial. International Journal of Nursing Studies, 51(6), 856–864. https://doi.org/10.1016/j.ijnurstu.2013.10.019

40.

Moyle

Johnston

A. N. B.

O’Dwyer

S. T.

(2011). Exploring the effect of foot massage on agitated behaviours in older people with dementia: A pilot study. Australasian Journal of Ageing, 30(3), 159–161. https://doi.org/10.1111/j.1741-6612.2010.00504.x

41.

Nasreddine

Z. S.

Phillips

N. A.

Bédirian

Charbonneau

Whitehead

Collin

Cummings

J. L.

Chertkow

(2005). The Montreal cognitive assessment (MoCA): A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x

42.

National Institute for Health and Care Excellence . (2018). Dementia: Assessment, management and support for people living with dementia and their carers. (NICE Guideline NG97; updated 2022).

43.

National Institute for Health and Care Research . (2020a). DHSC issues guidance on the impact of COVID-19 on research funded or supported by NIHR. https://www.nihr.ac.uk/news/dhsc-issues-guidance-impact-covid-19-research-funded-or-supported-nihr

44.

National Institute for Health and Care Research . (2020b). NIHR shares first update on implementation of the restart framework. https://www.nihr.ac.uk/news/nihr-shares-first-update-implementation-restart-framework

45.

Nelis

S. M.

Quinn

Y.-T.

Lamont

R. A.

Henderson

Clare

(2018). Living well with dementia: A systematic review and correlational meta-analysis of factors associated with quality of life, wellbeing and life satisfaction in people with dementia. Psychological Medicine, 48(13), 2130–2139. https://doi.org/10.1017/S0033291718000405

46.

Nichols

Steinmetz

J. D.

Vollset

S. E.

Fukutaki

Chalek

Abd-Allah

(2022). Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: An analysis for the global burden of disease study 2019. The Lancet Public Health, 7(2), e105–e125. https://doi.org/10.1016/S2468-2667(21)00249-8

47.

Nikam

(2015). Zotero software for effective reference management. Journal of Advancements in Library Sciences, 2(1), 36–47.

48.

Quittan

(2015). Massage and pain relief prospects. In Encyclopedia of pain (pp. 1098–1100). Springer.

49.

Rodríguez-Mansilla

(2014). Ear therapy and massage therapy in the elderly with dementia: A pilot study. Journal of Chinese Medicine, 104(4), 61–62. https://doi.org/10.1016/s0254-6272(13)60149-1

50.

Rodríguez-Mansilla

González-López-Arza

M. V.

Varela-Donoso

Montanero-Fernández

Garrido-Ardila

E. M.

Paredes-Morejón

(2013). Ear therapy and massage for the treatment of insomnia and anxiety in institutionalized older adults with chronic pain and dementia. Journal of Traditional Chinese Medicine, 33(4), 461–467. https://doi.org/10.1016/s0254-6272(13)60149-1

51.

Saragih

I. D.

Suarilah

Son

N. T.

Lee

B.-O.

(2023). Efficacy of non-pharmacological interventions to reduce pain in people with dementia: A systematic review and meta-analysis. Journal of Clinical Nursing, 32(15–16), 5285–5299. https://doi.org/10.1111/jocn.16522

52.

Schaub

von Gunten

Morin

Wild

Gomez

Popp

(2018). The effects of hand massage on stress and agitation among people with dementia in a hospital setting: A pilot study. Applied Psychophysiology and Biofeedback, 43(4), 319–332. https://doi.org/10.1007/s10484-018-9416-2

53.

Scottish Intercollegiate Guidelines Network . (2023). Sign 168: Assessment, diagnosis, care and support for people with dementia and their carers.

54.

Senderovich

Gardner

Berall

Shultz

Grant

Santaguida

(2022). Therapeutic touch in the management of responsive behaviors in patients with dementia. Dementia and Geriatric Cognitive Disorders, 51(2), 142–149. https://doi.org/10.1159/000523752

55.

