Using Correct Topicals for Geriatric Massage Clients
With age come a number of changes.
A session with a trained geriatric massage therapist and the right topical can address a senior client’s needs and also enrich the practitioner.
Know Your Client
Karen Fink, board certified holistic nurse and licensed massage therapist at University Hospitals Connor Integrative Health Network (CIHN) in Cleveland, Ohio, emphasized that every client is different. “It’s important to know your client,” she said.
As is the practice with clients at CIHN, “He or she should be the center of your practice. You have to assess their expectations,” said Fink. That requires an individual evaluation of the skin’s hydration, elasticity and tendency to bruise before selecting a topical for massage.
Reviewing your client’s medication list should also be part of intake. If your client is taking steroids or blood thinners, the type of topical as well as the amount of pressure you use will make a difference. For instance, the needs of an 85-year-old vibrant woman with beautiful skin differ significantly from those of an inactive 65-year-old who takes several medications for chronic conditions. A lubricant without adequate glide encourages more pressure, which can be damaging to aging skin, Fink noted.
Select a Consistency
Fink prefers to work with oils and gels, reporting that these topicals do not produce excess drag on the skin. “They don’t absorb into the skin as rapidly so don’t dry out like a lotion,” she added, noting that gels and oils also warm faster and easier in her hands than lotion or cream.
For therapists unfamiliar with oils, Fink recommends conducting a bit of research into which ones support the immune system and prevent skin damage. “There is not a lot of evidence-based information out there. Rather, there is more clinical-based experience,” she said.
Fink always purchases organic, hypoallergenic, food grade oils free of parabens, polyparabens and additives. She finds that sweet almond oil and unscented shea butter help hydrate the skin.
Flaxseed oil contains important omegas that also nourish the skin, she added. “I recommend experimenting to find what works best.” She pointed out that the therapist should assess for nut and avocado allergies with geriatric massage clients.
At the end of a massage session, Fink wipes the oil off the client’s skin with a gentle stroking motion while the body is facedown. “I wash the hands and feet with warm towels,” she said. This practice reduces the chance of falling for clients with balance issues.
Geriatric Massage Clients in a Facility
Debra Seidman, program manager and licensed massage therapist of 21 years at New York-based nonprofit Tender Touch for All, works mostly with seniors living in a facility, so infection control is key to her practice.
For geriatric massage clients’ delicate and often fragile skin, she prefers to use lotion, but warns that carrying a tube of lotion from patient room to patient room could increase the risk of cross-contamination. Instead, she uses the lotion a client owns. “They are already using it, so you know their skin can handle it.”
Lotion brought from home typically has a lower water content, which allows it to glide over the skin more easily, making it better suited for massage than facility lotion, Seidman explained. She prefers lotion in a bottle because you can squeeze or shake the product out and don’t have to scoop it from a jar as with a cream, which can compromise an infection control protocol.
Regardless of which topical you choose to use, massage in a facility is normally of shorter duration than that performed in a spa or private practice. Seidman reported that if massage is performed in a common area, the session usually runs 10 to 15 minutes with the client fully clothed. In the privacy of a room, massage could last longer, depending on the client’s medical condition, but such a session is still shorter than a standard office visit.
Seidman cautions therapists not to use lotion on areas with pressure ulcers, radiation burns, and open wounds or at an injection site. “When you apply a lubricant, you pose a risk that it will seep into that area,” she said. “In fact, massage could be contraindicated altogether.”
Most importantly, Seidman pointed out that therapists who massage older clients should be certified in geriatric massage to ensure the safety and well-being of the client.
Nicole Joy of Think Whole Person Healthcare in Omaha, Nebraska, believes in allowing the geriatric massage client to select his or her preference when it comes to topicals. She explains the benefits of each product to clients and allows them to decide.
In many cases, the product of choice is cream rather than oil. “Creams are less likely to stain or make the client feel greasy for the remainder of the day. And cream has less of an effect on the hairline,” she said, explaining that many older clients don’t shower and wash their hair on a daily basis. “You don’t want them to leave the massage feeling sticky.”
When the client agrees, Joy does use jojoba oil, which is more balancing than some other oils and has long-lasting effects. “This plant oil is the most similar to the oils produced in the skin, especially on aging skin that is drying and thinning, she said. “Jojoba oil can trick the skin into thinking it’s balanced. It promotes healthy skin, especially on the forearms and hands, which bruise easily.”
Joy noted that her clients cite moisturizing as the main reason for coming to massage. “Some older clients are unable to bend over and reach their legs and feet. Massage provides whole body moisturizing and hydrating,” she said.
Many clients who come to A Good Day Geriatric Massage in Tampa, Florida, present with fragile skin, prone to bruising, dryness and open sores, so owner Michelle Schumacher chooses a sensitive skin formula of an advanced therapy lotion for massage. “It is tested to be hypoallergenic. My clients have a myriad of health issues. I don’t want to introduce something harmful for them,” she said.
Additionally, she finds that this topical provides just the right amount of grip, an important factor in delivering the best massage.
In some cases, Schumacher uses a topical analgesic when she finds a tight spot. “My clients like it. In fact, most of them own the over-the-counter version,” she said.
Just as important as what ingredients are in a lotion, it’s also critical to know what is not. Schumacher avoids fragrances, which might contain alcohol or additives and could trigger an allergic reaction in her clients. She also cautioned against applying some essential oils directly to the skin, as they could cause injuries.
When it comes to technique, Schumacher accommodates the client’s preference, adapting to the medical condition. She will alter her routine to suit the client but noted that most of her clients have had massage before and are receptive to it. First-timers are sometimes pleasantly surprised at the results.
Healthy Touch Helps
Schumacher’s aim is to provide soothing, relaxing, restorative and comforting massage to all her clients. She fills “the touch gap” for clients living alone. “Some seniors no longer experience safe touch. They may not realize they need it, but massage absolutely helps,” she said.
Whether you choose to use cream, oil or lotion, the right topical can enhance the massage experience for your older clients.
About the Author
Phyllis Hanlon has written nonfiction articles and book reviews as well as human interest stories, profiles and award-winning essays. Her specialty areas include health and medicine, religion, education and business. She regularly delights in the joys of massage.