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The Caring Touch: Reflexology, Massage Therapy & the Elderly

Over the last decade interest in complementary therapies has grown enormously worldwide. A recent study in the U.S. showed that 18% of American adults received one or more treatments from a massage therapist in the last year compared to only 8% in 19971. In Ireland people are thinking more about their health and lifestyles. Nowadays when people feel stressed they see it as a negative factor, not just because they feel tense, but because they think of it as bad for their health - and they are right. Stress is considered to be a major factor, if not the cause, in at least 75% of all illnesses2. Stress is also known to contribute greatly to the ageing process3.

With these facts in mind it is not hard to see why therapies like massage, aromatherapy, Indian head massage and reflexology have become popular in many settings, from maternity hospitals to hospices, from beauty clinics to drug rehabilitation centres. Massage has found a home in caring environments like nursing homes, and with home care groups. In the nursing home setting it is worth thinking about the value of simple physical contact, and the hugely positive psychological effect it can have on the elderly. As Dawn Nelson points out in her book 'Compassionate Touch', "attentive nurturing touch can be a significant therapeutic factor in treating despondency in the aging and/or the ill because of its multiple psycho-social, mental, emotional and physical benefits"4.

Enhancing the Quality of Living

Massage is especially beneficial for people aged sixty-five and older, as it helps to maintain mobility and independence. It promotes healthy skin through the application of nourishing oils, many of which are proven to improve the suppleness of mature skin types. It stimulates the sebaceous glands in the skin to produce more of the body's own natural moisturiser and stimulates the circulation in the superficial capillaries. Treatments also improve general blood circulation and lymph flow; this is of particular relevance to elderly people with poor mobility, as circulation in the extremities can easily become impaired. The symptoms of impaired circulation can start simply as cold hands or feet, but can develop to cramp and pains, loss of sensation and loss of kinaesthetic awareness. By improving the suppleness of muscles and fascia, massage can also affect joint flexibility. This can have major implications for quality of living; for example, improving hip and knee mobility could make the difference between being able to climb stairs or not. With declining peripheral vision, maintaining mobility in the neck allows us to turn our heads to see our surroundings. If driving, this could literally be the difference between life and death. When dealing with arthritic joints in the chronic phase, when there is no inflammation, massage of the surrounding muscles can help ease the stress on the joints.

Massage treatments should always be tailored to suit the client's needs. When working with elderly clients, physical condition is more relevant than chronological age. The elderly can be divided into three categories regarding treatment:

  • Robust, who show few outward signs of impaired health, look younger than their age and are sharp mentally and physically active.
  • Age appropriate, who show some of the typical signs of ageing.
  • Frail, people who look and feel fragile to the touch.

All three types will benefit from treatment but adaptations must be made, and in all cases a thorough medical history should be obtained.

It is helpful to think of the effects of massage as being similar to exercise. People in the robust category can engage in gentle to moderate exercise and so would benefit from gentle to moderate intensity massage. Those people in the age-appropriate category may need to consult with their doctor and stick to gentle exercise, so gentle massage would be appropriate. People in the frail category will require the gentlest care, even with doctor's consent. Issues such as tissue fragility and extremely low stamina must be taken into account. Very light massage for short durations can still be beneficial.

In a typical holistic massage treatment a variety of massage techniques are used, each with their own effects and benefits. Broad brushing movements, described as effleurage strokes, are exceptionally good for warming up the area to be massaged. They enhance circulation, especially venous return. Kneading movements, described as petrissage, usually follow. Kneading movements help keep muscles and connective tissues pliable and elastic. Gentle tapping and cupping movements, described as percussion, help improve muscle tone. The proportion of each type of stroke can be varied to suite the client's needs at the time of the treatment.

Restoring Suppleness & Flexibility

In my recent experience I treated an elderly client who described himself as robust all his life, but now in his mid-seventies was rapidly moving in to the age-appropriate or even the frail category. He presented with stiffness in the legs and back. This was causing difficulty stepping over the high ledge getting in and out of the bath. After working on his back and legs over a six-week period I could feel a dramatic difference in the quality of the tissues. Muscle which felt almost totally rigid in the first session now felt supple and flexible. The client said, 'it's like magic, not only can I get in and out of the bath, I feel like jogging down the street'. Then my client said, "But I am still nervous standing up in the bath". I asked why and the response surprised me, "Oh you know, I can't feel anything through the soles of my feet so my balance isn't that good".

