What Are Benefits Of Massage Therapy For Seniors’ Symptoms?

My patients may know I have begun my university education, having practiced Registered Massage Therapy in Halton Region, Ontario the past thirteen years. I am pursuing advanced learning in health and social sciences to help the community better with mental and emotional health care support. This article was written and submitted as a research paper for an Introduction to Gerontology class at McMaster University in spring term 2016 by Eleanor S. Hayward RMT, receiving the grade of ‘A’:

What Are Benefits Of Massage Therapy For Seniors’ Symptoms?

As the world exhibits population aging, Canadians’ expanded life spans may impact quality of life as they experience injuries and symptoms of physical and mental disorders. Seniors are facing physical or psychological symptoms influencing functional capacity and end-of-life palliative care. By studying the literature, I propose a comforting solution is provided by massage as a rehabilitative, restorative, supportive and palliative modality. Massage is often provided by a variety of health care professionals, usually trained massage therapists though nurses, physio and occupational therapists sometimes offer touch therapy as a component of care. Massage can be taught to patients as a method of self-care, or to caregivers for optimal wellness. By incorporating massage therapy into senior citizens’ lifestyles, symptoms including pain, anxiety and depression can be managed to improve health and wellness throughout life. There is a growing body of scientific evidence which enforces that giving and receiving massage improves, maintains or decreases loss of function and increases health. This essay outlines some of the benefits around the modality of touch and its applications for elderly patients today in Canada.

Analysis

Though massage has an expansive cultural history for families internationally, massage therapy has been practiced in Canada since World War I, regulated in 1991 as a health profession in Ontario. Massage therapy is described as “the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of a group of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body…These techniques affect the muscular, skeletal, circulatory, lymphatic, nervous, and other systems of the body. The basic philosophy of massage therapy embraces the concept of vis Medicatrix naturae, which is aiding the ability of the body to heal itself, and is aimed at achieving or increasing health and well-being.” (Medical Dictionary for the Health Professions and Nursing, 2012, para. 5)

According to Statistics Canada (2012) Seniors suffer from disabilities embodying pain, lack of flexibility and mobility and/or mental/psychological symptoms (Figure 1). These disabilities may result in functional limitations affecting activities of daily living, impairing quality of life and subjective well-being (Novak, Campbell & Northcott, 2014, p 100-101). “Massage can exert its effects through physiological, mechanical, and psychological pathways. Massage promotes relaxation, reduces muscular tension, relieves pain, improves circulation, and increases flexibility.” (Mitchinson, Fletcher, Kim, Montagnini & Hinshaw 2014, p. 6)

Physical Symptom Management

Physical pain may result in limited flexibility and mobility, and be located anywhere in the body. Massage may provide relief from pain located in many areas, and the following study by Ernst (as cited by Yen, Chui, Markowski, Fitzpatrick, Wang & Corkery, 2015) shows how soft tissue massage (STM) affects low back pain (LBP) specifically “by increasing pain threshold, and inhibiting pain signals enter[ing] into the central nervous system. It may also provide mental relaxation and enhance healing through improving circulation.” (p. 201) Compared with spinal manipulation, STM is gentler and seems to be more qualified for the aging and older adult. Study participants demonstrate STM alone and STM in conjunction with exercise and education respond better than a groups with just exercise and education, or with a sham trial. Also, “significant treatment effects favoring massage emerged, with less severe symptoms and less dysfunction [than acupuncture or self-care education alone], with still some decreased [LPB] symptoms noted at 1 year [albeit participants were aged 20 to 70]” (p. 201). Concluding “existing evidence, though limited, generally supports that STM [is] effective for treating LBP in aging and older adult populations” (Yen et al. 2015, pp. 201-202).

Psychological Symptom Management

Mental problems can lead to functional disorders resulting in loss of competence, and although prevention is essential to good mental health in old age, non-drug therapies can help relieve depression and anxiety among other symptoms. Cognitive disorders including dementia present a challenge for healthcare workers needing better solutions for symptom management to improve patient function psychologically and socially (Novak et al. 2014).

Suzuki and Takayuki’s (2010) study suggests tactile massage reduces aggressiveness and stress level in patients with dementia, and participants are reported to have improved sleep through the night, decreased wandering, decreased anxiety, decreased paranoia and delusional ideation.

