MASSAGE FOR ELDERS:
An Ever-Growing Opportunity

This "undertouched" market segment is growing rapidly, and presents a real opportunity for massage therapists.  But special methods must be used for aging customers.

By Joan S. Lohman

"Harder! Press harder!" 102-year-old Elizabeth shouts as I apply gentle pressure with my thumbs to the knots along her rhomboids and upper trapezius. "Just because I'm skinny and old doesn't mean I break easily!"

For the past 15 years, I have cradled hundreds of elders like Elizabeth between my hands in my work as a massage therapist. Many of my clients have been in their 90s, some in their 70s and 80s. The oldest was 103. My elder clients are in the age group society treats as "the untouchables." The hour I spend with a client is often the one time each week she or he can look forward to attentive, compassionate touch.

My clients are also part of the fastest-growing segment of the U.S. population--those over 75. The first baby boomer turns 65 in 2011, and 78 million boomers are "barreling towards old age," says Ken Dychtwald in Age Power. By 2020, one in five Americans will be over 60, according to the Population Reference Bureau, a nonprofit demographic study group. This demographic shift offers both a challenge and an opportunity for massage therapists--a challenge to reach out to the undertouched, and an opportunity to develop a rewarding elder clientele. (See Demographics of Aging.)

In this article, I explore the territory of elder massage: how to build an elder practice, the benefits of massage for elder clients, the challenges of working with the elderly and the rewards of this specialization for the massage therapist. I hope that many massage therapists who have not yet explored this satisfying work will be called to a new adventure.

How I Started My Elder Practice
The phone rang at 6 a.m. "You must come at once," commanded Helen, an 89-year-old retired physical therapist. "I must have a massage . . . today! The work you did on my feet last night . . . I slept through the night with no foot cramps for the first time in years."

Squeezing & Stretching the hand provides connection & reassurance, and sends a relaxation response throughout the body.

I had met Helen the night before at one of my lectures on the benefits of massage for elders. She had sat in the front row and volunteered to receive a  hands-on demonstration. When I decided that I wanted to provide bodywork for elders, I began contacting retirement communities, senior centers, and convalescent hospitals, and found their staffs eager to provide an opportunity for their residents and patients to receive massage. A letter to either an activities director or a facility director, followed by a phone call and personal visit, led to more than a dozen requests for on-site lectures on the benefits of massage. From this series of introductory lectures, three retirement homes invited me to provide bodywork to their residents. Helen became my first regular elder client. That was 15 years ago.

From that initial outreach, I continue to receive referrals from clients, families and conservators of clients, and staffs at retirement homes. Caregivers pass me from one client to another.

Confronting Stereotypes About Aging
Many of my older clients talk about how, inside their aging bodies, they feel as young as ever. Betty used to say, "I never thought I'd live to be this old."
"How old are you?" I asked her.
"Eighty."
"And how does 80 feel?"
"I feel as young as ever, except for my ears and my knees!"

Betty and hundreds of other clients have shattered many of my assumptions about aging. Here are some of the myths and the real clients who defy those myths.

Myth Number One: Elders are shy about their bodies. The first day I met Frieda, 92, a retired city council woman, she pranced gaily into the room, threw off her bathrobe, and marched in front of me nude. "Look at my hips," she said. "Can you tell if one is lower than the other?"

Betty, 85, often came to her appointments barefoot, wearing only a light-blue robe over her undergarments. "Why should I bother to wear clothes when dressing and undressing takes me so much time?" She would fling her robe on the couch, reach into her bra for a prosthesis, toss the fabric breast onto the couch, climb onto my table with her mastectomy scar fully exposed, and declare, "Getting a massage is so decadent. If I were a cat, I'd purr. How did I get to be so lucky?"

On the other hand, some clients are more modest. I always drape my clients with a sheet (and blanket when needed) and uncover only the area being massaged.

Myth Number Two: Elders no longer experience sensual pleasure. Justin, 87, a retired pathologist with a surgeon's soft, sensitive hands, always asks me to spend extra time on his hands. "Ah," he says, sighing deeply. "It's amazing how much feeling the hands have. When you knead my hands, I feel all the tension in my body melting."

