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.)
Demographics of Aging
Thirty five million Americans are over 65
In 1900, the average American lived to be 46
In 2000, the average American lived to be 76
By 2020, one in five Americans will be over 60
By 2025, Americans over 65 will outnumber teenagers by more than two to one
The "old old" (over 75 years) is the fastest-growing subset of our aging population
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.
"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.Benefits For Elders
- Reduces stress
- Deepens relaxation
- Deepens breathing
- Lowers blood pressure
- Stimulates circulation
- Relieves joint pain
- Reduces swelling and edema
- Stimulates bowels
- Stimulates flow of lymph
- Improves sleep
- Releases endorphins
- Decreases fear and anxiety
- Brings sense of well-being
- Decreases isolation
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.Conditions That May Preclude Massage
- Thrombosis (blood clot)
- Thrombophlebitis (inflammation of a vein)
- Severe edema (swelling)
- Skin lesions, bruises or sensitivity
- Abdominal aneurysm
- Note: Always check with the client's physician after a stroke or a heart incident for advice about appropriate massage
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.
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
Willingness to confront our own aversion to aging: In our youth-worshipping culture, it is hard not to equate wrinkles to a loss in value. We constantly witness condescension toward older people. "It's as if," says San Francisco Chronicle columnist Jon Carroll, "those wrinkles equal dead brain cells."
I believe condescension is a form of distancing, of pushing away what is unknown or frightening. Bodywork allows us to make contact with the being beneath the wrinkled exterior, to get up close to what may be unfamiliar. An elder body is a map of the personÕs history and genetics. Broken capillaries, age spots, incontinence, and stroke-related speech difficulties are part of the territory, surface landmarks.
When I entered the field of elder massage in my early 40s, I had had little experience with elders. As I stood looking into the faces of a circle of 20 old women, many in wheelchairs, and began my first talk on the benefits of massage, I was sweating and apprehensive. The women around me looked so old, their faces deeply furrowed.
In the circle, Ida, a 90-year-old retired missionary responded to my presentation of acupressure points. "I always got acupuncture in China," she said. "It kept me going." Reaching out a gnarled, arthritic hand, she asked me to show her self-acupressure. "Maybe it will help my arthritis," she remarked. For 10 minutes, Ida shared her experience of the power of Chinese medicine, as I held acupressure points on her hands and arms. I was so engaged by the depth of her response that I forgot that she was old. This experience with a wizened elder taught me to look beneath the wrinkles, to connect with the human being whose life is reflected in those etched lines.
Our conversation was also the beginning of a shift in my attitude about my own aging. Thanks to the many clients who have allowed me to know them through the intimate trust of massage relationships, I am becoming less afraid of getting old.Billing
- Many clients will write their own checks
- In some cases, you may bill a family member or conservator
- Some insurance companies will cover massage as a medical necessity
Respectful communication with each client: How we talk with elder clients may be as critical as how we touch them. Many professionals in the geriatric care field habitually speak to elders in ways that are ageist, disrespectful and patronizing. My teeth grate when I hear my clients called "dear," "sweetie" or "honey." I call my clients either "Faye" or "Mrs. Jones," depending on the client's preference.
What we speak about is equally important. Sharon Ellison, founder of Ellison Communication Consultants, conducted a geriatric convalescent unit study analyzing the content of what was said to one patient over 24 hours. The results were shocking. Not once did a care provider speak about an issue that was not related to health, food, practical care or the weather. The patient she was observing was a retired Stanford University professor.
Every client has interests besides getting to the next meal and getting to the toilet. I count on meaningful conversation and challenging questions from Rose; I consider her one of my teachers. "Who are your heroines?" she'll ask one week. Another time, "Did you know that Abigail Adams helped write the Constitution?"
"Respect," says author Mary Pipher in her groundbreaking book, Another Country: Navigating the Emotional Terrain of Our Elders, "means turning the elderly into elders. We need media that portrays the old as worthy of our time . . . We need cultural stories that point us back to older people as a source of joy and wisdom . . . On an individual level, respect means giving the old time and attention...".
