On January 1, 2011, the first baby boomers turned 65. Every day since then, and for the next 18 years, 10,000 people will turn 65 according to the U.S. Census. This will lead to all of us seeing more geriatric clients. This means it is important to be aware of the difference between massaging your younger clients and massaging senior clients. Even though many in this demographic are active and in robust health, others are more sedentary and frail. There can be a big difference between what a 60-year-old can handle, and what a 90-year-old can handle, in terms of massage therapy. It is important to have a basic understanding of the aging process and the considerations to keep in mind when working with older clients. This will help you be more successful in providing appropriate pain relief for them.

What Does Aging Look Like?

Accoding to Wikipedia, aging is the accumulation of physical, social, cultural and psychological changes that people go through over time. More simply said, it is the process of getting older. While most of these abilities diminish with age - especially our physical abilities - some get better. For example, we become more patient and somewhat smarter, as we experience years of local, national, and global events. Some people embrace the aging process for what it is, while others fight it tooth and nail. Regardless of these differences, aging is a reality: it will happen to all of us, whether we like it or not. It is also among the largest known risk factors for most human diseases. For massage therapists, that means that aging clients - even very active and healthy ones - are at a higher risk for injury than younger clients. Roughly 100,000 people worldwide die each day of age-related causes.

What happens to our bodies as we age? Most of the  following information is excerpted from the Merck Manuals online, The Aging Body www.merckmanuals.com/home/older_peoples_health_issues/the_aging_body/changes_in_the_body_with_aging.html.

The Brain and Memory

The changes in our brain cause us to become more forgetful as we age. Nerve cells begin dying off and repair themselves more slowly. This can cause some elderly people to lose strength and sensation. Blood flow to the brain and the number of cells in the spinal chord also decreases. This causes us to take longer to learn new things and to recall what we know. Our memory begins to fail us and this memory loss can progress into Alzheimer's disease. Working with clients in the late stages of Alzheimer's can be challenging. Many will not remember who you are even if you see them on a weekly basis. This can cause some of them to be hostile towards you or frightened of you. Remember to approach them slowly and talk about what you are doing to them at each point during the massage. You might notice that once you lay your hands on them, most of their anxiety will disappear.

Bones, Joints and Muscles

Changes to the bones, joints and muscles will probably be the most obvious differences you will notice when you work with older clients. With age, bones tend to get thinner, weaker and more likely to break. This is one of the reasons the most common age-related conditions are osteoporosis and arthritis. The vertebrae become less dense and the disks between them lose fluid and become thinner, making the spine shorter. This is one of the reasons why we get shorter as we age.

Joints are also more susceptible to injury because of the normal wear and tear of movement. The surfaces of joints do not slide over each other as well as they used to. Ligaments and tendons lose elasticity, making joints feel tight or stiff. They are more likely to tear, and when they do, they heal more slowly. This causes most people become less flexible.

Our muscle mass and strength begins to decrease around age 30 and continues throughout the rest of our lives. Weight bearing exercises can do a lot to compensate for this, and the total effect of muscle mass and strength reduction is no more than about 10% to 15% during an adult's lifetime. Sarcopenia - more severe muscle loss - results from disease or extreme inactivity, not from aging alone. The loss of muscle that occurs from the normal aging process leads to an increase in percentage of body fat over time. By age 75, the percentage of body fat typically doubles compared with what it was during young adulthood.

When massaging clients with weaker bones, joints and muscles, the most important thing to remember is to modify the amount of pressure you use. Older clients generally cannot handle a lot of pressure on their bodies. Be mindful of how each individual client is responding to your touch and adjust if necessary. Patients with arthritis are going to want you to spend more time on those areas. If a client took  a fall recently, or is recovering from hip replacement, remember that their recovery time could be double that of a 30-year-old in the same situation.

Heart and Veins

As we age, our blood vessels and arteries stiffen, causing the heart to work harder to pump blood through them. The heart rate becomes slightly slower and the heart might become bigger. This can lead to high blood pressure (hypertension) and other cardiovascular problems. However, even with these changes, a normal older heart can function well. Differences between young and old hearts are usually only apparent when the cardiovascular system is stressed — for example, during exercise or an illness.

We know that massage improves circulation, and this is even more so for geriatric clients. Even the gentle touch needed for older clients does wonders to improve their blood flow. The calming effect of massage can also help lower blood pressure in those who might have hypertension. Just remember that an hour long massage might be too long. I typically start with a 1/2 hour massage, and extend it to an hour if the client is doing well.

The Skin

With age, the skin becomes less elastic, thinner and more fragile. Skin loses fat as we age so it becomes less smooth and we bruise more easily. This thinning of the skin also causes us to lose body heat more quickly, making us more intolerant of the cold. We sweat less so our skin becomes drier. Shingles is a disease that will present in about 1 in 5 people over the age of 50. It is caused by the same virus that causes the chickenpox. For unknown reasons, the virus remains dormant in the nerve cells for years, until something activates it again, usually resulting from a weakened immune system. As an adult it presents as Shingles, causing painful blisters and rashes on the skin and a general sense of malaise.

Someone with Shingles should never receive a massage. Just the weight of clothing on the skin can be too painful for some. Because older clients typically have drier skin, remember to be generous with the amount of lotion or creams you are using on them. And again, their thinning skin means you should modify the amount of pressure you use.

These are just some things to consider when examining the aging process. Some other common contraindications when working with geriatric clients include, but are not limited to: the site of a repeated injection, burn wounds, skin ulcers, bed sores, any type of joint replacement and what I have found to be the most common issue: loneliness.

People are now living longer than they ever have before, and our society does not seem to know how handle this. Whether living alone in their own house, or living in a retirement community, many can become sad or depressed as their bodies and minds age. Just having someone there on a consistent basis, whose attention is devoted to them for 30-60 minutes a week, can make a huge difference in their emotional well-being. Many will look forward to your visits just to have someone to talk to. While massage therapists are by no means "counselors," some clients just really need you to listen to whatever is on their mind at the moment, whether that be happy news, sad news, or just community gossip. Be receptive to hearing what they have to say. Your weekly visit could truly be the highlight of their week.