82 ■ Modalities for Massage and Bodywork

TABLE 5-1 Body Systems and Massage Implications

Body System Physiologic Change Functional Effect Massage Implications

Integumentary Skin loses elasticity and becomes thinner and more frail; wrinkling and sagging are evident

Tears easily, heals more slowly than when younger; bedridden clients are more prone to pressure sores

Reduce pressure and shearing, avoid lesions; bring any sores to attention of client or caregiver

Decreased subcutaneous fat Reduced temperature regulation; increased risk of injuries and bruising from weakened support of blood vessels

Keep clients warm with blankets

Reduced glandular activity (sudoriferous and sebaceous)

Rough, dry, flaky, and itchy skin (xerosis), reduced temperature regulation

Use quality lubricants, keep clients warm with blankets or use a cool washcloth on the forehead or back of neck

Increased pigmentation Presence of irregular moles, precancerous and cancerous lesions, keratosis, and liver spots on sun-exposed areas such as arms and face

Avoid suspicious areas and open lesions

Reduced number of hair follicles Hair thins and grays Nonapplicable

Nails grow slowly Nails may be thick, rough, splitting; increased fungal infections

Avoid unhealthy nails

Respiratory Rigidity of chest wall (ribs calcify and muscle tone is reduced) as seen in clients with kyphosis and osteoporosis

Reduced thoracic movement (chest expansion); reduced respiratory function and resultant decreased endurance

Use semireclining position; shorter treatment time

Loss of lung tissue elasticity Reduced lung capacity (17% between the ages of 50 and 70) and resultant decreased endurance

Use semireclining position; shorter treatment time

Cardiovascular Thickening and narrowing of vascular lumen due to accumulation of cholesterol and fats

Decreased circulation, increased blood pressure, increased fatigue and instances of orthostatic hypotension

Shorter treatment time; elevate lower limbs; reduce times client changes positions and assist during the process

Loss of vessel elasticity Superficial capillaries break more easily

Reduce pressure and shearing

Heart enlarged (cardiomyopathy) Reduces cardiac output (increased CHF*) and increased instances of orthostatic hypotension

Reduce times client changes positions and assist during the process; avoid areas of pitting edema

Decreased efficiently of venous return

Increased varicosities and blood clot formation in legs, especially in sedentary clients

Elevate legs; and avoid vigorous massage on legs reduce pressure

Gastrointestinal Decreased saliva production Dry mouth (xerostomia); medications may contribute to this

Offer water before and after massage

Decreased gastric secretions and peristalsis

Slowed digestion and increased constipation

Use semireclining position; gently massage abdomen

Decreased tone of sphincter muscles

Increased esophageal reflux and heartburn and fecal incontinence

Use semireclining position; allow client to remain clothed; adult diapers

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CHAPTER 5 Geriatric Massage ■ 83

Body System Physiologic Change Functional Effect Massage Implications

Musculoskeletal Bone mass decreased Bones become more porous, brittle, and fragile (after 60, women lose about 8% bone mass each decade; men lose about 3%); increased instances of osteoporosis and fractures (common fracture sites are the hip, ribs, clavicle, and arm)

Reduce pressure; ROM* and stretches should be avoided or cautiously applied

Muscle mass decreased (correlated directly to decreased activity)

Decreased strength and altered gait Reduce pressure; provide unobstructed passage; allow more time for client activities

Glycogen (fuel) stores in muscles are reduced

Decreased endurance and increased fatigue

Reduce treatment time; allow more time for client activities

Changes in joint structures Articular cartilage erodes and synovial fluid becomes fibrotic; decreased mobility; altered gait

Reduce pressure; ROM* and stretches should be avoided or cautiously applied; provide unobstructed passage; allow more time for client activities

Intervertebral discs dehydrate and narrow

Creates spinal changes such as decreased height and flexed position of kyphosis (osteoporosis may be a cause of this deformity); altered gait

Use semireclining position; ROM* and stretches should be avoided or cautiously applied; provide unobstructed passage; allow more time for client activities

Elastic fibers in connective tissue degenerate (correlated directly to decreased activity)

Reduced flexibility Use gentle joint rocking

Neurologic Nerve cell degeneration and decrease in cerebral blood flow (about 20% between 50-80)

Reduced response time and decreased reflexes; loss or increased sensitivity to pain, which increases injury risk; decreased tolerance to heat or cold; decreased balance and coordination; altered gait

Reduce pressure; shorter treatment time; provide unobstructed passage; allow more time for client activities; provide a warm blanket or cool washcloth on forehead and back of neck

