Session Planning

Making Informed Decisions for Older Clients

By Diana L. Thompson
[Somatic Research]

The value of good research lies not just in its validation of our work, but also in how we can successfully use it to inform our therapy sessions. In this example, an older adult population is the criteria for consideration.

Perhaps you are curious to learn more about older adults because you have a new client in her 70s, named Betty. She does not report any specific medical problems, but she has a host of symptoms, including pain, constipation, and loss of balance. You may find this confusing because there is no known medical origin. You are motivated to find out more about the aging process in hopes to explain Betty’s situation and help you be a more effective massage therapist. Also, you have a sense that you need to identify a different set of parameters for treating someone who is healthy and active but seemingly more frail than your 30-something clients.

The older adult population is one we all should learn about. The statistics on aging are compelling. The demographics of aging are dramatically changing. An increasing number of people are living longer. Compared to a decade ago, people reaching age 65 live, on average, 19 years longer —20.3 for women and 17.4 years for men.1 In 2000, the elder population (65 and older) in the United States totaled 35 million, just over 12 percent of the population; by 2030, that number is expected to peak at 71.5 million, representing nearly 20 percent of the total U.S. population. The peak in 2030 represents the last of the aging baby boomers, born between 1946 and 1964, and who begin turning 65 in 2011. This larger population of elder Americans will be more racially diverse and better educated with a higher median income compared to previous generations.2

The probability of massage therapists seeing an older adult in their practices is increasing, not only due to the increase in population of elder adults, but also due to the increase in income and education of this growing population. Complementary and alternative medicine (CAM) use is more predominant among people with a higher income and more years of education.3

Information from research can help you determine if this is a population you might want to learn more about. By identifying demographics of aging, we confirmed that more people are living longer. We also affirmed that there are more people getting older because the baby boomers are now reaching age 65, representing a demographic bulge across the Western hemisphere. And we learned that this segment of society is more likely to get massages than elder adults of past generations.

Given this information, we might want to become skilled at treating older adults. Perhaps your new 70-something client is an anomaly, but Betty may be a stepping-stone to building a niche clientele.

Find Statistics

To learn about the demographics of the identified population, a general search of the Web is easiest. Use whatever search engine you are comfortable with—Google, Ask, Bing, Yahoo!—and type in “statistics on aging” or “statistics on older adults.” Different search terms yield different results. Track your search terms so you can repeat your searches, should you need to retrace your steps.

Select websites that are more likely to have large budgets for funding research. Government sites, such as,, and draw from census data and other large surveys to compile statistics. Data from these sources are considered to be generalizable because of the large sample size, with a high level of evidence because they are reproduced every two to five years. However, they are primarily representative of U.S. citizens and include little to no international data.

Once you identify demographic information that defines the population, explore the needs of the population. For example, identify common conditions older adults face. Explore specific information on chronic conditions, such as pain, arthritis, balance and falls, constipation, and insomnia.

None of these sites will tell you if massage is an effective treatment for the symptoms associated with aging or with chronic conditions of the elderly, or how massage is effective for treating those conditions or symptoms, or which types of massage have been found to be safe and effective for each. Time to go to the medical research. When searching for medical research, use medical databases, like PubMed, or BioMed Central—both are free. While a general search is perfectly fine for statistics, never rely on a general Web search for medical research.

First, let’s see if we can identify a common profile of the older adult.

Profile of Older Adults

Older adults may present with a wide range of conditions, making it challenging to identify a typical profile. Applications of massage therapy for the elder adult will vary depending on the presenting symptoms and conditions of the person receiving care. Massage practitioners are best served if they are knowledgeable about the range of health conditions common to this growing population.

Approximately 80 percent of older adults have at least one chronic health condition and 50 percent have at least two chronic conditions. The most frequently occurring conditions among older people in 2005–2006 were hypertension, arthritis, heart disease, cancer, and diabetes.4

While the health status of older adults varies widely, three distinct categories can be identified: healthy, active older adults; older adults living with chronic conditions; and older adults requiring end-of-life care or palliative care.

Healthy, active older adults

In 2007, 39 percent of non-institutionalized older adults assessed their health as excellent or very good.5 Although people’s bodies change and can in some ways decline over time, these changes do not invariably lead to diseases such as hypertension, arthritis, and dementia. Aging often involves common biological, physiological, and psychological changes affecting digestion, vision, balance, and mood, for example. Healthy, active adults will likely require attention to functional considerations, such as balance, pain with movement, and loss of mobility.

Common conditions of nondisease-related aging that fall within the scope of massage therapy treatments with research data available include constipation, decreased flexibility, loss of balance, and pain.

Adults Living with Chronic Conditions

With 39 percent of older adults reporting excellent to very good health, but 80 percent of older adults having chronic conditions, an overlap of populations is evident. This is an indication that while older adults may present with a positive outlook on their health, massage therapists must remain mindful of underlying chronic conditions. All of the conditions listed within the healthy, active older adult section may be symptoms of a chronic condition.

Common chronic conditions of older adults that fall within the scope of massage therapy with research data available include anxiety, arthritis, cancer, dementia, depression, and insomnia.

Adults Requiring End-of-Life Care or Palliative Care

Palliative care seeks to improve quality of life for people who are facing a life-limiting illness. Patients can continue to receive aggressive medical treatment while receiving palliative care and recovery is possible. When end of life is imminent, hospice services may be requested. Hospice focuses on caring not curing. Both end-of-life/hospice and palliative care place pain management and symptom control as top priorities.