In addition to receiving massage, one noted older study delightfully demonstrates “retired elderly volunteers who provided massage therapy to infants received health benefits. Stress, anxiety and depression were reduced for the elderly adults” (Field, Hernandez-Reif, Quintino, Schanberg & Kuhn, 1998, p.229).

Palliative Care Symptom Management

Novak et al. (2014) point to studies in palliative care suggesting alternatives to medical treatment in end-of-life care. I think the terminally ill and dying patient deserves supportive care to enhance their quality of life while neither hastening nor postponing death, but easing any distressing symptoms.

The study by Mitchinson et al. (2014) confirms veterans receiving massage as part of a comprehensive palliative care (PC) service experienced clinically important decreases in pain intensity, pain unpleasantness, anxiety, and shortness of breath in response to massage. They conclude “Massage is a unique, safe, individualized therapy that addresses the physical, psychological, social, and spiritual aspects of suffering experienced by persons with advanced illnesses. This study supports the concept that touch is very important to dying patients… Massage should definitely be considered for relief of suffering in PC patients.” (Mitchinson et al. 2014)

Although providing care to the patient Novak et al. (2014) states many hospital doctors and nurses feel uncomfortable with dying patients. I suggest the power of touch bridges the gap of care. Edvardsson, Sandman and Rasmussen (2003) summarize “that giving touch in the care of older patients is a transforming experience…instead of seeing a severely demanding patient suffering from dementia and/or pain, one is able to see the person behind the disease as a human being, like oneself.” (p.601). Furthermore, study participants including nurses and occupational therapists were able to “improve the situation for a patient, i.e. being able to act on one’s own without having to ask superiors for medication and advice.” (p. 604). This underlines the benefit of massage to fortify palliative care without relying solely on the medical model.

Discussion

Scientific evidence makes clear massage therapy has benefits for seniors physically, psychologically up until and throughout the end-of life phase. Although there are perceived barriers to receiving body-based treatment, there are ways to integrate the power of touch on individual, organizational and societal levels of Canada’s health care approach. The applications are endless.

Perceived barriers of care to seniors include the need to travel to a trained professional as well as the high cost of treatment. Trained Registered Massage Therapists provide valuable care, although as health professionals, have a relatively high fee for services. For example, the Registered Massage Therapists’ Association of Ontario has recommended an hourly fee of $89 plus HST (RMTAO Fee Schedule, 2016). Massage therapy services are not currently covered by the Ontario Health Care Plan (OHIP), though Canadians do often have access to massage therapy under private, extended healthcare insurance plans. Unfortunately retired seniors may not have this advantage.

To overcome these barriers at an individual level, elderly people can be taught the value and learn techniques of self-massage treatment. Health professionals may lead individual or small group lessons to familiarize seniors with compassionate self-touch for stress reduction. Technology may also play a role in providing repetitive lessons to enforce self-care massage skills, reducing the cost of hiring a professional for each treatment. Similar resources can provide training to informal caregivers, enhancing benefit in the community with support at home and reducing travel and cost to the elderly patient. For older patients who have a more flexible budget, a trained massage facilitator can be hired for in-home visits to eliminate the need of travelling-out if transportation and/or mobility are an issue.

At an organizational level, businesses could include extended health insurance benefits in retirement packages and ensure inclusion of services not covered by provincial plans to help provide partial or full costs of complementary treatments. Community centres may hold massage workshops for caregivers and seniors interested to learn basic skills for relaxation purposes, benefitting from both giving and receiving touch. It is acknowledged that liability may be an issue for more complicated cases; waivers could be utilized as a solution underlining informed consent, though simple gentle superficial hand massage has benefit with limited risk. Long term care facilities could hire massage therapists and offer assessments and treatment plans for condition-specific programs to its residents, giving care for brief durations more frequently while building a trusted professional relationship for enhanced contact. A more cost-effective solution could entail engagement with formal massage education institutions by arranging for massage student trainees to provide supervised care at a minimized fee in exchange for geriatric treatment experience.

Historically, massage was a part of family interaction by keeping in touch literally with each other to strengthen comfort within the unit, increasing health and communication while assuaging pain. Societally, families can still benefit from these effects by increasing education about the benefits of touch, creating opportunity for the average person to learn symptom-alleviating techniques and by making time to massage our partners, children, parents and grandparents to uplift, support and listen to one another.

