PART 2 OF 4: Geriatric massage takes into account physical, psychological, and socioeconomic factors. The elderly population presents us with unique challenges. There is an increased incidence of disease, medication use, impairment, and disability. This blog will help teach you about how to position your geriatric clients and provide maximum comfort during their massage.
Geriatric massage is the modification of massage techniques and body positions to meet the needs of the elderly. Aging is a persistent decline in age-specific fitness as a result of internal physiologic degeneration, or the process of growing older. Old age is a life stage determined by three factors; chronologic age, changes in social roles, and changes in functional capacities. Sixty-five is the chronologic age considered by most developing countries as the beginning of old age, according to the World Health Organization (1). Changes in social roles include occupational retirement and eligibility for pension benefits. Changes in functional capacities are physical and sensory declines such as changes in muscles and joints, decreased neural response time, and impairments of sight and hearing.
Massage Therapy & the Elderly: Ask the client in which positions he or she sleeps at night and reproduce these positions when possible. Many elderly clients are uncomfortable while prone. Dental appliances may contribute to this, even when a soft face rest cushion is used. Some clients, especially those with gastroesophageal reflux disease or congestive heart failure, may be uncomfortable lying flat while supine. In these situations, use a semireclining position. Also, consider limiting the number of times your client changes positions and allow more time for positional changes if moving is difficult. Do not massage elderly clients on the floor or in a massage chair because it may be difficult for them to get onto and up from the floor or massage chair.
Also, consider limiting the number of times your client changes positions and allow more time for positional changes if moving is difficult as can occur among individuals with Parkinson disease or other mobility impairments.
Aging skin is often thin and delicate. When using massage lubricants, use an adequate amount to reduce friction because friction may injure the skin of elderly clients. The risk of bruising and bone fracture increases in the elderly and back massage was reported to cause a spinal fracture in a 66-year old man who had osteoporosis (2). Use lighter pressure and avoid extreme spinal mobilizations (including mobilizations of the cervical region), which has the potential to injure the client with osteoporosis and other bone and joint diseases because of decreased bone mass and compromised intervertebral joints. Gentle rocking is appropriate for elderly clients.
If your client is bedridden or chair-bound, local massage is contraindicated over areas at risk for ulcer formation. At-risk areas for bedridden clients are back of the head, over the scapula, the elbows, the sacrum, and over the heels. At-risk areas for chair-bound clients are over the scapula, the sacrum, the ischial tuberosities, the popliteal areas, and plantar surfaces of the feet. The therapist cannot rely on assessment to determine the presence of developing decubiti because the client may have inflammation manifesting as nonblanching skin that is difficult to observe, particularly in individuals with darker skin. Furthermore, the National Pressure Ulcer Advisory Panel (2014) states that massage or vigorous rubbing should not be used over skin that is at risk of developing pressure ulcers because it is painful and may cause further tissue damage or promote inflammatory reactions, especially in older adults (4 ). Guy (5) and Shahin et al (6) also advised to avoid massage pressure over at-risk areas because pressure may exacerbate local tissue damage.
Foot problems are common in the elderly, so inspect the client’s feet, even if you do not massage them. Physical limitations and visual impairments make it difficult for the elderly to inspect their own feet. If the client is wearing socks or slippers, ask for permission before removing them and replace them afterward. If you do massage the feet and use lubricant, do not place lubricant between the toes because lubricant may contribute to bacterial infections. Avoid unhealthy or suspicious areas and bring them to the attention of the client or caregiver.
If your client is wearing a hearing aid during the massage, refrain from moving your hands close to the ears. Objects near the device may produce an uncomfortable squeaking noise. Be careful of massage to the lower cheeks, because this may be painful if the client is wearing dental appliances.
Respect your client’s slower pace rather than maximizing massage time. The client may need more time to remove and put on clothing, which may be multiple layers. More time also may be needed to take care of comfort measures such as using the toilet, drinking water, and arranging pillows and blankets.
When the session is complete, replace the client’s eyeglasses, socks, or slippers and anything else you removed before the massage began. If you dimmed the room lights, raise the light level before you leave the massage room. Your client may like to share a personal story with you. Make time for that. This may require more time between scheduled appointments.
For further reading please visit Part 1 of this four part blog series.
Article and Journals Referenced:
- World Health Organization: Definition of an older or elderly person. Retrieved from http://www.who.int/healthinfo/survey/ageingdefnolder/en/
- Guo Z, et al: Isolated unilateral vertebral pedicle fracture caused by a back massage in an elderly patient: a case report and literature review, Eur J Orthop Surg Traumatol 23(Suppl 2):S149–S153, 2013.
- National Pressure Ulcer Advisory Panel: Prevention and treatment of pressure ulcers: quick reference guide, 2014. http://www.npuap.org/wp-content/uploads/2014/08/Updated-10-16-14-Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-16Oct2014.pdf
- Guy H: Does massage help to prevent pressure ulcers? Nursing Times 107:32–33, 2011. http://www.nursingtimes.net/nursing-practice/specialisms/wound-care/does-massage-help-to-prevent-pressure-ulcers/5033735.article
- Shahin ES, Dassen T, Halfens RJ: Pressure ulcer prevention in intensive care patients: guidelines and practice, J Eval Clin Pract 15(2):370–374, 2009
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.