Geriatric Massage: Pressure, Mobility Challenges & More - Massage Magazine

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Working with the elderly population can be a rewarding endeavor in the massage therapy field. Geriatric massage involves massage techniques and applications to meet the needs of the elderly population.​

Aging is a decline in wellness due to functional waning of internal physiology. Over time, an individual will reach “old age.” Sixty-five years old is the chronological age considered by most developing countries as the beginning of old age; a person may be classified as elderly or a senior citizen. This is simply an accepted number in science. Be careful not to assume anyone of this age or older fits a stereotypical view of the elderly.

Currently in the U.S., one in seven people, or 16% of the population, is age 65 or over. That figure, says the U.S. Census Bureau, is expected to increase to 19% of the U.S. population by 2025.

Conditions of Aging​

The elderly population presents unique challenges. There is increased incidence of disease, medication use, impairment and disability. Some elderly clients are active while others are inactive. Therapists must consider these factors when formulating a treatment plan.

Elderly individuals may fall within a continuum of being either robust or frail, depending on varying factors. A distinction between robust and frail individuals is prudent to make at this point. Typically, robust elders can perform daily tasks with minimal fatigue, display average to higher levels of physical activity, present with normal body weight and possess great memory recall.

Conversely, a frail individual may fatigue easily with basic life tasks, display lower levels of physical activity, appear underweight (perhaps due to chronic disease) and present waning memory or signs of dementia.

The elderly population presents us with unique challenges as anatomy and physiology changes. Conditions leading to death in elderly individuals are heart disease, cancer, COVID-19, stroke and accidents. As the body wanes, a therapist needs to consider many anatomical and physiological factors.

Skin begins to lose elasticity, becoming thin and fragile. Subcutaneous adipose decreases, leading to cold intolerance. Pigmentation increases in varying spots, which may appear as liver spots (senile lentigo), premalignant changes such as actinic keratosis occur, or skin cancers such as basal cell carcinoma and squamous cell carcinoma may develop.

Bones and joints begin to lose integrity. Osteoarthritis is likely within the weight-bearing joints. An annual loss of bone and muscle mass coinciding with hormone waning will be witnessed. Ligaments and tendons lose resiliency, thus reducing flexibility and coordination.

Declines in muscle tonicity and strength, coupled with neurological deficits, can create unstable gaits and postures. Sarcopenia and osteopenia, waning of muscles and bones respectively, may occur with the rate of decline dependent upon physical fitness levels, dietary choices and the nature of one’s occupation and activities.

In aging females, menopause occurs as levels of estrogens decline and ovarian functions wane. Uterine projects such as fibroids and pelvic floor disorders may develop. In aging men, testosterone may decline steadily. Urinary flow disturbances may occur as the prostate may exhibit benign hypertrophy. Pancreatic function may decrease, leading to type 2 diabetes mellitus and/or hypoglycemia. A goiter, an enlarged thyroid, may form as thyroid hormone production wanes, reducing metabolism and increasing weight gain.

Respiratory function may be impacted greatly due to an inability of the lungs to defend against pathogens and environmental pollutants. The risk of respiratory infection increases as one ages, as the elderly are more at risk for upper respiratory infections. Breathing challenges can exacerbate other chronic health conditions.

Arterial plaque may accumulate within arterial walls, leading to atherosclerosis. Hypertension may result, leading to coronary and carotid artery disease and the formation of aneurysms. Varicose veins may appear anywhere (not only in the legs) once pressure builds enough to damage valves within veins. Congestive heart failure can be just as silent as hypertension, both of which can cause the heart to become overly taxed and weaken over time.

Some conditions, such as skin diseases, may become a source of embarrassment and social anxiety. Be sure to approach clients with compassion, acceptance, empathy and nonjudgment.

The best time to schedule massage sessions for elderly clients is during daylight hours. Many elderly clients prefer not to drive after sunset due to impaired night vision and sensitivity to light glare.

Treatment Details​

Massage can benefit the elderly, but certain considerations must be kept in mind.

Arrange your massage space furniture so clients can easily move around. Have enough space between furniture and walls so a walker can easily pass. Be sure furniture is stable enough to support body weight.

Respect the elderly client’s slower pace by allowing ample time for usual intake, massage and post-session tasks. An hour session may very well become 75 minutes. Schedule accordingly.

Also respect your client’s slower pace rather than maximizing massage time. Your client may like to share a personal story with you. Honor space to allow your client to share.