Eighty-year-old Sarah revealed her sensuality in her love of music, as well as her love of massage. One day I was applying effleurage to her calves as we listened to a lied sung by Richard Tauber. She lay quietly, a contented expression on her face. Suddenly her eyes popped open. "Can you feel that?" she exclaimed. "It's so gorgeous."

What, I wondered, the massage or the music?

As if answering my thought, she spoke: "I feel this gorgeous music running down my skin, from head to toe, like a shower!"

Many elders have acute sensual awareness. If they have lost hearing or vision, their sense of touch may be heightened. For those who seldom receive touch, massage may bring tears of gratitude or release somatic memory.

Myth Number Three: All elders are frail and must be handled delicately. Recently, I told a stranger about my massage work with elders. "Oh, I'd be afraid to touch them," she responded, "afraid I'd hurt them."

Sarah, like the Elizabeth I mentioned at the beginning of this article, always wanted deep, strong work, especially around her neck, shoulders and upper back. "You can NEVER press too hard," she would say as I pushed my thumbs into shoulder muscles as taut as the riggings on a schooner.

Dorothy, on the other hand, has hypersensitive skin on her hands, arms and feet. Deep touch is painful. She bruises easily, so I avoid the painful areas and work more deeply on less sensitive parts, where she appreciates more forceful pressure.

My elder clients' touch preferences are as individual as any other group--some need it soft and some like it hard.

Attitudes And Skills Required For Elder Massage
Working with elders, I have developed a specific set of attitudes and professional skills--skills such as setting boundaries, waiting patiently and honoring individual differences. These allow me to respect myself, as well as my clients.

Firm boundaries and realistic schedules: Many of my older clients have no set schedule other than mealtimes and doctor visits. Therefore, it is up to me to determine the time frame of our session. Because I often work in my clients' room or apartment, I have found it especially vital to create good boundaries. I schedule at least 15 minutes between appointments, since elders may move slowly and need extra time for dressing and undressing.

Eleanor, 91, whose arthritis causes her to walk slowly, stops to tell a story as she's moving from the toilet to the bed. She asks me to stay for tea, wants to show me all of her family memorabilia and tell me just one more story. She, her husband and her children escaped the holocaust. I treat the floodgate of memories released by massage with sensitivity. I am attentive to Eleanor while I am with her, massaging her sore legs and appreciating the remarkable being who lives in her frail body. And I tell her gently and firmly when I need to leave.

On the other hand, Rose, 95, pops up off her bed, dresses with ease and only needs help with a recalcitrant brace for her ankle. She encourages me to leave promptly to avoid traffic. Her concern for my welfare touches me.

Patience and an ability to wait: In my work, I spend a lot of time waiting: waiting for elevators, waiting for residents on walkers or in wheelchairs to go in and out of elevators, waiting for a client to come to the door, waiting for a client to slowly disrobe or write a check. I take these as opportunities to breathe, relax my shoulders, stretch or reflect on my state of mind. These are also opportunities for me to be in relationship with a client as she buttons a blouse or finishes a sentence.

A willingness to be fully present: I have several clients with Alzheimer's whose questions and stories are repetitive: Why am I here? Why can't I go home? How long have I lived here? Catherine has asked me these same questions almost every week for three years as I massage her legs and back. She may ask one question a dozen times in the same hour. I answer her evenly, without judging or getting frustrated. Every week she inquires about my garden and tells me how much she misses putting her hands in the earth. Each time, the questions and stories are fresh to her mind.

Yvonne, a painter and dancer now confined to a wheelchair by a stroke, always confronts me at her apartment door. "I want to die," she exclaims fervently. "Please help me die. I've lived my life. I'm ready to go."

Every week I tell her, "I understand that you feel ready to die." I try to imagine how it would feel to want to be released from one's body. "I can't help you die, Yvonne," I respond, "but I would like to be present with you on this day, for this hour."

Within a half hour she tells me how happy she is and how, if she must still be alive, she is glad for my visit.

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