While older adults enter palliative and hospice care with a variety of illnesses, treatment will not vary much with each individual condition. The primary goal of care is comfort. For massage therapists, conditions may be too advanced to focus on reducing adhesions, for example, and consideration of long-term benefits may not be the priority. Therefore, this population can be treated as a single group. Research is available on massage for this segment of the population.

Use Research to Inform Session Planning

Before seeking out research to inform your session, identify your systematic approach to designing a massage session. We all have a system, whether we know it or not, and use it automatically. If you pause to consider the steps in your system, it may help you organize a plan for clients presenting with an unfamiliar condition or set of circumstances.

Here is a simple four-step approach:

1. Gather information.

2. Identify the client’s desired outcome.

3. Identify your goals for the session.

4. Select the techniques that will best accomplish goals/outcomes.

A search of the medical research will inform each of these steps. Different conditions can be searched, using  “and” to connect it to the older adult population. For example, at CAM on PubMed, search for “pain and older adults,” “constipation and older adults,” or “insomnia and older adults.”

Gather Information

Use intake forms and interviewing techniques to uncover the client’s current health status, presenting symptoms, and diagnosis if available. Inquire about the client’s health history—something from the past may influence the session or outcome. Identify all medications, even over-the-counter pain relievers.

The research can be helpful in identifying common symptoms associated with chronic conditions. This will assist you in asking more informed questions during the interview. For example, constipation is a side effect of pain medications, common in older adults. They may be too shy to mention it. By asking if they are experiencing constipation, you might relieve them of the embarrassment of bringing it up themselves, and you show you are a well-informed practitioner specializing in elder care.

Assessment tools are helpful in gathering information. You may ask clients to rate pain on a scale of 0–10, rate the ability to perform daily activities using a functional rating index, or chart the results of range-of-motion testing. The research can help you identify common measurement tools that can verify if your treatment plan is effective.

Identify the Clients’ Desired Outcome

It is important to consider clients’ needs and desires when planning the massage session. Even if we think we know what is best for clients, it is imperative to put clients’ wishes first and ensure they feel heard and respected. If possible, ask them to prioritize the preferred outcomes. Relief from pain may be paramount. They may also seek improved mobility or balance. Rather than symptoms, they may speak of activities they wish to do more often or more easily but can’t because of the symptom or condition. Both symptoms and daily activities are important to consider when designing the massage session.

If you find yourself at odds with clients’ goals, find the research that supports your ideas for the session. You may have a compelling case. In elder care, there are many variables. Of course, clients may feel they know more than you about their condition. Be flexible.

Identify Your Goals for the Session

Consider the stage of inflammation when identifying session goals. There are clear delineations between treating acute verses chronic conditions. If the client is in an acute stage of inflammation, you probably want to take a gentle approach and reduce inflammation, reduce pain and muscle spasms, and maintain available range of motion (ROM). If the client has a chronic condition, there is more variety available with regard to the depth of pressure and types of technique to apply. This is influenced by the client’s personal preference. In general, focus on increasing flexibility and improving function, while reducing pain and other symptoms with chronic conditions.

In an end-of-life situation, providing comfort and care are primary goals of the massage. With each scenario, it is important to identify precautions and contraindication for the presenting conditions and medications. If the chronic condition is cancer, for example, consider the surgical sites, injection sites, port-a-caths, etc.

This is where the research can be helpful. You may not know what to consider with a cancer patient. The research may provide a variety of symptoms associated with cancer and insights to various cancer treatments and the side effects that you have not had experience with. This information may lead you to ask more informed questions of your client, and identify goals you may not have considered before.

Select Techniques to Accomplish Goals/outcomes

Draw from your personal experience—what you learned in school and in continuing education courses. Also, search for studies that identify what has been effective for a group of people. Weighing all options, you may select manual lymph drainage or ice to reduce inflammation and pain, and passive gymnastics to maintain ROM. In chronic care, you may opt for active-assisted movements or passive-resistive movements to increase ROM and function. If the research points to reflexology for improving insomnia—a common condition for older adults—you may wish to add that in to your plan.

The key is to identify what you want to accomplish and then select how you want to achieve that outcome. Then, it is important to remain flexible during the session and integrate the client’s personal preferences, modifying the session as techniques are found to be successful or not.

Providing massage therapy to older adults can be a challenging experience, given the wide range of conditions a massage therapist must be knowledgeable of and the ever-changing health status these clients experience throughout the aging process. That said, delivering attention, comfort, and relief to an often-isolated population with massage can be very rewarding.


An LMP since 1984, Diana Thompson has created a varied and interesting career out of massage: from specializing in pre- and postsurgical lymph drainage to teaching, writing, consulting, and volunteering. Her consulting includes assisting insurance carriers on integrating massage into insurance plans, and educating researchers on massage therapy theory and practice to ensure research projects and protocols are designed to match how we practice. Contact her at


1. S. Greenberg, A Profile of Older Americans: 2008, U.S. Department of Health and Human Services, Administration on Aging, 2008.

2. K. Robinson et al., Older Americans: 2008 Key Indicators of Well-Being, Federal Interagency Forum on Aging-Related Statistics, 2008.

3. P.M. Barnes, B. Bloom, and R.L. Nahin, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Reports; no. 12. Hyattsville, MD: National Center for Health Statistics. 2008. AARP, NCCAM, Complementary and Alternative Medicine: What People 50 and Older Are Using and Discussing with Their Physicians, Consumer Survey Report; January 18, 2007.

4. S. Greenberg, A Profile of Older Americans.
K. Robinson et al., Older Americans: 2008 Key Indicators of Well-Being.

5. AARP, NCCAM, Complementary and Alternative Medicine: What People 50 and Older Are Using and Discussing with Their Physicians.