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I grew up in the North of England, and when I was a child, most elderly people had at least some degree of disability. This is admittedly a lot longer ago than I would like to admit, but it was a rare grandmother who didn’t use at least one walking stick (if not two) and pretty much everyone’s grandfather was bent double; although they could normally manage to get to the Legion for a pint. Mobility was difficult, disability and ill-health were common, and treatment of any kind (other than “pills”, often prescribed months at a time by the GP) was non-existent. 

Elderly clients (by which I mean those over seventy) didn’t figure much in our business plans when we opened our clinic and went through “visualising our ideal client”. If you saw our last blog post, you’ve probably realised that we were quite poor at guessing who would come through the door, and so the substantial number elderly people who have wanted to be treated by us has been a bit of a surprise, although their custom is of
course welcome! 

We have found a few challenges to treating older clients, some which are obvious (check the steps into the workspace!) and some which aren’t. So, to try and stop other therapists learning the hard way like we did, I figured I would share some of what we learnt. 
Firstly, they might be social media savvy than you think (but an old fashioned reminder never goes amiss). 

If you are looking to attract older clients, you’ll find them on Facebook. Yes, they might have set the font to the biggest size possible, but you can bet they’re online and checking out your business page, and probably messaging each other about you. And whilst Facebook use is apparently declining in younger people, for the elderly (and just as importantly, their adult children), Facebook is huge. We found that posts aimed at the adults with elderly parents who were prone to falls or nutritional issues brought in quite a bit of business (a nice surprise considering we’d only written it to use a humorous photo). We didn’t expect many of our elderly clients to have access to email for our booking confirmation – but not only do they have it, they’ve set it all up on their mobile phones, and they’ve generally got a pretty sensible email address too. As with our fibromyalgia clients, repeated reminders and a text message on the day of the appointment is much appreciated and reduces incidents of “was that today?”
However, at least for us, most of our older clients don’t have a printer. If we need anything filled in on paper (terribly old fashioned, I know), we have to print it ourselves, and likewise if we want to give them an exercise plan or advice sheets. 
Secondly, they may not know much of their medical history (although they’ll remember if you ask). 
Considering I can’t remember what I had for dinner last week, I certainly can’t judge someone not quite remembering what the operation they had fifteen years ago was for. Or – if they have had several operations for different thing – even that they had one at all. This can lead to fun conversations when you discover a surgical scar where you weren’t expecting one! “Oh that on my shoulder? Yes, they took some bone away….”.
Although our clients often will give us what looks like a detailed and complete medical history, we have taken to assuming that there are things missing, and we are very careful with any waxes or balms we might use. Better safe than sorry, even with a signed intake form. 
 
Thirdly, they tend to have a lot of trust in their GP and “the hospital” (so be careful what you say!)
There have been other blog posts about language, and how clients can misunderstand. Studies show that people who see their GP often forget or misunderstand up to 60% of what they are told within 24 hours of an appointment, and so it’s not a surprise that GPs and “the hospital” try to present things in a simple manner.
Unfortunately, we have all had instances – and the effects are now well known – where a miscommunication or misunderstanding has led to fear of movement or exercise. Attempts to correct this need to be done very carefully – I remember dealing with one client who had been an absolute delight until I suggested that when “the man in the hospital” might not have explained things quite right when he told her that her “spine was crumbling”. If looks could have killed I would have been in serious trouble, and I was informed in no uncertain terms that it had been said by “the hospital”, making it quite clear that I should know my place! After a couple more appointments – where both rapport and trust were developed – I managed to explain that perhaps her picture of her spine was mistaken, but it was a salutary lesson. 
Interestingly, younger clients (by which I mean those between around 30 and 60) are happy to criticise their GP, the hospital and all and any specialists, and will quite happily declare that they don’t trust them. 
Fourthly, remember that they might not be able to hear you very well (but they might not want to admit it)
Hearing loss in the elderly is really common, but for various reasons not everyone affected decides to go for hearing aids. Indeed, some people are fantastic lip readers…but this only works if they can see your face, and if they are particularly good at hiding their deafness, it might take a while to realise that the nods and “yeses” are actually just what the client thinks they should say, rather than actually being the answer to your question. 
If you are performing a technique that involves standing behind a client, it’s worth working out a way to tell them when to make certain movements and explain what you’re going to do before you start doing it. It’s also important to work out how you will get information from the client about the level of pressure if they are lying prone and can’t see you. 
Finally, they have the best stories (and they’ll enjoy telling you them!)
Given that the set rule about NHS GP appointments only lasting ten minutes was formally abolished some years ago, many GPs (at least near us) seem to still implement it, and will even have signs up reminding you to only talk about one issue, and that your appointment is only ten minutes. So having someone want great deal about what is wrong, and then not rush them, is often quite novel of older clients. Add in to this the possibility that there is not a lot of social contact, and once an older client gets talking, it can be difficult to redirect the conversation. Of course, we are part of the problem – they like talking, but we like hearing. 

From a business perspective, it means that we need to allow a little extra time between appointments than we did initially, but with pain science showing us that pain is heightened by isolation and loneliness, it’s almost a clinical duty to have that extra conversation. And whilst that talking time isn’t charged for, it makes the world of difference to the client’s experience…and that will often result in better word of mouth recommendations.
 Written by Greg Pritchard State 11 Clinic
www.state11.co.uk/therapists
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