Perhaps like no other profession, massage therapy provides benefits to a wide range of people. Yes, there are contraindications that need to be monitored, but generally speaking, young and old, healthy and ailing—most everyone gains from regular massage therapy sessions.
True, too, however, is the idea that massage therapy is never one-size-fits-all. Even among your clients who don't have specific conditions, you don’t simply massage them the exact same way. Every client—every body—is different, and these differences are what dictate how a massage therapy session and treatment plan are developed.
The idea of individualizing a massage therapy session is particularly important when dealing with a specific demographic. When working with elderly clients, there are myriad factors—both physical and mental—that need to be considered. Following are some of the essentials.
The Aging Body
Until the fountain of youth is discovered, people will continue to get older—and the natural process of aging will continue to change them, both physically and mentally. Skin wrinkles and sags, tearing more easily and healing more slowly. Respiratory changes happen, and people generally start to see decreases in muscle and bone mass, sometimes reducing their strength and flexibility, or increasing their risk for osteoarthritis.
The gastrointestinal system also starts to slow down, so older clients might be more prone to heartburn. A reduction in cerebral blood flow may lead to changes in sensitivity to pain, cold intolerance, and decreases in balance and coordination. The heart begins to enlarge, too, thickening and narrowing vascular walls, and sometimes causing an increase in blood pressure and a decrease in circulation.
If it sounds like the aging body is all about slowing down and change, that’s only part of the story—but an important part nonetheless. Being aware of some of these common differences in an aging body gives massage therapists a good place to start when working with these clients.
The Power of One
As a massage therapist, you tailor each session to the needs of the client, and this practice becomes particularly important when working with special populations. You understand there are additional considerations when working with clients who have diabetes, for example, or cancer patients. (For more information on massaging clients with cancer, see Massaging Clients With Cancer in the Winter 2010 issue of Massage Therapy Journal). And the same holds true when working with the elderly.
According to Susan Salvo, a massage therapist with 27 years experience with massage and adult education, one of the major differences massage therapists are going to find with elderly clients involves general health and medication. “The body naturally ages, affecting a person’s health,” she says. “90 percent of the elderly are reported to have at least one chronic medical condition, and the majority has multiple conditions.” Further, she explains, many of these medical conditions are managed with medication. Add to these facts that more than half are dealing with some type of disability—whether sensory, physical or mental—and the need for individualized treatment plans is obvious. “Massage therapists need to be able to ascertain,by observation and questioning, if the elderly client is robust and fit or frail,” says Salvo. “Then, modify the massage accordingly.”
Doing a thorough intake, critical with every client you work with, perhaps becomes even more so for aging clients. You need to inquire about any medication they are using, as well as if there are special needs or concerns that have to be accounted for during the massage session. Remember, too, that you might need to assist with the intake form, perhaps reading the questions to the client.
You’re also going to want to limit stretches and joint mobilizations, as well. “Use gentle stretching and joint movements, such as rocking,” Salvo suggests. “Avoid extreme mobilizations, which may harm a client with osteoporosis.” Because falling is the most common safety issue for people over 65, be sure the walkways—both outdoors and inside your practice—are clear. Replace any eyewear you removed during the session, and remind the client to sit up for a moment before standing. “You need to be ready to assist, too,” Salvo explains.
On a more personal level, Salvo notes, massage therapists need to respect the slower pace of these clients. “Allow extra time for clients to undress, as sometimes they’ll be wearing layers and layers of clothing,” she says. “Be sure to account for transition time, or time to hear a story.” Remember, Salvo explains, these clients are going through lifestyle and emotional changes, such as retirement, reduced income or the loss of loved ones. “Cultivate patience, tolerance, kindness and attentiveness,” Salvo encourages. “Don’t be afraid to touch someone, and use common sense and good judgment.”
There Is no Normal
“It’s paramount that the therapist understands that just as there are not typical 30 year olds, there are no typical 70 year olds,” explains Salvo. “An elderly person can be fit and active and independent, living without assistance. The therapist must tailor their session to the health and needs of each client.” Because so many elderly clients are potentially dealing with chronic conditions, too, Salvo suggests massage therapists adopt an “it depends” philosophy when working with them. “Screen clients properly,” she reminds, “and ask about the client’s experience with the disease or medication, modifying your session accordingly.”
Salvo also recommends that massage therapists serious about working with elderly clients seek out additional education or training specifically focused on this population. “Once you have skills, experience and some confidence in these areas,” Salvo suggests, “consider offering in-services to medical and civic groups as a way of spreading the work about how massage is helpful for the elderly.”
General Session Guidelines
Reduce Pressure. Due to changes in the client’s skin, as well as chronic medical conditions that need to be accounted for, reducing downward pressure and sliding force is recommended. What if your client requests deeper pressure? “You can honor a client’s request for deeper pressure by making immediate modifications,” Salvo suggests. “Then, return to the appropriate, safer pressure.”
Shorter Sessions. Your elderly clients aren’t going to need 60- or 90-minute sessions. “Treatment time is typically about 30 minutes,” Salvo says. You can begin the session with five minutes of unhurried effleurage, deep breathing and gentle rocking. Follow with 20 minutes of focused work on feet, legs, back, shoulders or neck, letting your client determine where they’d like to concentrate the massage. Then, do about five minutes of closure work.
Position for Safety. With elderly clients, consider limiting or avoiding the prone position. “Supine and seated positions are the safest,” Salvo recommends. Also, be aware of how many position changes are done during the massage session, remembering that the fewer times the client has to move, the better.
Be Flexible. These clients particularly are going to need a massage therapist who is flexible. Some, if not most, elderly clients are going to appreciate a massage therapist who can come to them instead of having to go to someone’s practice. “Schedule sessions during daylight hours,” Salvo explains. “Also, you may have to massage the client on their sofa or bed, or in a favorite chair.”
Clinical Fragility Scale
When working with older clients, assessing where they are physically is of utmost importance. Following are some general guidelines to help you develop an effective treatment plan.
Very fit: Robust, active, energetic, well-motivated and fit. These people commonly exercise regularly.
Well: Without active disease, but less fit than the people considered “very fit.”
Well, with treated comorbid disease: Disease symptoms are well-controlled.
Apparently vulnerable: Although not dependent, these people commonly complain of being slowed up, or have disease symptoms
Mildly frail: Limited dependence on others for activities of daily living.
Moderately frail: Help needed for activities of daily living.
Severly frail: Completely dependent for activities of daily living; terminally ill.
*Source: Canadian Study of Health and Living