By researching this paper, I better understand how the power of touch affects us all throughout life. Beginning in childhood I have found that our Western culture has become more detached from touch in fear of allegations of abuse, creating non-hugging rules in institutions, resulting in limited knowledge and experience in the power of positive touch with informed consent. As published in Time (2012), “The Problem with ‘No Hug’ Policies in School”, “safety is sometimes a code word to disguise schools’ burning desire for order. Young children need to touch each other — we all need human contact — and they need to slowly figure out what’s appropriate and what’s not.” Massage as a form of touch can enhance health and wellness to address symptom management at all ages including seniors on individual, organizational and societal levels.

Conclusion

Although the medical model of care includes benefits of medication and surgery, there are limitations to the effectiveness of this approach and many Canadians seek solutions either to complement their allopathic intervention or approach care with lower risk alternative therapies for health and wellness. Specifically massage therapy provides a viable rehabilitative solution in restorative, supportive and palliative categories. With informed consent and trust, the entire community benefits from the comfort of touch administered by self, health professional, caregiver, or elderly patients, whether given or received. Services can be offered in private health centres, public community centres and institutions or in-home. Soft tissue manipulation helps seniors with appropriate intervention for physical and psychological health, presenting a desirable addition to palliative care. By incorporating massage therapy into senior citizens’ lifestyles, symptoms including pain, anxiety and depression can be managed to improve health and wellness throughout life.

References

Cohen, L. J. and DeBenedet, A. T. (June 19, 2012). The problem with ‘no hug’ policies in school. Time. Retrieved from http://ideas.time.com/2012/06/19/the-problem-with-no-hug-policies-in-schoo/

Field, T. M., 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 (2), 229-239. Retrieved from http://doi.org/10.1177/073346489801700210

Massage Therapy (n.d.). Medical Dictionary for the Health Professions and Nursing. Retrieved June 4 2016 from http://medical-dictionary.thefreedictionary.com/massage+therapy

Mitchinson, A. and Hinshaw, D. (2014). Integrating massage therapy within the palliative care of veterans with advanced illnesses: An outcome study. American Journal of Hospice and Palliative Medicine, 31 (1), 6-12.  Retrieved from http://web.a.ebscohost.com.libaccess.lib.mcmaster.ca/ehost/detail/detail?vid=5&sid=fd4224bf-5cec-43f1-b2fb-bfceb79e6319%40sessionmgr4004&hid=4207&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#AN=EP94065640&db=gnh

Nowak, M., Campbell, L. and Northcott H., (2014). Aging and society: Canadian perspectives, (7th ed.). Toronto, ON: Nelson Education Ltd.

Registered Massage Therapists’ Association of Ontario (2016). Understanding massage therapy services and fees: Fee schedule. Retrieved from https://secure.rmtao.com/Massage_Therapy/your_massage_dollars/understanding_rmt_fees.htm

Social and Aboriginal Statistics Division (2012). Canadian survey on disability. Statistics Canada, p. 3. (See figure 1). Retrieved from http://www.statcan.gc.ca/pub/89-654-x/89-654-x2013002-eng.pdf

Suzuki, M., Saruhara, T., (2012). Physical and psychological effects of 6-week tactile massage on elderly patients with severe dementia. American Journal of Alzheimer’s Disease and Other Dementias, 25 (8), 680-686. Retrieved from http://aja.sagepub.com.libaccess.lib.mcmaster.ca/content/25/8/680.full.pdf+html

Yen, S., Chui, K., Markowski, A., Fitzpatrick, D., Wang, Y., Corkery, M., (2015). Lumbar spine manual therapy for aging and older adults. Topics in Geriatric Rehabilitation, 31 (3). 199-202. Retrieved from http://web.a.ebscohost.com.libaccess.lib.mcmaster.ca/ehost/detail/detail?vid=3&sid=fd4224bf-5cec-43f1-b2fb-bfceb79e6319%40sessionmgr4004&hid=4207&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#AN=EP108935805&db=gnh

 

Figure 1

population-with-disability-statsNote: Total for Canada excludes Nunavut, the Northwest Territories, and Yukon.

Retrieved from Dr. Yvonne LeBlanc’s PowerPoint Presentation The Aging Body: Personal Health and Illness, McMaster University, Spring 2016.

 

By Eleanor S. Hayward RMT