Christine Smyth LicAc, MBAcC, M.Sc., B.Sc.(Hons.) NADA-UK practitioner Dissertation (2012) for B.Sc.(Hons.) in Acupuncture at the College of Integrated Chinese Medicine (CICM), Reading A SMALL SCALE STUDY INTO THE EFFECTIVENESS OF THE NADA-UK PROTOCOL ON CARERS OF DEMENTIA PATIENTS IN THEIR HOME ENVIRONMENT

What are the perceived effects of using auricular acupuncture (NADA-UK protocol), on a pilot study group of ten carers of dementia patients over a six week period, as assessed by participants using three self-reporting outcome measures at the beginning and end of the treatment period? Research question

To see if: * there is an association between the use of the NADA- UK protocol and health outcomes in elderly carers of dementia patients over a six week period * there is an improvement in quality of life outcomes as measured by MYMOP2 and the CICM Clinical Audit questionnaires * there is an improvement in the carers’ depression, anxiety and stress scores as measured by DASS21 questionnaire * to evaluate the feasibility of a larger scale trial in the light of the results of the above pilot study Aims

Figure1: Study Area The study took place on the Isle of Wight over a 6 week period between October and December Source: Office for National Statistics (ONS) - Mid 2010 Population Estimates

* “ Dementia is the next global time bomb.” * “In the UK there are 600,000 unpaid family members caring for dementia patients at home.” * “Economically, in the UK, the cost of dealing with dementia is £23 billion each year; it is a disease that affects people, families and whole communities.” Professor Peter Piot, BBC Radio 4, Director of Global Health (London School of Hygiene and Tropical Medicine, London)

* Source: In , the Department of Health commissioned a detailed survey in England of non- professional carers in households over the age of 16 years (NHS, 2010) Key results from DoH survey ( ) indicate that of the five million adult carers (not just dementia carers) in England: * 60% were female * caring had affected health: 34% felt tired; 29% felt stressed; 25% had disturbed sleep; 22% were short tempered or irritable * 42% said their personal relationships, social life or leisure time had been adversely affected by their caring * six in ten anticipated an increase in their caring time in the next five years * 25% of carers were aged 65 or over; 42% between 45 and 64 * many of the carers were driven to resort to prescribed drugs for their symptoms of depression, anxiety and stress (Prozac, Paroxetine, Amitriptyline)

10 volunteer carers all female volunteers mean age =70.8 years treatments over 6 weeks - between 26/10/2011 and 1/12/2011 Carer profile in study group: Figure 2: Carer age profile (years) Figure 3: Years spent caring for dementia patients key

Stress is a major factor in many disease processes and chronic health conditions: caring for dementia patients is demanding and stressful and carers have high levels of anxiety and depression. “I’m all cared out”

* As a NADA-UK practitioner, previous personal observation showed the protocol to be effective in: * calming agitated and anxious patients * helping patients find a balance in their condition and ultimately take responsibility for their recovery * providing a regular, safe and cost effective community acupuncture * providing a non-verbal treatment involving sitting in silence for 35 minutes * complementing other existing medications and therapies * minimising patient discomfort with no removal of clothing Why NADA?

Figure 4: NADA- UK Protocol

* Literature review * Completion of three outcome measures : before and after 6 weeks of treatments * MYMOP2 (Paterson, 1996) * DASS21 – DEPRESSION, ANXIETY, STRESS (Lovibond and Lovibond, 1995) * CICM Clinical Audit (Shaw et al. 2007a; Shaw et al. 2007b) * NADA-UK five needle protocol treatments * Blood pressure/heart rate(pulse rate) * Tongue diagnosis * Carer diary logs: containing their comments * Interview with organiser of carers’ support group. Data collection for study

Key: Symptom 1 = main complaint Symptom 2 = secondary complaint 6= worst score 0= best score Figure 5:

Score 6 = worst; Score 0 = best Symptom 1= Anxiety stress, depression, frustration Symptom 2 = poor sleep, exhaustion Figure 6: Individual MYMOP2 category scores

Score 6 = worst; Score 0 = best Symptom 1= Anxiety stress, depression, frustration Symptom 2 = poor sleep, exhaustion

Figure 7: DASS21 Mean scores for the group: comparing pre- and post-treatment score Group and individual DASS21 results showed a significant reduction in the carers’ scores for depression, anxiety and stress. Pre-treatment the group had worse scores that the normative DASS population, with only 2% of the normative population having a worse score than the carer group. This placed the carers in the severe to extremely severe category for all three states. However, post-treatment the group scores decreased to a level whereby approximately 22 % of the normative population were in a more severe category than the carers. mean

Figure 8: CICM Clinical Audit: effect of treatment on various aspects for study group.

Figure 9: CICM Clinical Audit outcome measure Results: two individuals compared to group mean

General results of pulse and blood pressure for the group All participants were asked to have a check-up with their doctor as some of the initial blood pressure readings were deemed to be high. The general trend was for the pulse rate to lower after treatment. Generally, the overall trends for blood pressure readings after treatments indicated that there was a lowering of both systolic and diastolic blood pressure.

Evidence of clear benefits of the NADA protocol for the carers: reduced anxiety, stress and depression better sleep, improved confidence and motivation improved coping in carers, including increased energy, and better relaxation increased self-awareness, health, empowerment, and balance between mental and physical well-being. Data on heart rate, blood pressure, and tongue diagnosis indicated increased relaxation and a calming effect from the treatment Findings:

Conclusions : Firstly, all the participants believed that their mental states and some physical conditions had improved over the course of the study Secondly, the success criteria of the feasibility objectives for a larger scale trial had in all important respects been met Thirdly, the NADA-UK protocol may be an effective treatment for individuals experiencing intense levels of daily stress and anxiety

Carers' comments at the end of the treatments “I feel that I have turned a corner. I feel really relaxed and calm.” “The pain is less in my neck and shoulder and I find that I do not need to take so many painkillers; the headache pain is no longer stabbing. I feel ‘floaty’, almost free of pain.” “I have been sleeping deeply and more soundly.” “It helps me as I can get so wound up and stressed; I feel that I can cope better.” Carer suffering from Parkinson’s disease. “It is the only time when my head, arms and hands do not shake.” “I have a real sense of well being.” “Ear acupuncture has been like an anchor, a life line for me.”

It has been a privilege and an honour to work with this group of carers Christine Smyth -