Rose hungers for engaging conversation. No one on the staff of the retirement home where she lives approaches her to discuss anything but housekeeping and health issues. One day, after our massage session, Rose turned to me and said, "Thank you for treating me like a human being."
Gifts For The Massage Therapist
Working with elders offers great rewards. In valuing the interests, concerns and bodies of a population who are so often "set aside," we become privileged witnesses to an earlier generation. And in honoring their aging process, we can prepare for our own aging. Some of the other benefits I've experienced include:
The gift of slowing down: The slower pace of most of my clients invites me to slow down. Even if I have rushed on crowded freeways or race-walked down congested hallways, when I get to my clients' room or they arrive at my office, I attempt to attune my rhythm with theirs. At 103, Thelma was always sitting in her lounge chair when I arrived. I knew, with her limited sight, that I needed to get close before she could see me. She was also hearing impaired, so I would shout when I arrived at her door, "Hello, Thelma! Happy Friday. It's Joan!" and her face would burst into a smile.
I would pull a chair next to her, place my hand on her arm, and make contact with her before getting her up, crossing the room slowly, and removing each article of clothing with care for her balance and her frailness. My goal was to respect her pace and her needs rather than maximizing the massage time.Where/How To Work
I see a number of my elders in my private office. Some are transported by family members or caregivers and others drive. Senior facilities can often provide a private space to work. I have set up my massage table in a beauty salon, a guest apartment, and a small chapel, which the chaplain dubbed the Body and Soul Shop. Since many elders are too frail or disabled to climb onto a massage table, I either lower my table or work on a client's bed. I use sheets to protect the bed from lotion or oil.
Opportunities to confront our own mortality: Massage therapy with elders offers some of the same rewards and emotional challenges as hospice work. In the 15 years I have served an elder clientele, I have lost over 40 clients to death. While each client's death affects me differently, I have needed to take time to process each loss, either by writing about the client, talking with family members and friends, or simply taking a walk and remembering my connection with the deceased.
I remember the day I arrived for 90-year-old Ethel's regular appointment, and found her in bed, lying motionless. She had had an early-morning stroke.
I stayed with her until she was taken to the hospital, called her daughter and son, and followed her to the hospital until her family could arrive. During the weeks after her stroke, Ethel had no speech. She had been a nonstop talker and storyteller, notorious for her inability to listen. As I massaged Ethel's stiff shoulders, arms and neck, friends would come, tell her stories and offer best wishes. She could only respond to me and to them with her big grayish-green eyes.
"For once in her life, mom's been forced to listen," commented Ethel's daughter, Clair. "The stroke has given her, and us, that gift."
In Mitch Albom's best-seller Tuesdays With Morrie, Morrie tells Mitch: "Aging is not just decay, you know. It's growth. It's more than the negative that you're going to die, it's also the positive that you understand you're going to die and that you live a better life because of it."
Each time I leave a client, I am aware that this may be our last session. "See you next week," I say. And, occasionally, a knowing client will respond, "If I'm still here."
Appreciation from grateful clients: Many of my clients feel discarded, either by their families or by the culture, simply because they are old. A half hour or an hour of respectful, attentive touch helps them feel valued.
One evening I was saying "good night" to a grumpy client who was feeling ill. I took her hand. "I wish there were something I could do to make you feel better," I said.
I feel better just because you are here," she responded. "I don't know when the last time was that someone held my hand."
As I was stroking Barbara's back during her first massage, she began to weep. I asked her what was wrong. "No one has touched me with this much tenderness since my husband died 10 years ago," she said. She then told me stories about her husband, and thanked me for reminding her that she was still very much alive.
