No matter who we are or where we come from, our bodies will go through certain changes through time. Just as we slow down, massage therapists can adjust massage sessions to give the most benefit to an elderly client.“You keep your goals very moderate,” says Jane Neumann, LMT, who specializes in treating older people with Parkinson’s disease (PD) or dementia. “You’re not curing their condition. You’re there to be present and to touch them with kindness. It is very moving work.”
According to a 2018 analysis of data from the 2012 National Health Interview Survey, 29 percent of people in the U.S. age 65 and older have used at least one type of integrative health approach, and massage was in the top three.1
However, more recent research has found that massage therapy and other integrative health approaches are underutilized by older people. A 2020 study used data from the PRECISION Pain Research Registry to assess the use of integrative health approaches for chronic low-back pain. The researchers found that while massage was used more than other integrative approaches in the study, increasing age was associated with lower use of any integrative approach.2
“Out-of-pocket costs and accessibility may be important barriers for seniors in using massage to treat low back pain,” says John Licciardone, DO, MS, MBA, regents professor of Family Medicine at the University of North Texas Health Science Center at Fort Worth and director of the PRECISION Pain Research Registry. However, further research into the benefits of massage, particularly for age-related conditions such as dementia, may help change this. A 2019 study found “strong evidence for use of massage” for clients with dementia and Alzheimer’s disease living in residential facilities.3
And a 2019 review and meta-analysis found that massage may serve as a nonpharmacological strategy to improve behavioral and psychological symptoms in people with dementia. “So far, pharmacological management is limited because of small effect sizes and side effects of the drugs. Therefore, it is important to assess nonpharmacological treatment options such as massage,” write the researchers.4
In a 2019 survey, Sarah Donley, RN, and Martha Nance, MD, medical director of the Struthers Parkinson’s Center in Golden Valley, Minnesota, found that massage was the most frequently used therapy by 272 of 435 people with Parkinson’s disease.5 “In today’s world, health care providers and insurers base the majority of what they do on ‘evidence-based treatments.’ We need to build that base of evidence for massage therapy as an adjunct in the management of PD,” they say.
Age-related health conditions that massage therapists may encounter include PD, diabetes, osteoporosis, cancer, Alzheimer’s and dementia, each of which may impact a massage session differently. “There is a difference between working with active seniors and a more disabled population,” says Neumann. Depending on the client’s condition and needs, therapists may adjust the length of the session, where the session takes place and which techniques work best.
Eddi Goldberg Perlis, LMT, CMLDT, follows a specific protocol when working with clients with dementia. “I can’t just start at the foot. I have to build trust with the client,” she says. Instead, she asks to hold the person’s hand and she continues to ask permission at each step. “I will ask if it’s OK to touch their arm, and then their shoulder, but still my hand will be holding theirs.”
“People experiencing these kinds of disorders often lose contact with other people,” Neumann says. “They don’t experience the touch we usually have in everyday life.” The value of touch is bolstered by recent research. A 2020 study on the effects of hand massage (HM) and therapeutic touch (TT) on 255 older people living in nursing homes found that their levels of anxiety decreased and their levels of comfort increased. “It is thought that nurses can easily integrate HM and TT, which are nonmedical, nonpharmocologic interventions with no adverse effects into care activities,”write the researchers.6 In another study, researchers found that slow-stroke back massage significantly reduced anxiety in candidates for cataract surgery.7
As people age, their subcutaneous fat layer and epidermis are thin, and their skin takes longer to heal. Some health conditions, such as diabetes and kidney disease, also cause dry skin, while certain medications may cause itchiness and scratching. “Seniors in deteriorating health may develop what is referred to in geriatric care as ‘parchment skin,’” says Neumann. “You can see through it to the veins and ten-dons beneath and it can tear easily, so more lubrication and less tissue engagement isneeded.”
With proper training, massage therapists may help spotchanges in skin such as skin cancer or developing bedsores. A 2019 study in web-based skin cancer prevention training for massage therapists found that the protocol “begins to fill a gap in skin cancer risk reductionresearch.”8
“Training with photos of skin changes and discussion ofhow to talk with clients’ caregivers about our observations about signs of possible pressure sores in an ethical and effective manner is much needed,” says Neumann, “along with more visual training to understandwhich changes in skin texture and resiliencerequire adjustment.”
Working with Guardians
With very elderly or disabled clients, a massage therapist may be working with their guardian or a person assigned power of attorney instead of directly with the client. A power of attorney directive allows people to name a trusted person to act as their agent to speak on theirbehalf.
“Many of my clients are not competent,” says Perlis. “I have a health history questionnaire that I will review with the power of attorney or guardian.” However, she makes sure to also establish a connection with the client. “I will ask if it is OK if I speak to their guardian or power of attorney. I try to respect their wishes.”