Smallwood

Brown

Coulter

Irvine

Copland

(2001). Aromatherapy and behaviour disturbances in dementia: A randomized controlled trial. International Journal of Geriatric Psychiatry, 16(10), 1010–1013. https://doi.org/10.1002/gps.473

56.

Soofi

(2025). A qualified critique of the terminology of behavioral and psychological symptoms of dementia (BPSD). AJOB Neuroscience, 1–12. https://doi.org/10.1080/21507740.2025.2601356

57.

Suzuki

Tatsumi

Otsuka

Kikuchi

Mizuta

Makino

Kimoto

Fujiwara

Abe

Nakagomi

Hayashi

Saruhara

(2010). Physical and psychological effects of 6-week tactile massage on elderly patients with severe dementia. American Journal of Alzheimer's Disease and Other Dementias, 25(8), 680–686. https://doi.org/10.1177/1533317510386215

58.

Ting

Y.-Y.

Tien

Huang

H.-P.

(2023). Effects of aromatherapy on agitation in patients with dementia in the community: A quasi-experimental study. Geriatric Nursing, 51(3), 422–428. https://doi.org/10.1016/j.gerinurse.2023.04.010

59.

Wang

K.-L.

Hermann

(2006). Pilot study to test the effectiveness of healing touch on agitation in people with dementia. Geriatric Nursing, 27(1), 34–40. https://doi.org/10.1016/j.gerinurse.2005.09.014

60.

Warren

(2023). BPSD reconsidered: Diagnostic considerations to preserve personhood in persons with dementia. Frontiers in Dementia, 2, 1272400. https://doi.org/10.3389/frdem.2023.1272400

61.

Watt

J. A.

Goodarzi

Veroniki

A. A.

Nincic

Khan

P. A.

Ghassemi

Thompson

Tricco

A. C.

Straus

S. E.

(2019). Comparative efficacy of interventions for aggressive and agitation behaviors in dementia: A systematic review and network meta-analysis. Annals of Internal Medicine, 171(9), 633–642. https://doi.org/10.7326/M19-0993

62.

Woods

D. L.

Craven

R. F.

Whitney

(2005). The effect of therapeutic touch on behavioral symptoms of persons with dementia. Alternative Therapies in Health and Medicine, 11(1), 66–74.

63.

World Health Organization . (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines.

64.

Wang

(2017). The effectiveness of massage and touch on behavioural and psychological symptoms of dementia: A quantitative systematic review and meta-analysis. Journal of Advanced Nursing, 73(10), 2283–2295. https://doi.org/10.1111/jan.13311

65.

Yang

M.-H.

Lin

L.-C.

S.-C.

Chiu

J.-H.

Wang

P.-N.

Lin

J.-G.

(2015). Comparison of the efficacy of aroma-acupressure and aromatherapy for the treatment of dementia-associated agitation. BMC Complementary and Alternative Medicine, 15(1), 93. https://doi.org/10.1186/s12906-015-0612-9

66.

Yang

M.-H.

S.-C.

Lin

J.-G.

Lin

L.-C.

(2007). The efficacy of acupressure for decreasing agitated behaviour in dementia: A pilot study. Journal of Clinical Nursing, 16(2), 308–315. https://doi.org/10.1111/j.1365-2702.2006.01428.x

67.

Yang

T.-P.

Wang

C.-J.

Wang

J.-J.

(2016). The effectiveness of aromatherapy hand massage in patients with dementia. Journal of Gerontological Nursing, 42(9), 38–46.

68.

Yoshiyama

Arita

Suzuki

(2015). The effect of aroma hand massage therapy for people with dementia. Journal of Alternative and Complementary Medicine, 21(12), 759–765. https://doi.org/10.1089/acm.2015.0158

69.

Zhang

J. J.

Mei

J.-H.

Wang

H.-X.

Gao

H.-X.

J.-F.

Cheng

Gao

L. L.

Wang

C. C.

Y. X.

(2022). Effect of auricular acupressure on acute pain in nursing home residents with mild dementia: A single-blind, randomized, sham-controlled study. Evidence-Based Complementary and Alternative Medicine, 2022(1), 1–8. https://doi.org/10.1155/2022/6406383

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