Wednesday, March 14, 2018

Working with Elders in Pilates

Life expectancy in the US is 76 for men and 81 for women, up eight years since the ’70s, according to recent statistics. In recent years my practice with elders has doubled. I call "elders" people 80 and above, of which I have four clients: My 91 year old clients began working with me when they were in their late eighties, about four years ago, never having experienced either Pilates or yoga. An 82 year old woman has been doing Pilates with me for six years beginning in her seventies, while another client who is 89 began in her mid-eighties. This is a brief overview of issues that have come up and not intended to cover specific exercises and practices. Further, I see each of these clients individually and not as a group.

Most come weekly. I have come to appreciate their challenges and strengths. What makes Pilates unique and successful with elder clients? How can we make the best use of our sessions to serve this demographic, and what needs must we be made more aware of?

It’s crucial to remember that each person is unique. A WWII veteran, pilot, and architect, 91, has severe scoliosis, a chronic sore left foot he favors, and very poor vision. These factors compromise his balance, stability, and mobility. His head tilts to the right 20-30 degrees unless he is thinking about sitting/standing up straight. He also wears hearing aids. Yet his attitude and mind are spry and engaged, and his ability to visualize his body as a three-dimensional moving structure puts him way ahead of the game.

One client, though not as compromised with spinal restrictions other than arthritis, has poorer hearing and is less outgoing. These factors alone radically alter the feel of our sessions and make it more challenging to keep her engaged. 

Another has been a life-long gardener and continues take care of her garden. Physically she is the fittest of the three. Her fitness means that she can get down on the floor and get up again with agility and no mishap. Being able to get up from a prone or supine position is one of the most important skills we can teach. Here are other challenges and things to bear in mind when working with this demographic. To help us remember, the first six points are alphabetically listed.

Arthritis/Agility: in hands it affects ability to hold things like straps and weights. in feet, it compromises stance and balance. I begin most sessions with a spiky ball, rolling under feet and between hands to help warm up the joints. Some clients will not be able to get down to the floor, or even on all fours on the table. Finding ways to subtly alter planes of movement is essential.

Balance and Benign Paroxysmal Positional Vertigo (BPPV): the chance of developing vertigo increases with age, especially after age 60. Practicing the Brandt-Daroff exercises or the Epley Maneuver with them on the Cadillac can be an important part of their session. None of my elder clients is comfortable with supine back extension. 

Coordination and comfort: extra padding for bony backs and knees, making sure clients are comfortable and cared for throughout your sessions enables both them and you to concentrate on the work. Elders often rely on the familiarity of their routines and movement patterns to compensate for compromised function. Our job is to challenge and expand their capacity, but in an environment where they feel safe and comfortable. 

Deafness: even with the best hearings aids, you have to speak clearly. What appears as lack of focus is frequently the result of just not hearing. I find myself doing the flight attendant thing, making gestures to accompany my words, and making sure they can see my face so they can read my lips.

Energy: they tire more easily. Observing their color, breath (or lack of it) and demeanor will tell you if you’re going too fast. Pacing that requires pauses for rest and assimilation can be a real gift. They are more variable as well. A poor night of no sleep or a tiring previous day, and their capacity is very much affected. Ask how they are, how they feel, before you begin and as you move through the session so you can improvise accordingly.

Focus: repeating instructions clearly and with verbal economy saves energy.  Keeping an elder engaged who has a tendency to tune out due either to poor hearing or mental vagueness is important for both instructor and client. If you’re impatient, they will feel it, so keep it light and fun. Once, my very deaf gardener forgot to wear her hearing aids. Instead of shouting through the session, I mimed things in funny ways and got us both laughing. Finally, I put a tiara on her head to convey that she had to sit tall and straight. (see photo below) 

Rigidity/Parkinsons: lack of over-all mobility and coordination makes transitioning from one position to another difficult. Don’t take these transitions for granted. Talking through how to get up or lie down more efficiently is necessary and can be a teaching moment for both of you. For example, observing an inability to bend knees into chest can clue you into working on hip flexor strength and flexibility. Stretching is an essential part of every session.

Finally, knowing what we may and may not improve through our work with elders is important. With my scoliotic pilot, I will not be able to erase a lifetime of scoliosis. But I can keep him from deteriorating as rapidly as he might without Pilates. Slowing degeneration IS progress. Let’s face it - the body will continue to age, but it can do so with less stress and debility. Many elders are more isolated, less stimulated, and so less engaged than younger members of society. Don’t underestimate the impact your relating has. This may be the one day they get out - only two of these elders drive. Pauses in sessions can be moments of connection. Ask them about their lives. This can be rich and fulfilling for both of you. They’ve lived almost a century - their experience is valuable but under-valued in our culture. When I work with elders, I feel honored to host them. It’s a joy to help make their experience a safe adventure in conscious and embodied movement. I’ve learned to trust my intuition and imagination as I explore ways of better expressing movement instructions and create sessions that are nourishing, educative, and restorative. They have taught me to savor time and relish physical capacity in any way it shows up. I am a better teacher thanks to our interactions.

Lavinia Magliocco
Equipoise ~ enlightened exercise LLC


No comments:

Post a Comment