Know Your Client
“Muscle stiffness is one of the core symptoms of PD, and it makes sense that massage would help to relieve that symptom—with fewer side effects than medication,” say Donley and Nance. “[Massage] would be expected to specifically treat muscle stiffness, and unlike medication, the treatment can be tailored to whichever muscles are particularly stiff.”
Neumann often uses passive mobilization of the arms that she calls “wing stretchers” to help relax chest and arm muscles that are contracted. “You sometimes need to work very slowly in muscles or muscle pairs that are affected—they tend to naturally contract forward as the condition advances, so part of your goal is to give a moment of spreading,” she says. “You want to remind the muscles they don’t have to work that hard.”
Donley and Nance point out that in PD the ability to move may “change from the beginning of a session to the end—the person may be able to walk in but have trouble walking out (or vice versa).” They add that clients may also need to take medication during the session or need help getting on or off the table, which is why thera-pists should be thorough during intake. “There are specific things to know that you want to inquire about,” says Neumann.
Elderly clients may stay fully clothed, with a session taking place in their beds, chairs or wheel-chairs. “I rarely use a massage table unless the client is very robust,” says Perlis. “I can massage the person wherever they feel most comfortable.” In fact, she often finds that massages on a regular chair or recliner provide easier access to the client’s back. She will use a side-lying position if a client is in bed, with a pillow placed under one knee and the client holding a pillow.
Clients who are frailer and with serious health conditions benefit from shorter, gentler and less ambitious sessions. “It’s a different pace of work,” says Neumann. “Working with someone with Parkinson’s really requires slowing it down.” She points out that a stretch may take twice as long as with younger clients.
At Day-Break Geriatric Massage Institute, Perlis learned techniques to accommodate elderly clients. For example, she says a half-hour massage is preferred to a one-hour massage so as not to overstimulate the client. She remem-bers one elderly client with a prior history of blood clots who requested a deep tissue massage, but she had to inform him it would not be advis-able. “Sometimes what you tell the client is not what they want to hear,” she says.
“It’s important to know who the client is,” she emphasizes. “I talk to the nurses, or when I do a home visit, I will spend a good amount of time talking to the person, assess the surroundings and speak to the family if necessary.” That helps augment the intake process and helps her understand what accommodations to make that will most help her clients benefit from massage. One 80-year-old client with progressive supranuclear palsy in particular benefited from accommodations. “She was very stiff and wasn’t able to move very much,” remembers Perlis, who massaged her in her recliner while letting her choose what music to play. “You really get a chance to know your clients and what they are going through. I really love what I do."
Neumann stresses the importance of emotional self-care for massage ther-apists who work with older clients who may have incurable health conditions. “You need to be willing to examine your own feelings about mortality because you are with them all the time. You don’t need to be working through emotions at the tableside with the client.”
Perlis says it’s important to monitor oneself for stress. “It’s important to take care of yourself because of the work that you do—you can deplete yourself.” However, she has no doubt that for her, geriatric massage is the right fit. “Talking to elderly people is easy for me—listening to them, hearing what they have to say.”
Massage Therapy Journal
Massage for Active Seniors
1. Rhee TG, Marottoli RA, Van Ness PH, Tinetti ME. "Patterns and perceived benefits of utilizing seven major complementary health approaches in U.S. older adults." J Gerontol A Biol Sci Med Sci. 2018.
2. Licciardone JC, Pandya V. "Use of complementary health approaches for chronic low-back pain: A pain research registry-based study." J Altern Complement Med. 2020.
3. Smith BC, D’Amico M. "Sensory-based interventions for adults with dementia and Alzheimer’s disease: A scoping review." Occup Ther Health Care. 2019.
4. Margenfeld F, Klocke C, Joos S. "Manual massage for persons living with dementia: A systematic review and meta-analysis." Int J Nurs Stud. 2019.
5. Donley S, McGregor S, Wielinski C, Nance M. "Use and perceived effectiveness of complementary therapies in Parkinson’s disease." Parkinsonism Relat Disord. 2019.
6. Yucel SC, Arslan GG, Bagci H. "Effects of hand massage and therapeutic touch on comfort and anxiety living in a nursing home in turkey: A randomized controlled trial." J Relig Health. 2020.
7. Mohammadpourhodki R, Sargolzaei MS, Basirinezhad MH. "Evaluating the effect of massage based on slow stroke back massage on the anxiety of candidates for cataract surgery." Rom J Ophthalmol. 2019.
8. Loescher LJ, Heslin KM, Szalacha LA, Silva GE, Muramoto ML. "Web-based skin cancer prevention training for massage therapists: Protocol for the massage therapist's skin health awareness, Referral, and Education Study." JMIR Res Protoc. 2019.