Witnessing the harvest of our clients' life's passions: My clients share with me what they have cared about for a lifetime, and their stories give me a sense of connection to their history. Rose grew up on Caruso, Gilbert and Sullivan, and the Bhagavad Gita. She sings from "The Mikado" when I visit. Sarah had a collection of 10,000 classical records that she began collecting as a girl. She played Vivaldi and Mozart as background music to our massages. Plagued with arthritic knees and wheelchair-bound, Ann could no longer travel. She had been an avid bird-watcher and botanist. Whenever I took a trip to Central America or to the Sierra Nevada mountains in California, Ann would ask for a full report of the birds and flowers I had seen.Where To Find Elder Clients
- Retirement communities
- Senior centers
- Convalescent hospitals
- Conservators of elders
- Senior health-care clinics
- Senior programs at churches and synagogues or social clubs
Benefits Of Massage Therapy For Elders
While massage therapy offers older clients all the benefits that accrue to younger clients, it is particularly effective for elders because of the physical and emotional challenges experienced by older adults. Many elders are sedentary due to painful arthritis, balance difficulties or circulation problems. Gentle but stimulating massage can accomplish some of the same results as exercise.
Research indicates that social connection is a key component to health and happiness in the elderly. "Isolation is a powerful risk factor for poor health," according to Successful Aging, which chronicled the results of a MacArthur Foundation Study of Successful Aging. An ongoing relationship with a massage therapist can be a significant part of an elder's support network. The elder knows that at least once a week, she or he will receive the focused attention of a caring individual.
Recently, Marjorie, 81, told me, "I woke up in the middle of the night in terrific pain and thought of you. I could relax because I knew you would be coming to see me. I used ice and heat like you suggested, and then I went back to sleep."
"Old age is not for sissies," say many of my elder clients. Providing massage therapy to older adults is also not for sissies, yet it is as rewarding as it is demanding. It requires us to have a genuine interest in the lives of elders, to "get over" squeamishness about body functions and physical decline, to be willing to enter the institutional world of elders, and to treat our elder clients with dignity, no matter what their eccentricities or circumstances.
One of Rose's comments illustrates why I have stayed in this field for many years now. One day after her massage, we were sitting, facing each other, practicing shoulder stretches to release tight, sore shoulders. "I can feel my flame again," she said, looking at me intently.
Then she pointed to her chest. "Your visit has reignited my flame."
An AMTA member for more than a dozen years, Joan S. Lohman, CMT, has been providing massage therapy to elders for 15 years. In addition to her massage certification, she is certified in Rosen Method Bodywork, which honors the connections between muscle tension, breath and emotional holding. She leads healing arts exchanges in Central America through Capacitar, an international women's network, whose purpose is to heal and empower through listening to body wisdom. Lohman is currently writing a book: Touched: Reaching Beneath the Wrinkles.
Joan Lohman, 3897 Whittle Ave., Oakland, CA 94602 (510-530-8031); firstname.lastname@example.org
Albom, Mitch. Tuesdays With Morrie. New York: Doubleday, 1997.
Barstow, Cedar. Tending Body and Spirit: Massage and Counseling with Elders. Boulder, Colorado: Cedar Barstow, 1985 (inspired by students at the Boulder School of Massage Therapy).
Doress, Paula Brown, Diana Laskin Siegal, and the Midlife and Older Women Book Project. Ourselves, Growing Older. New York: Simon and Schuster, Touchstone, 1987 (written in collaboration with the Boston Women's Health Book Collective).
Dychtwald, Ken. Age Power: How the 21st Century Will be Ruled by the New Old. New York: Jeremy P. Tarcher/ Putnam, 1999.
Dychtward, Ken and Joe Flower. Age Wave: The Challenges and Opportunities of an Aging America. Los Angeles: Jeremy P. Tarcher, Inc., 1989.
Kahn, Robert L. and John W. Rowe. Successful Aging. New York: Pantheon Books, 1998.
Nelson, Dawn. Compassionate Touch: Hands-On Caregiving for the Elderly, the Ill and the Dying. Barrytown, New York: Station Hill Press, 1994.
Pipher, Mary. Another Country: Navigating the Emotional Territory of Our Elders. New York: Riverhead Books, 1999.