The Effect of Acupressure on Agitation and Salivary Cortisol in People with Dementia: A Pilot Study

2016. Objectives: This study aimed to identify the acupressure effect over time, compare the efficacy in different dosages, and identify feasibility issues with saliva sample collection and acupressure implementation in agitated nursing home residents with dementia. Design: Time serial design with eight dosage-combination groups. Setting: Three residential care homes (RCHs) in Hong Kong. Participants: Agitated RCH residents with dementia. Interventions: Acupressure was performed for 9 minutes altogether on five acupoints: Fengchi (GB 20), Baihui (GV 20), Shenmen (HT 7), Niguan (PC 6), and Yingtang (EX-HN 3). Two frequencies (once and twice a day) and four durations (1, 2, 3, and 4 weeks) formed eight dosage combinations. Outcome measures: The primary outcome was agitation, measured by the Cohen Mansfield Agitation Inventory. The secondary outcome was stress, measured by salivary cortisol. Results: Twenty-four participants from three RCHs completed the study. Acupressure was successfully completed for 88% of total sessions, and 79.17% of participants completed more than 80% of expected sessions. The effect of acupressure on agitation onset was seen immediately at week 1 (p < 0.001), resurged at week 4 (p = 0.001), and was sustained until week 6 (p < 0.001). The effect on stress began immediately to a mild extent at week 1 (p = 0.011) and peaked at week 4 (p = 0.010). Acupressure was observed to show the largest effect when it was performed twice a day (p = 0.026) for 2 weeks (p = 0.005). Valid saliva samples were collected for 53.33% of participants. Hyposalivation caused this unsatisfactory yield of valid saliva samples. Conclusion: Acupressure can be conducted on agitated RCH residents with dementia, but low yield of saliva samples related to participants' hyposalivation is a problem. Preliminary findings suggest that acupressure is effective in reducing both agitation and stress. Its onset of effect was immediate, and the effect was sustained until 6 weeks after the intervention. The optimal dosage appears to be a course of acupressure twice a day for 2 weeks.