What is one benefit of using the hand underhand position with people living with dementia?

Statistics show that more than 60% of people with dementia experience challenging behaviors related to communication difficulties. A gentle technique known as the hand-under-hand position offers a crucial way to improve interactions, but what is one benefit of using the hand underhand position with people living with dementia? This article will explore the core advantage of this compassionate strategy.

Quick Summary

The hand-under-hand technique significantly reduces anxiety and agitation by providing a sense of safety, control, and reassurance through non-confrontational, respectful physical touch. It reframes caregiving as a cooperative partnership rather than a directive action.

Key Points

• Reduced Anxiety: By providing a sense of security and support, the hand-under-hand position helps calm and reassure people living with dementia, minimizing anxiety and agitation.

• Enhanced Participation: This method allows the individual to feel like an active participant in their own care, leveraging remaining motor skills for tasks like eating or grooming.

• Fosters Trust: The respectful, non-confrontational nature of this touch builds trust and rapport between the person with dementia and their caregiver, strengthening their relationship.

• Preserves Dignity: Instead of being controlled or maneuvered, the person maintains a sense of autonomy and dignity by having their hand rest on top, guiding the action.

• Utilizes Tactile Communication: When verbal communication fails, this gentle, consistent touch serves as a powerful form of non-verbal communication, conveying comfort and safety.

• Decreases Resistance: The cooperative nature of the hand-under-hand technique leads to less resistance and more cooperation during necessary care tasks.

The Core Advantage: Promoting Security and Reducing Anxiety

One of the most profound benefits of the hand-under-hand position is its ability to provide a person with dementia a deep sense of security and control, which in turn significantly reduces anxiety and agitation. Unlike a traditional handshake or a guiding hand placed forcefully over their own, the hand-under-hand approach feels supportive and non-threatening. For someone whose world is often filled with confusion and unpredictability, this gentle, consistent touch offers a much-needed anchor. It communicates, non-verbally, that you are a partner in their journey, not an imposing force attempting to control them. This simple change in physical interaction can de-escalate stressful situations, build trust, and improve the overall emotional well-being of the individual.

The Science Behind the Comfort

This technique is not just anecdotal; it is rooted in how the brain processes touch and emotion. Tactile touch, particularly pressure on the palm, can stimulate the release of oxytocin, a hormone associated with bonding, trust, and reduced stress. Simultaneously, it can help lower cortisol, the primary stress hormone. This neurological response makes the hand-under-hand position a powerful tool for calming a person who may be experiencing fear, distress, or confusion. By allowing the person's hand to rest on top of the caregiver's, it also leverages preserved muscle memory. This subtle guiding motion helps them engage in familiar tasks, reinforcing their sense of competence and independence. As the disease progresses, fine motor skills are often lost, but gross motor abilities are retained longer. The hand-under-hand method capitalizes on these retained skills, allowing for continued participation in daily life.

Practical Applications in Everyday Life

This technique can be applied to a variety of everyday tasks, transforming potentially confrontational moments into collaborative ones. Here are a few examples:

• Eating: When assisting with meals, placing your hand under theirs allows you to gently guide the utensil without taking control. The person can still feel the motion and be part of the feeding process, maintaining their dignity.
• Grooming: For tasks like brushing hair or washing a face, this position allows you to guide their hand to the appropriate item. This maintains a sense of autonomy while providing the necessary support.
• Mobility: When moving from a chair to a standing position or walking, using the hand-under-hand technique offers stability and guidance. The person feels supported and secure, reducing the fear of falling and minimizing resistance.

A Comparative Look at Touch Techniques

Understanding the difference between this method and other approaches is critical for effective dementia care. The following table highlights the key distinctions:

Feature	Hand-Under-Hand Position	Hand-Over-Hand Position	Command-and-Demand Approach
Effect on Patient	Promotes feelings of security, control, and partnership.	Often perceived as intrusive, forceful, and condescending.	Can cause extreme anxiety, resistance, and feelings of helplessness.
Physical Mechanics	Caregiver's hand is underneath, guiding from below. Allows person to feel they are leading.	Caregiver's hand is on top, controlling the person's hand. Feels directive and disempowering.	Uses verbal commands and physical force, ignoring non-verbal cues.
Primary Outcome	Reduced anxiety, increased cooperation, and preserved dignity.	Increased agitation, resistance, and feelings of being controlled.	Severe escalation of challenging behaviors and emotional distress.

