“It feels like communication,” June commented when I held her hand between my own. She was resting in her bed in the assisted-living center where she lived. When I had met her more than a decade before, June was a vibrant, physically active, and mentally engaging woman. We had performed together in an intergenerational dance theater performance in Denver, Colorado, in 1993. I had been seeing her regularly over the previous year to give her massage. Now in her 80s, she was a hospice patient, and I had the privilege of giving her nurturing touch in the last weeks of her life.
That was in 2004. I still think about June, and all I learned from her. She was a friend, a co-creator in dance, a revered mentor, a beloved member of her community, and a feisty, wise woman. And she loved massage. Even as the needs of her physical health dictated a change from massage on a table to massage on her bed, she enjoyed the physical touch, and the deep and profound level of relaxation it provided.
My Personal Journey
I’ve never really thought of myself as practicing “geriatric” massage. Older clients have easily come into my practice since I first began as a massage student in 1984. While in school, I had the opportunity to offer massage as part of my fieldwork in a skilled nursing facility. The nursing staff was a little skeptical; some of them were concerned the residents might like it too much—and then demand or expect it. As it turned out, each person I touched was grateful in the moment for the attention I was able to give them.
Esther was admitted to the facility after having suffered a stroke that paralyzed one side of her body. The physical therapy assistant recommended that I see her, thinking massage might be a good complement to her rehabilitation. I saw her a couple of times; then one day I arrived at her room and noticed her husband was with her. I stood quietly at the door, and watched as he leaned over her bed and gently applied lotion to her face. He was so loving and tender, and though Esther could not speak, the affection between them was palpable.
When the kindly gray-haired gentleman noticed me, he stopped and stood up straight. Upon hearing I was there to offer massage, he said, “Oh, I hope what I am doing is OK. I don’t want to hurt her.”
“Oh, no, you won’t hurt her,” I said. “What you are doing is wonderful, and I am sure she loves your touch.” He seemed reassured, and was pleased when I suggested that he watch me as I massaged her feet. He wanted to learn what he could do to help her. And sure enough, when I returned the next week, I saw Esther and her husband again. His eyes sparkled as he shared with me that he had been practicing the techniques I showed him.
Many seeds were planted during the weeks I visited this facility. One day I saw an elderly woman sitting in a wheelchair against the wall of a common room. She was slumped over and downcast. I sat beside her, took her hand, and gently massaged it. As I did this, she looked up at me without speaking and began to massage my hand. I only spent a few minutes with her, but when I came back down the hallway an hour later, she was still sitting upright, and looking around, clearly more engaged in the world around her than she had been an hour before. I never even knew her name, her age, or her physical condition, but she made a profound impression on me. I realized that a little caring touch and attention could make a difference in someone’s day. She made a huge difference in mine!
Life Transitions—Birth and Death
A few years before I went to massage school, I studied midwifery and attended the births of my sisters’ and friends’ babies as a birth attendant. I continued to attend the occasional birth after I was certified as a massage therapist. Then, in 1989, I took the volunteer training with Hospice of Boulder County (now TRU Community Care), and began to offer massage to patients in their homes. From the beginning, each person I touched had something new to teach me. For me, there were significant similarities to working with women giving birth and touching those nearing death. Birth and death are both powerful transitions in the life cycle, at once familiar, yet mysterious.
I came to appreciate the power of silence, of deep listening, of responding to what was needed in the moment. I learned to adapt to the physical setting and getting the patient and myself comfortable, whether in a home, hospital, or hospice setting. I learned to let go of my personal agendas and preconceived notions about what I thought the patient needed. I learned to respect the community of people—whether family, friends, or health-care providers—who support patients along the spectrum from birth to death; from wellness to acute, chronic, or terminal illness.
Intergenerational Awareness
We live in a culture that does not place particular value on the senior citizens among us. Though I see much evidence of changes for the better, I’ve also seen how this attitude has contributed to one of the biggest ills of aging—that of isolation and loneliness. As a child, I was fascinated by my grandmothers; so as a massage therapist, it was natural for me to look to my elderly clients with the same curiosity and interest in the richness of their life stories. Sometimes I feel those stories in the tissues of the body I touch. Sometimes I see the stories in the expressions I see on their faces, or the old photographs framed on their walls and resting on bedside tables. And often I have the joyous privilege of listening to their stories in their own words.
I espouse a client-centered massage, so when I am with my elderly clients, I am always open to hearing whatever they wish to say. I have heard stories of hard lives working on the farm; of piloting airplanes during World War II (including a veteran of the Women Airforce Service Pilots); of achievements in science and art; and of travel adventures around the world. I have been humbled by their courage, strength, humor, and self-reliance as they adapt to the challenges of aging. Most of all, I have listened to stories of family—the joys, sorrows, and rewards of life celebrating the intergenerational power of love.