Decrease in neurotransmitter production

Increased potential for dementing processes and other neurologic diseases

Reduce pressure; shorter treatment time; be tolerant of client’s behavior which might change abrupty

Endocrine Decreased T3* and T4* production

Decreased metabolic rate Provide a warm blanket; shorter treatment time

Female ovaries cease to respond to FSH* and LH* from the pituitary

Menopause; symptoms include hot flashes and periodic sweating

Non applicable

Cessation of female ovulation Reduces hormones levels of estrogen, which affects bone density

Reduce pressure; ROM* and stretches should be avoided or cautiously applied

TABLE 5-1 Body Systems and Massage Implications—cont’d

Continued

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84 ■ Modalities for Massage and Bodywork

BENEFITS OF GERIATRIC MASSAGE The following is a brief summary of the benefits of geri-atric massage. 5,12,25,26

Blood circulation —Increases blood circulation, thus speeds healing of injury and illness

Lymph circulation —Increases lymphatic circulation, thus reduces the edema of inactivity

Blood pressure —Decreases blood pressure with increased relaxation Depression —Reduces depression with increased relaxation and reduced anxiety Gastrointestinal— Stimulates bowel activity and reduces constipation Mobility —Partially restores loss of mobility due to inactivity Skin condition —Improves condition of dry or cracked skin with lubricant use Pain —Reduces pain by stimulating touch and pres-sure receptors Sleep— Improves the quantity and quality of sleep by increasing relaxation and reducing anxiety Vitality —Increases vitality with reduced pain, increased mobility, and improved sleep Relaxation— Promotes mental and physical relax-ation; deepens breathing; decreases fear and anxiety Increased self-esteem —Improves client’s quality of life, self-esteem, and sense of well-being Reduced isolation —Decreases feelings of isolation as massage involves contact with another We often view the elderly in our society as the

untouchables. In a study by Barnett published in the International Journal of Nursing Studies, the age group

•••••••••••••

touched the least in medical settings was 66 to 100 years of age. 27 However, “The use of touch and physical closeness may be the most important way to commu-nicate to ill and aged persons that they are important as human beings,” says Ashley Montagu, author of Touching: The Human Significance of the Skin . 28

Research indicates that social connection is a key com-ponent to health and happiness in the elderly when receiv-ing regular massage. 25 An ongoing relationship with a massage therapist can be a significant part of an elderly client’s life as he or she knows that he or she will receive focused attention from a caring person.

TREATMENT GUIDELINESFOR THE E LDERLY The following are simple guidelines to help the thera-pist provide pleasant and safe massage experiences for the elderly.

Thorough Intake The purpose of older adult intake procedure is to eval-uate the client’s health status, both strengths and limi-tations, so that effective and appropriate massage can be delivered ( Figure 5-3 ). 29 A thorough intake process creates a session that is both age-appropriate and con-dition-appropriate. Instruction in how to conduct an intake interview or devise a treatment plan is beyond the scope of this chapter, but the therapist should be mindful of a few important principles and items that need special consideration.

The first principle is to listen to the client. What the cli-ent has to say is more important than what the therapist

Body System Physiologic Change Functional Effect Massage Implications

Urinary Decreased bladder capacity and incomplete bladder emptying

Urinary urgency and frequency Suggest client use toilet before and after massage

Decreased tone in sphincter muscles

Urinary (and fecal) incontinence Suggest client use toilet before and after massage

Sensory Pupils decreased in size and less light enters eyes

Decreased accommodations to near/far and to light/dark; impaired vision

See adaptive measures outlined in Box 5-4

Walls of auditory canals thin, ear wax accumulates, and eardrums thicken

Impaired hearing See adaptive measures outlined in Box 5-4

TABLE 5-1 Body Systems and Massage Implications—cont’d

Data from Wold GH: Basic geriatric nursing , ed 4, St Louis, 2008, Mosby; Ebersole P, Hess P, Touhy T, Jett K: Gerontological nursing and healthy aging , ed 2, St Louis, 2005, Mosby; Ebersole P, Hess P, Schmidt Luggen A: Toward healthy aging, human needs & nursing response , ed 7, St Louis, 2008, Mosby; Gould BE: Pathophysiology for the health professionals , ed 3, Philadelphia, 2006, Saunders; Diego MA, Field T, Sanders C, Hernandez-Reif, M: Massage therapy of moderate and light pressure and vibrator effects on EEG and heart rate, Int J Neurosci 114:31-44, 2004; Beera MH, Berfow R: Merck manual of geriatrics , ed 3, Whitehouse Station, NJ, 2000, Merck Research Laboratories; Worfolk JB: Keep frail elders warm! Geriatr Nurs 1:7-11, 1997.

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