PART 1 OF 4: Individuals 65 years and older are the fastest-growing population in the U. S. The size of this population is expected to grow, increasing from 15% to nearly 24% by 2060 (1). This creates a need for knowledge and skills related to geriatric massage. Read on and learn how to make your practice more accessible for older clients.
The best time to schedule massage sessions for elderly clients may be during daylight hours. Elderly clients often prefer not to drive their vehicles after sunset because of impaired night vision and increased sensitivity to glare. Arrange office furniture so your client can move around easily. Adequate space is needed between furniture and walls so a client using a walker or other mobility device can easily pass (32 inches is recommended) (2). Be sure lighting is adequate while the client is moving through the room, and be certain there are no unsecured throw rugs or cords in the path because the elderly are at increased risk for falls.
Be sure to have adequate lighting and reduce noise in the room where the intake is conducted. Assist the client with filling out forms if needed. Assess your client’s health and vitality. Ninety-two percent of elderly clients have at least one chronic condition and some elderly clients have multiple chronic conditions (3). Inquire about limitations from impairments or disabilities.
A thorough intake is essential. Query your client about medication use, methods of administration, and any medication side effects he or she may be experiencing. While the elderly make up 15% of the population, they account for 34% of prescription drug use and 30% of over-the-counter drug use (4). Many elderly individuals take multiple drugs, with two in five elderly individuals reporting taking five or more prescription drugs. Commonly used medications in this age group are cardiovascular agents, antihypertensives, analgesics, antiarthritic agents, sedatives, tranquilizers, antidepressants, and laxatives/antacids (4).
Provide unobstructed passage to and from the massage table. Also, keep equipment and supplies in the same place, and explain to clients about any changes during subsequent sessions. If possible, use a massage table that can be raised and lowered easily, such as an electric-lift table. Lower the table to approximately 18 to 24 inches when the client gets on or off the table. The specific height to which the table is lowered is determined by your client’s actual height. A wider table is preferred such as a width of 33 inches so the client can change body positions more easily. Avoid using massage chairs because it may be difficult for the elderly to get on and off the massage chair. Be sure your table is barrier-free and devoid of pillows and bolsters while your client transfers to and from the table.
Falling is the biggest safety issue for elderly clients. Many older people experience dizziness related to: vision or hearing impairments, medication side effects, or sudden changes in blood pressure. Dizziness related to a sudden drop in blood pressure is called orthostatic hypotension and occurs most often when the individual is moving from a lying down or sitting position to an upright or standing position. Orthostatic hypotension, or dizzy spell, occurs within 3 minutes of sitting up or standing and is associated with injuries from falling. One third of community-dwelling elderly people and 60% of nursing home residents fall each year (5).
Respect the elderly client’s slower pace by allowing ample time for tasks such as conducting the intake interview, explaining procedures during each visit, removing and donning clothing, inquiring about and responding to comfort measures such as a request for a blanket, and getting on and off the massage table.
Suggest that the client use the toilet before the massage begins and be prepared for a toilet break during the session. Have a robe available to use when disrobed clients need to leave the massage room to use the toilet.
Cover the naked or clothed client with a blanket during the massage because many elderly people experience cold intolerance. If you use a table heating pad, turn it on before the client arrives to warm the table surface and turn it off when the client is on the table because many elderly have poor thermal regulation and decreased sensitivity. Avoid the use of heat packs, ice packs, hot stones, and other types of hydrotherapy that may burn the client. Assist in the removal of any eyeglasses or hearing aids and the placement of walkers and canes if needed. At the conclusion of the session, replace these items.
Sometimes it is best to perform the massage at the client’s residence rather than at the therapist’s office. Space is often limited so do not bring a portable massage table. Instead, massage clients where they are most comfortable, which may be their bed, recliner, or wheelchair.
Articles and Journals Referenced:
- Mather M, Jacobsen L, Pollard K: Population bulletin: Aging in the United States, 2015. Retrieved from http://www.prb.org/pdf16/aging-us-population-bulletin.pdf
- National Council on Aging: Health aging facts. Retrieved from htttps://www.ncoa.org/news/resources-for-reporters/get-the-facts/healthy-aging-facts/
- National Council on Patient Information and Education: Fact sheet on medication use and older adults. Retrieved from http://www.mustforseniors.org/documents/must_factsheet.pdf
- Fuller GF: Falls in the elderly, Am Fam Physician 61(7):2159–2168.
Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at firstname.lastname@example.org.