Touch: a fundamental aspect of communication with older people experiencing dementia: physical touch is integral to nursing practice yet there are gaps and inconsistencies in the literature informing care, particularly in relation to older people with dementia. Madeline Gleeson and Fiona Timmins examine the issues

In nursing, 'touch may be the most important of all non-verbal behaviours' (Nesbitt Blondis and Jackson 1982) but Tutton (1998) questions whether nurses actually reflect on their own use of touch and the potential that touch has to contribute to high quality care. Tutton (1998) suggests that touch in nursing is more often associated with procedures, and that this 'powerful expression' may be under-utilised.

For a variety of developmental and environmental reasons, many older people are deprived of touch (Scurfield 1998). This deprivation is exaggerated in the formalised care setting and nurses ought to consider addressing this issue. Scurfield (1998) suggests that nurses should consider how they can use touch as an effective means of communication with the aged, suggesting that touch provides an opportunity to promote the older person's adaptation to their environment. However, in the reality of institutionalised situations, nursing touch is confined to procedures or tasks. Perrin (1997) noted that time spent on non-task activity with people experiencing dementia was 'virtually non-existent'.

This area is a cause for concern as the need for touch increases with age. As Montague (1978) says: '... in old age ... the tactile hunger is more powerful than ever, for it is the only sensuous experience that remains to him. It is at this time, when he has again become so dependent upon others for human support, that he is in need of embraces, of an arm around his shoulder, of being taken by the hand, caressed, and given the opportunity to respond.'

key words

* Touch

* Dementia

* Elderly: nursing

Literature review method

In order to explore this topic more fully a literature review was undertaken to explore the use of touch with older people experiencing dementia. The main source for the literature search was the CINAHL database. The key words used in the search were 'touch', 'elderly' and 'dementia'. A combination of key terms, 'touch and elderly', yielded 36 citations in the mental health collection and 219 in the nursing collection. A combination of the key terms 'touch and dementia' yielded 36 citations in the mental health collection and 62 in the nursing collection.

Another source for the literature search was Medline (1966-2002). The key words used in the search were 'touch and the elderly' (125 citations) and 'touch and dementia' (40). A search was also performed using the journal Dementia Care using the key word 'touch', and four citations were retrieved.

General trends in the literature

The exploration of touch in the nurse/patient interaction is not new, studies having been performed since the 1970s in both the UK and the USA. Key researchers in this area include Kim and Buschmann (1999) and, while literature on communication and therapeutic touch abounds, research into physical touch and dementia comprises isolated, small-scale correlations studies using convenience samples. There is little experimental research on the topic and little exploration of the effects of physical touch per se.

The following themes emerged from the literature:

* physical touch as an aspect of nursing practice

* the effect of...