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The elderly is the fastest growing population in the country. Population experts estimate that more than 50 million Americans, about 17 percent of the population, will be 65 or older in 2020. The elderly presents the massage therapists with some unique challenges. There are the obvious physical changes such as thinning skin, reduced muscle mass, and vision and hearing impairments. This population faces many lifestyle and emotional changes such as retirement, reduced income, and the loss of loved ones. To meet the challenges of this population segment, the therapist needs to cultivate patience, tolerance, caution, thoroughness, kindness, and attentiveness.

Geriatric massage is a form of massage designed to meet the specific needs of the elderly population and takes into account the needs and challenges of the aging. Swedish strokes are adapted to reduce damage to the skin, so pressure and shearing is reduced. The following are simple guidelines to help the therapist provide pleasant and safe massage experiences for the elderly

Thorough Intake

The purpose of older adult intake procedure is to evaluate the client's health status, both strengths and limitations, so that effective and appropriate massage can be delivered. A thorough intake process creates a session that is both age-appropriate and condition-appropriate. The scope of this article does not provide instruction in how to conduct an intake interview or devise a treatment plan, but to remind the therapist of a few important principles and items that need special consideration.

The first principle is to listen to the client. Do not rush through the intake process. Seniors typically need more time to perform tasks, and there is often more medical information to document. While there are many elderly people who are in excellent health, approximately 92% of older people have a chronic illness or medical condition that must be taken into consideration when performing the massage. Be sure to inquire about medications, both what kind and why they were prescribed.

Be sure you have the name and contact number of a family member or friend, in case of an emergency, as well as the client's primary care physician's name and contact number. Consult with the client's physician if questions arise about the client's condition.

Robust and Frail Seniors

Assess the client's vitality and vigor during the intake interview. Decide, based on the client's health status and activity level, if the client is more robust or frailer. Active, robust seniors still experience body changes that accompany the aging process, but can benefit from a more traditional massage. Dry skin responds well to highly emollient cremes, and the therapist has the opportunity to observe any skin changes while the client is draped on a massage table.

If the client is frailer, traditional Swedish massage is avoided in favor of broad, perpendicular acupressure and rocking techniques. The purpose of the latter is to provide some mild form of exercise by gently moving the limbs. However, geriatric massage should not be used as a replacement for exercise. More than 70% of elderly are sedentary.

Reducing pressure

Because of the changes in aging skin, such as reduced elasticity and decreased subcutaneous fat, the elderly are more easily injured. This necessitates reducing both downward pressure and shearing force of the hands sliding over the skin. Reduced pressure does not translate into a light massage.

Stretching and joint movements

Include gentle stretching and joint movements such as rocking if the client feels up to it. Constantly monitor the client as these movements can be tiring for him or her. Avoid extreme spinal mobilizations (including the neck), which may harm the client in cases of increased bone porosity.

Shorter sessions

Treatment time is shorter, about 30 minutes, to reduce the possibility of fatigue. One suggestion is a 5 minute introduction of unhurried effleurage, deep breathing, and gentle rocking. Next, 20 minutes of focused work on the feet, legs, shoulder, or neck (client determined). This is followed by 5 minutes of closure work.

Guard against chilling

Because of reduced metabolism and decreased subcutaneous fat, many elderly feel uncomfortably cold. Use heavy blankets over the client's naked or clothed body and if appropriate, an external heat source such as a portable heating unit.

Appropriate Session Location and Time

The session location suits the client, which means that massage might be performed at the client's residence rather than the therapist's office. Furthermore, the actual session may take place in the client's bed or sofa, especially if getting on and off the massage table is not safe for the client. Rarely is the floor a good place for massage as it may be difficult for the elderly to get up from the floor.

Massage sessions are scheduled at the safest time for the client, such as during daylight hours if the client is driving to the therapist's office.

Be patient and reverent

The attitude in which a therapist approaches working with the elderly is often different. "This ain't sports massage," says Joan Lohman, massage therapist who specializes in geriatric massage. The therapist respects the client's slower pace rather than maximizing massage time. Schedule time in the appointment to allow for the client to undress (sometimes layers and layers of clothes have to come off); you may have to help him or her onto the table and off the table. The client may need a time of transition after the massage or would like to share a story. If you watch and listen, you may become an honored witness to an earlier generation's wit and wisdom.

Every client will be different; every session will be different, even if it is the same client seen each and every week. In Mitch Albom's best-seller Tuesdays With Morrie, Morrie tells Mitch that "Aging is not just decay,.. 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 client will be in a different phase of this growth called aging. As stories are shared, some clients need to cry, some need to express anger, some need to complain, and others need to convey their fears. Provide the space for your clients to express their feelings with your attitude of compassion. Rose states that a therapist's "manner and presence are as important as the touch you give." A half hour of respectful, attentive touch helps your client feel valued.

Susan owns and operates Bodyworks Massage Therapy by Susan Salvo and Associates which she founded in Lake Charles, Louisiana in 1983. Ms. Salvo is a charter member of the Louisiana Chapter of the American Massage Therapy Association. In 1989, she was honored with their Member of the Year award and, in 2003, with their Lifetime Achievement Award. In 1987, she founded the Louisiana AMTA sports massage team, which is still active today.

Ms. Salvo is a nationally known author, having written Massage Therapy: Principles and Practice and Mosby's Guide to Pathology for the Massage Therapist, both published by Elsevier. Ms. Salvo has contributed to the National Certification Exam as a member of their test item writing committee. She has written the chapter "Teaching to Students with Learning Challenges" for Teaching Massage, published by the Associated Bodywork and Massage Professional. She has also contributed a chapter "Geriatric Massage" for Modalities for Massage and Bodywork published by Elsevier. Ms Salvo is one of the featured experts interviewed in the documentary film, History of Massage Therapy in the United States released in 2007.