A Step-by-Step Guide to Using the Hand-Under-Hand Position

1. Approach from the front and at eye level. Never approach from behind, which can be startling and frightening. Kneel or sit down to be at their level if they are seated.
2. Make a welcoming connection. Use a gentle, positive tone of voice and make eye contact. Wait for an invitation into their personal space.
3. Offer your hand. Extend your hand palm up, inviting them to place their hand in yours.
4. Establish the grip. Gently place your hand under theirs, so their hand rests on top of yours. Your fingers and thumb should be holding their hand gently, not squeezing.
5. Use it as a rudder, not a steering wheel. Guide their hand to the necessary item or location with a slow, gentle motion. Allow them to be the active participant, with your hand simply providing support.
6. Maintain constant contact. This provides continuous reassurance and a physical feedback loop, helping them feel safe throughout the task.
7. Watch for non-verbal cues. Observe their body language. If they show signs of distress or try to pull away, release your grip and give them space. Respect is paramount.

Key Principles for Success

• Do with, not to: This philosophy emphasizes that caregiving is a cooperative effort. You are not performing a task to the person, but assisting them with it.
• Observe and adapt: Not every technique works every time. Be flexible and attuned to the person's mood and needs on any given day.
• Lower your voice pitch: When speaking, a lower, calm voice can be more soothing than a high-pitched one, which can sound more alarming.
• Focus on the feeling: When explaining a task, focus on the sensory experience rather than a complex verbal explanation. For example, “Let’s feel this warm towel” is more effective than “Now we’re going to wash your face.”
• Build trust over time: Consistently using this gentle, respectful approach builds a foundation of trust that makes future interactions smoother and more pleasant for both of you.

Conclusion

The hand-under-hand position offers a compassionate and effective way to connect with and care for individuals living with dementia. By leveraging non-verbal communication and the soothing power of touch, caregivers can provide a sense of security and control. This not only reduces anxiety and agitation but also helps preserve the person's dignity and ability to participate in their own daily care. It represents a fundamental shift towards more person-centered care, showing that even in challenging moments, respect and partnership can prevail. For more detailed information on this approach, consider exploring the methods developed by dementia care expert Teepa Snow through her organization, Positive Approach to Care: Positive Approach to Care.

Frequently Asked Questions

What is the hand-under-hand position?

The hand-under-hand position is a caregiving technique where you place your hand underneath the person's hand to guide them during an activity. It provides a sense of support and partnership, allowing the person with dementia to feel more in control of the situation.

How does this technique help with agitation in people with dementia?

It reduces agitation by providing a calming, predictable form of physical contact. When someone with dementia feels insecure or confused, a directive or forceful touch can increase their distress. The hand-under-hand method, however, is non-invasive and reassuring, helping to de-escalate anxiety.

Is the hand-under-hand position only for people with dementia?

No, while widely used in dementia care, the principle of providing respectful, supportive physical guidance can be beneficial for anyone who is physically or cognitively compromised and requires assistance, such as those with visual impairments or developmental disabilities.

How can I introduce the hand-under-hand position to my loved one?

Start by approaching calmly from the front and making eye contact. Then, offer your hand openly and allow them to place their hand on yours. Never force the contact. If they pull away, respect their space and try again later. Consistency builds trust over time.

Does this technique help with eating difficulties?

Yes, it is very effective for assisting with eating. By placing your hand under theirs, you can gently guide their hand and the utensil to their mouth, allowing them to feel the motion and continue participating in the familiar task of eating, which can be less frustrating for them.

What should I do if the person resists the hand-under-hand position?

If they resist, immediately stop and give them space. Their resistance is a sign they are feeling threatened or overwhelmed. Back away calmly, lower your voice, and try to re-establish connection later. Always prioritize their comfort and security over completing the task immediately.

Why is this better than placing my hand over theirs?

Placing your hand over theirs can be perceived as controlling and domineering, potentially causing the person to feel trapped or infantilized. The hand-under-hand approach empowers them by allowing them to feel as though they are still in control of their own movements, with you as a supportive presence.