Last month, in part one of this article, we explored the typical changes that occur in physical and mental condition and function as people age. If you serve older adults in your practice, it's important to have a working understanding of signs and symptoms that might point to an underlying disease. Although we certainly aren't in the role of diagnosing any condition, we do have the responsibility to be watchful of changes and to refer to other health practitioners when appropriate. While some age-related changes generally are thought to be "normal," others might be signs of disease. Being informed about and anticipating such changes will strengthen your ability to assess your clients' needs, initially and on an ongoing basis.

Initial Assessment

Assessing the needs of elder clients might require you to modify your approach to fit individual differences in functional abilities. The purpose of any assessment is to determine four things:

1. What are your client's goals and expectations for the massage? The focus of your assessment might be different if your client is there because they are seeking relief from back pain versus reducing the effects of stress from caring for their sick spouse.
2. Does your client have a condition that typically responds well to massage? The information you gather in the assessment helps you predict the specific benefits and outcome of massage for your client.
3. Which techniques will be most beneficial to your client? The modality or techniques you select should be based on the client's condition, needs and preferences.
4. Does your client have any condition that would either contraindicate massage or limit your choice of techniques? A thorough assessment ensures the massage will be both safe and effective.

Being willing to change how you conduct your assessment is critical to accommodate an older clientele. With a few practical adaptations, you will be able to gather the information you need to serve your clients with confidence.

Develop keen observation skills. Use you eyes, ears and intuition to gather information. By tuning in to both the person and the environment, you learn about functional abilities, posture, movement and pain. The client's reason for having a massage and their goals will determine the extent of the assessment. First, find out why they are getting a massage and go from there. The information you need will be different if they are there because their doctor referred them due to shoulder pain or because their daughter gave them a gift certificate.

Make the assessment process "user friendly." Simply asking your client to fill out your intake form might not be the best way to get the information you need. Many elders have difficulty writing due to arthritis or tremor. Even reading the small print of your form might be daunting to some. A few simple changes will save time and frustration for you and your client:

• Do the assessment verbally. This gives you a chance to establish rapport with your client while assessing their needs.
• Print your form with a larger, bolder font.
• Allow ample time for the form to be filled out.
• Consider sending the form to your client in advance so it's completed prior to the first session.
• Provide adequate lighting in your office area.
• Your client might be more comfortable sitting at a table rather than juggling a clipboard. A TV tray is a handy solution.

Even if a family member or friend accompanies your client, direct your questions and other communication to your client, not the companion. This empowers and honors the elder, and helps to establish a therapeutic relationship.

Signs of Possible Disease

The information you gather on your assessment form is only part of the story. Older adults often experience changes in physical or mental states that can be observed by looking, listening and feeling. If you sharpen your observation skills, you might pick up on important information not only during the initial assessment, but also during each visit. You then can make sound professional choices about how to proceed. The following changes might indicate an underlying condition or disease.

Vision: Sudden change in vision; eye pain, redness or swelling; or excessive discharge.

Hearing: Severe or abrupt hearing loss; ringing in the ears; or loss of balance.

Skin Conditions: Itching that causes sleep loss; new skin lesions or ulcers; mole that changes; bleeds, oozes, changes color or shape, or becomes larger; scars from past surgery; rash; edema; or red, shiny appearance (inflammation).

Bones and Joints: Pain that decreases mobility and range of motion; inflammation; scars from past surgery; recent fracture; or postural deformity (e.g., kyphosis of the spine).

Mobility: Physical pain, stiffness or swelling that inhibits the ability to accomplish daily activities; balance disturbance; decreased coordination; or a recent fall.

Urinary System: Burning on urination; urgency to urinate; "leaking" and stress incontinence; pain in the side or back; or incontinence.

Cognitive: Abrupt change in personality or signs of confusion or disorientation.

Being informed and ready to adapt to a client's changing needs will give you greater confidence in your skills, allowing you to enjoy the rich rewards of serving older adults in your practice.

Sources

1. Live for Life: What Is Normal Aging? Johnson and Johnson Health Management, Inc., 1990.
2. National Institutes of Health. Senior Health. www.nihseniorhealth.gov.
3. Merck Manual of Health & Aging. www.merck.com.