Comfort, Not Cure
As massage therapists, we all want our clients to feel better. We want to fix what ails them. We are often creative problem solvers working to achieve positive outcomes, improve functionality in the body, and diminish pain. Working with the elderly is humbling. There is no cure for old age, and in truth, there is no cure for most of the chronic conditions that ail people as they get older. Arthritis, cancer, dementia, diabetes, heart disease, and respiratory conditions are common conditions of the elderly. It is impossible to know everything about the pathologies our senior clients live with. But there are common factors, involving loss of function—both physical and mental—and the increased experience of chronic pain.
So what does help, if we can’t provide a cure? When people are in pain, or experiencing the loss of a familiar function, caring touch can help assure them they are still valuable human beings worthy of care and attention. Massage for the elderly has value for the comfort it affords the person, and it can alleviate the secondary pain caused by fear, stress, and worry. It is not a substitute for medical care, but it is a valuable complementary medicine, helping promote a sense of well-being, comfort, and connection.
Touching Memories
When I touch an older person, I am not just touching an “old person,” I am touching their lifetime memories. I have heard more than a few massage therapists wonder: “How do you massage an older person? They don’t have enough muscle that it makes any difference.” Ah, but the muscles are only one system of the ever-changing human body. The therapeutic value of touch is not only about manipulating muscles; it is about calming and sedating the nervous system. It is about giving the person something to feel good about.
Human skin is replete with myriad touch receptors for sensing pain, pressure, temperature, and vibration. The complex combinations of these sensations create perceptions and memories. When we touch someone in a caring way, we are affecting their nervous system, either reminding them of remembered pleasures of touch, or giving them new sensations—and therefore lasting memories—of comfort, safety, and well-being.
Lessons in Working With the Elderly
Working with seniors has been a big part of my 30-year professional career as a massage therapist. It has also been a big part of my personal life, as I honor the elders in my life. Sometimes massage therapists tell me they’re afraid of working with senior clients, fearing that they might hurt them, not knowing what techniques to use. They are also concerned about the emotional issues that arise in working with this special population, many of whom live with physical, mental, and emotional challenges.
Regarding the first issue around hurting the client, it is important to understand changes that happen in the body’s tissues with aging and illness, and seek training in appropriate techniques that are safe, appropriate, and effective. (See “Principles of Comfort Touch,” below.)
Regarding the second concern, I’ve been asked, “How do you protect yourself from your client’s pain and suffering?” Certainly I’ve learned to respect the feelings, fears, questions, and concerns that arise as I work with others, but I don’t really worry about protecting myself from my clients. I do acknowledge the need for self-care, which includes living a balanced and healthy lifestyle, as well as practicing techniques of grounding, breathing, and mindful body patterning.
I also practice with an understanding of the difference between sympathy and compassion. Here’s a story I’ve found helpful: Imagine you are walking down the street. You hear someone cry out for help. As you get closer to the sound, you see someone is in a pit. You jump in to help. Now you are both stuck in the hole! That is sympathy. But if you really want to help, you stay at the top of the pit, acknowledge the person’s plight, and offer them a ladder. In that act of compassion, you are helpful, but you maintain a safe and practical boundary, avoiding the “pitfall” of losing yourself to sympathy.
Spiritual Focus (or, Thoughts on Being Mortal)
As each year passes, I find myself approaching the age I once considered elderly. Aches and pains, and the annoyances of coping with chronic illnesses are a daily part of my life. But I am comforted in the knowledge that I am not alone. Priorities shift and change. I adapt and cope. I let go of the old, and accept new joys and challenges in my life.
I am grateful for all of the elders who have welcomed me into their lives and showed me the way to live fully—no matter the present circumstances—as they adapt to change. And I am ever so grateful for all my friends, colleagues, and students who embrace the opportunities to offer the gift of touch to the older ones in their lives. Thank you for making the world a better place.
Principles of Comfort Touch
Comfort Touch is a nurturing form of acupressure developed by Mary Kathleen Rose. Following six guiding principles (summarized by the acronym SCRIBE), it is designed to be safe, appropriate, and effective for the elderly and the ill. Simply stated, the practitioner learns to Slow down to connect with the client, maintaining a clear intention to offer Comfort, with an attitude that is Respectful of the person being touched. Direct pressure is applied Into the Center of the part of the body being touched, with Broad, Encompassing contact. While there is an apparent simplicity to this work, the practitioner will discover deeper layers of intricacy as they respond to the individual needs of each client. Learn more and share the work with your clients with Rose’s new text Comfort Touch of the Hands & Feet, available for $17, plus $4 shipping, at www.comforttouch.com.
Mary Kathleen Rose, BA, LMT, is the developer of Comfort Touch nurturing acupressure, author of Comfort Touch: Massage for the Elderly and the Ill (Lippincott Williams & Wilkins, 2009) and a DVD of the same title, as well as Comfort Touch of the Hands & Feet: A Guide for Family Caregivers (Wild Rose, 2015). Learn more at www.comforttouch.com.