As caring massage professionals, we feel a special responsibility to be mindful of potential risks for our vulnerable elder clients. The closeness that often develops places us in a position to offer assistance in valuable ways, such as working with them to minimize some of the risks faced by elders.
One of the greatest risks is the increased possibility of falls. Data from geriatric physicians suggests that a single fall can initiate a spiral of events that culminates in death within a year of the fall.
In such a scenario—which I have observed in my own elder clientele—the fall has traumatic physical and emotional repercussions.
Physically, the elder endures bruising and torn skin that may heal poorly, musculoskeletal pain caused by sprain and/or strain or a fracture that may require surgery—all of which require a sometimes extended period of immobility, increasing risk of blood clots and emboli.
Emotionally, the fear of falling a second time can lead to an elder’s restricting physical activity, declining to leave the house, avoiding new places and situations outside the day-to-day comfort zone, and becoming increasingly fearful and isolated.
These physical and emotional repercussions effectively suppress immune system functioning, leaving the elder more vulnerable to infection and delayed healing.
Factors that increase the fall risk in elder clients, even those without chronic health conditions, include age-related atrophy of skeletal muscle tissue, brittleness of joint-supporting ligaments, and shrinking of articular surfaces in weight-bearing joints, all contributing to less certain balance.
Balance can also be affected by chronic insomnia, diminishing reflexes and orthostatic hypotension, a common side effect of some medications prescribed for cardiovascular conditions.
Additional factors in fall risk include use of analgesic, antidepressant or sedative drugs; poor vision, out-of-date or damaged eyeglasses; lack of daily activity that lifts feet off the ground, and a chronic, progressive health condition such as Parkinson’s disease, osteoporosis or multiple sclerosis.
Foot deformities such as arch inversion, bunion, claw toe or hammertoe disrupt the equal weight distribution on lower limbs, a distribution that is necessary for stable posture and gait. Weak dorsiflexors can allow foot slap or foot drop during gait, significantly increasing fall risk, as do short leg syndrome or an anatomically short leg.
Factors that decrease fall risk include strength in postural muscles, dependable balance and joint flexibility. Therapeutic massage techniques can encourage, support and maintain these critical factors for ambulatory elder clients.
Posture and gait assessment can assist in identifying an elder’s fall risk status. Posture can displace a portion of the upper body away from equilibrium, including: a kyphotic curve that moves the head forward relative to the lateral midline and is common among elders with osteoporosis; and thigh deviations such as genu varum and genu valgum alter weight distribution and raise fall risk.
Addressing core muscles at the midline, and evaluating and targeting other postural stabilizers encourages erect posture. Dependable balance is enabled by easing unevenness in postural weight distribution and weight transfer during gait. Increasing joint flexibility, especially in the ankles, facilitates a steady gait pattern in which each foot clears the ground.
We can begin minimizing an elder client’s fall risk by creating a safe treatment facility that reduces the probability of a fall. Remove all area rugs, ensure that hallways are well-lighted and free of furniture pieces, electrical cords that protrude from the wall, and wall sconces or picture frames that are placed near head-level.
A secure railing installed into wall studs at hand-height can be helpful, if clients must walk a distance to reach the treatment room. Tile floors in hallways and bathrooms can be coated with a sealer that reduces slickness of the flooring.
Bathroom grab bars (again securely installed into wall studs) placed beside the toilet and shower are recommended, as is installing a dark-colored toilet seat, which can be seen more easily by an elder with poor depth perception.
In the treatment room, keep ambient lighting at the brightest setting available anytime the client will be moving about the room. Use a brightly colored top sheet that contrasts dramatically with the color of the bottom sheet and with the floor, reducing risk of tripping as the client gets on and off the table.
If the elderly client has any risk for orthostatic hypotension or has had a fall in the past, remain in the room at the session end to assist her into a sitting position with feet dangling toward the floor, until she is fully oriented and normal balance has been established.
Within our scope of practice, massage therapists can also support elder clients as they consider activities that contribute to strength, balance, and flexibility, such as yoga, tai chi and qigong.
We can also suggest medical consultation for signs of emerging health conditions that may increase fall risk, such as vision deficits, observable joint or foot problems that can result in unsteady gait and signs of progressive postural deviation.
Elders’ commitment to practices that support good health, along with attentive, focused work by massage therapists, can reduce the number of falls and their debilitating repercussions.
Julie Goodwin, L.M.T., is an author, bodywork educator, National Certification Board for Therapeutic Massage & Bodywork-approved provider and creator of TxPlanner.org. Her 30-year massage practice focused on elders and people in treatment for cancer. She has presented at American Massage Therapy National Conventions and the AMTA Schools Summit, and is the 2016 Alliance for Massage Therapy Education Educator of the Year.