To touch or not to touch?

There is a lot of research that shows that physical contact (the right sort) is good for our well-being. But with all the concerns about the risk of abuse, some older people may be missing out on something that could really improve their quality of life. Megan Mann asks us to think again.

What does touch mean to you? Is it a practical tool, a source of sensual pleasure, a sharing of emotion, the way that you communicate, or can it be an invasion of your personal space?

How we use and respond to touch will depend on many things, particularly our past experiences and will mean different things in different contexts. Different amounts of pressure, control, power and movement may be required, depending on the task, such as carefully threading a needle, tapping the keys of a computer, gently stroking a kitten or using force to chop logs. Without touch, we would be unable to coordinate even simple movements, and we couldn't walk, balance or hold things. Our sense of touch also protects us from danger, heat, pain and cold.

While our other four main senses (sight, hearing, smell, and taste) are located in a specific part of the body, our sense of touch is found everywhere, both inside and out. This is why it is called the ‘somatosensory’ or body sensing system. Every inch of our skin contains touch receptors, giving us information about the things our body comes into contact with. They carry the information to the spinal cord, which sends messages to the brain, where the feeling is registered.

Some areas of the body are more sensitive than others because they have a greater number of touch receptors. Have you ever bitten your tongue and wondered why it hurt so much? The sides of your tongue have a lot of nerve endings that are very sensitive to pain. Some of the most sensitive areas of your body are your lips, neck, feet and hands. The fingertips are especially sensitive with about a hundred touch receptors per square centimetre, as opposed to ten per square centimetre on the back of the hand, which is why people who are blind tend to use their fingertips to read Braille.

As well as using touch as a means of interpreting the world around us, research has also shown that it has powerful psychological affects in areas like persuasion, healing, reducing anxiety and tension. For example, premature babies who receive regular massage will gain weight more rapidly and develop faster mentally than those who don’t receive such attention.

Touch continues to have a psychological impact throughout our lives. People in hospital seem to have less anxiety and fewer headaches when they are regularly touched or caressed by people they love. Gentle stroking may also reduce rapid and irregular heart beats. Loving touch releases hormones which ease pain and help the healing process. Touch also has a powerful persuasive force, and studies have shown that it can have a positive impact on both marketing and sales. Salespeople often use touch to establish a rapport in order to sell more products, as people are generally more likely to respond positively to any request, if it is accompanied by a slight touch on the arm or hand.

How is our sense of touch affected as we get older? It seems that at the age of ten, most people have about 50 touch receptors per square millimetre of skin. By the time we are fifty years old, this has reduced to about 10. For much older people, this loss of touch sensitivity is made worse by the fact that they may also lose the physical contact of people they were close to. Their partners and siblings may have died, and children or grandchildren often live quite a distance away. Social contact with friends may be reduced or cease altogether, as sight and hearing deteriorates.

For those of us who experience regular physical contact with others, can we really imagine how lonely and unloved it must feel to go for days, weeks and in some situations months without any physical touch?

This brings up a big question for people working with older deafblind people. Should we encourage practitioners to have physical contact with older deafblind people, as a way of reducing their feelings of isolation? Would it be controversial to say that it might be beneficial to put our arms around someone and give them a hug, and to hold their hand when talking to them - if they felt comfortable within that situation?

Risk aware

We live in a society that is very concerned about abuse in our care system. It might be argued that because there is a risk of abuse, physical contact should be kept to a minimum and only used for purely practical reasons - such as direct communication. It is a sad fact that physical and sexual abuse do occur in society, and care needs to be taken to protect those most vulnerable. This will include older people who have dementia for whom making choices can be especially difficult.

But should the risks outweigh the undoubted benefits for many? The Department of Health issued a guide to best practice for health and social care professionals in May 2007.

Independence, choice and risk: a guide to best practice in supported decision making, Department of Health, available from www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance accessed 1 September 2008.

This aims to support the principle of empowerment and promoting choice for the individual, whilst managing risk proportionately and realistically.

There has recently been a shift in thinking and practice relating to risk in social care settings - from being risk averse to risk aware. Older deafblind people have had a lifetime of experiences, both good and bad. Intuition, fed by these experiences, equips them to recognise the difference between feeling safe and unsafe. So can this emotionally supportive form of touch be included in our practice without safety being compromised?

I’d like to think that we could incorporate a healthy and natural use of touch in our practice, and be guided by deafblind people themselves about how we can do that in a safe, supportive and appropriate way. As Jo, herself a deafblind woman, says, “Touch can be a life changing gift to a deafblind person.”

Maisy

Maisy is a deafblind lady in her nineties who has never married and has no close relatives. She lives in a residential home for older people. Most of her days are spent sitting alone in her room. Whenever she has a visitor she likes them to sit very close to her and hold her hand. I asked her why this was important to her. She said “I’m very lonely; I like to feel you near me, part of me”.

Mary

When anyone visited Mary there was an understanding that she would begin the visit with a hug. Not just a quick wrap of arms around you but a real, warm, affectionate cuddle. Mary had no vision or hearing and the tactile closeness that she sought was very important to her. It gave her the warmth of human contact that had always been important to her before losing sight and hearing, but was now an essential ingredient for ensuring good mental health.