This led into a discussion about reflexology. There are many forms of reflexology practised. Treatment can be applied to reflexes on the feet, hand or the ear. In this case foot reflexology was the clear choice. We switched from weekly massage treatments to weekly reflexology sessions. From the first session the reason for the loss of sensation was obvious. The soft tissues of the foot were almost totally rigid because they were so congested. The first two sessions were focused on regaining mobility. By the third session I felt like I was working a totally different pair of feet, the changes were so dramatic. On the day of the fourth session my client arrived with a big smile. He told me that after the last session he could feel the floor again. Now he had the confidence to stand in the shower for the first time in years, without fear of falling.

Once we had achieved a good level of suppleness in the tissues of the foot we began to focus on treatment of the reflexes. As every system, organ and gland is represented by a reflex point on the feet, we were able to address internal problems, like poor digestion and constipation. This led us to the relevance of diet and the use of vitamin supplements. On his most recent visit the client said he was on "a real health buzz and feeling great".

Improving Digestive, Respiratory & Sinus Conditions

One of the biggest advantages of reflexology over other forms of bodywork is its ability to affect the internal structures of the body. A person with breathing difficulties and congestion in the lungs cannot have the lungs massaged. With reflexology, working the chest and lung reflexes can, however, stimulate a reflexive action in the lungs. I have over the course of my practice seen many dramatic results achieved, especially in relation to digestive, respiratory and sinus conditions.

Because of the extremely potent effect of reflexology, care and sensitivity must be used when approaching treatment of the elderly. Over-stimulating the reflexes can place a strain on already struggling systems, leading to what is termed a 'healing crisis'. This is simply because too much is happening too quickly, causing the recipient to feel less well. Light and gentle reflexology applied at regular intervals can achieve great results with conditions like constipation, loss of appetite, insomnia and poor immune function without any negative effects.

As with massage, the therapeutic touch used in reflexology helps elderly clients reconnect with themselves and others in a way that strengthens their social and emotional well being. People at all stages of life, be they infants, children, adults or the elderly, need caring contact to thrive. Massage and reflexology make available this caring touch to those who would otherwise be deprived of the contact they need. This is especially true for the elderly who rely so much on caregivers to meet their needs. Many nurses and caregivers have trained with me over the years and have put their skills to use in precisely this way. They have found this enormously rewarding as it allows them to express the caring aspect of their occupation to the fullest. For most, it was the desire to care for others that started them on their career path in the first place.

People giving massage benefit in much the same way as those they are massaging. One study conducted by the Touch Research Institute in the University of Miami had elderly retired volunteers provide massage to infants. After one month the elderly volunteers reported less anxiety and improved mood after giving the infants massage. Their pulse decreased and levels of cortisol, a stress hormone, also decreased. They reported improved self-esteem, fewer visits to the doctor and more social contact5.

The many benefits of massage and reflexology can be experienced by receiving treatment or by giving treatment to someone else. So the only question is, would you like to receive treatment or are you someone who is prepared to give?

This article has been contributed by Aubrey Gowing, who is a director of the Holistic Healing Centre in Dublin. He has worked as a therapist and teacher for over seventeen years.

If you are interested in finding out more about treatment or training contact the Holistic Healing Centre, 38 Dame Street, Dublin 2, Tel: 01 6710813.

1 Touch Therapy Institute, Los Angeles.
2 Tucker, L. An introductory Guide to Massage (2001) Haddington, U.K. Scotprint
3 Evans, W., & Rosenberg, E.H. (1991) Biomarkers. New York: Simon & Schuster
4 Nelson, D. (1994) Compassionate Touch: Hands-on caregiving for the elderly, the ill, and the dying. Barrytown, N.Y. Stution Hill Press
5 Field, T., Hernandez-Reif, M., Quintino, O., Schanberg, S., & Kuhn, C. (1998) Elder retired volunteers benefit from giving massage therapy to infants. Journal of Applied Gerontology, 17, 229-239.