Be sure to have adequate lighting and reduce noise in the room where the intake is conducted. The majority of elderly clients have at least one chronic condition; many may have multiple conditions. Inquire about limitations from impairments or disabilities.

Inquire about medication use, methods of administration and any side effects he or she may be experiencing. Many elderly people take multiple drugs daily. Commonly used medication classes include anticoagulants, antihypertensives, analgesics, hypoglycemic, psychoactive and diuretics.

Falling is a major concern for elderly clients. Many older people experience dizziness related to orthostatic hypotension, loss of balance and reduced response time. Medication side effects may contribute to this issue. Stand near the client as much as possible in your treatment space.

On the Table​

If possible, use a massage table that can change height easily, such as an electric-lift table. A wider table makes flipping over easier. Avoid using massage chairs with frail clients or clients with osteoporosis.

Have an extra blanket available, as many elderly persons experience cold intolerance. If using a table heating pad, turn it on before the client arrives, since poor thermal regulation can be an issue. Place bolstering items upon the table after the client has transferred to upon the table.

Assist in the removal of eyeglasses or hearing aids. Also, assist in the placement of walkers and canes if needed.

Ask the client in which positions he or she sleeps at night and reproduce these positions when possible. Have several cushioning bolsters or pillows of varying sizes and shapes available for this task.

Many elderly clients are uncomfortable or have breathing difficulties while prone. Dental appliances may make the prone position uncomfortable, even when a soft face rest cushion is used. Avoid the prone position for long periods of time if a client has breathing difficulties or wears dental appliances.

Limit the number of times a client changes position, because doing so may be quite difficult. Be sure to allow more time for positional changes and assist when needed.

Pressure and Strokes​

If the client is robust, a classic Swedish-style massage can be performed when indicated. If your client is frail, use techniques that are rhythmic and gentle. Gentle joint mobilizations such as rocking are appropriate for the frail elderly.

Administer pressure with broad manual tools. Be mindful how much inflammation is created with pressure delivery. Aging skin is often thin and delicate. When using massage lubricants, use an adequate amount to reduce friction, as friction may injure the delicate skin of elderly clients.

View the client’s feet during sessions. 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 get it between the toes because lubricant may promote bacterial infections.

If the client is wearing a hearing aid during the massage, refrain from moving your hands close to the ears. Close proximity to the device may produce an unbearable sound. If the client is wearing dental appliances, massage upon the facial cheeks can be painful.

When guiding your client from one area to another, stand in front of the client or to the left. Use descriptive words to describe the room. Often using a clock analogy to help the client will be useful, i.e., “there is a chair at your 2:00.”

Guide any object towards the clients’ hand if there is a visual impairment. If the client has an assistant or interpreter of any type, be sure to direction conversation toward the client. Use linens of contrasting colors to avoid confusion. Increase the light level in the room if the lights are dim.

Speak in a normal tone of voice when you enter the treatment room. Maintain eye contact while speaking. For hearing-impaired clients, be sure to establish non-verbal communication. Hand signals tend to work best. Hearing aids make sounds louder but do not clarify the meaning of what is heard. Keep language simple and pertinent.

Meet Mobility Challenges​

For clients with mobility challenges, include a rest period when your client arrives as he or she may be physically fatigued from using a mobility device. Generally, the longer a client has been inactive, the more their bones will have weakened. Limit all stretching and joint mobilization techniques. In areas of neuropathy, use gentle, firm pressure. Poor thermal regulation may be an issue as well.

Legally, a wheelchair is part of the body space of the occupying person. Avoid leaning on the chair and push it only when asked. During the intake, sit down so both of you will be at eye level. Ask your client to describe the degree of limitation they experience.

You can massage a client in a wheelchair. Place pillows atop your massage table onto which your client can lean forward. If your table is unavailable, place a cushion in the client’s lap and have the person lean onto it or desktop devices.

Be sure the chair wheels are locked before the massage begins. Local massage is contraindicated over areas at risk for ulcer formation. At-risk areas for individuals who are chair-bound are over the scapula, the sacrum, popliteal areas, and plantar surfaces of the feet.

Immobile clients and those in wheelchairs are at a higher risk for deep vein thrombosis (DVT). Screen for DVT by looking for signs and symptoms such as an “on-the-bone” ache, unilateral swelling, warmth, redness and tenderness. If these are present, avoid the affected region. Refer the client to their health care provider for evaluation.

About the Author​

Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches “Professional Ethics for LMTs” and many other CE classes. He is a regular contributor to MASSAGE Magazine.

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