Client Health

Adapting Nail Care for the Elderly

The over-70 set can benefit from manicures and pedicures, as long as their health and safety are paramount. Learn the unique challenges of dealing with an older clientele.  

Though appreciated by all of your clients, your tender touch and sense of style are perhaps most meaningful to seniors, who have the life experience to truly appreciate professional nail services. Elderly clients, those in their 70s and above, may have outlived their spouses and lack enjoyable human interaction in their day-to-day schedules. Their need for assistance with accessing their toenails or grasping nail clippers can also make them more devoted than younger clients, never missing an appointment no matter the season. However, to be successful and work safely within this niche, nail techs should be aware of some changes that commonly occur with age:

 

Slower Nail Growth

Studies have shown statistically significant differences in growth rates before and after age 40. The result? “Older people’s more slow-growing nails are exposed to considerably more environmental influences and these exposures, over time, can impact the overall appearance and strength of our nails,” says Dana Stern, MD, a New York-based dermatologist. “Subungual hemorrhages will take longer to grow out. Toenail fungus will potentially take longer to resolve.” 

 

Ingrown Nails

Because physically reaching toenails and handling nail clippers becomes more challenging with age, regular nail care can suffer. So scheduling nail trims about every four weeks is a reasonable precaution. Taking into account that many seniors are on fixed incomes, consider charging for a nail trim only, versus requiring them to book a full pedicure.

If the client’s nails are already showing abnormalities, such as onychcryptosis (ingrown nails) or onychogryphosis (curved nails that look like a ram’s horn), then refer her to a medical professional first. “It’s advisable to see a podiatrist for more complex nail clipping issues that may require special instruments, like onychogryphosis,” Stern says.

Then moving forward, keep in mind that trimming toenails straight across (not to the shape of the toe) is safest to prevent ingrown nails.

 

Z-Hills client Norma has been in the beauty industry all of her life, so she and owner Amber Thomas have much to chat about during appointments.
<p>Z-Hills client Norma has been in the beauty industry all of her life, so she and owner Amber Thomas have much to chat about during appointments.</p>

Onycholysis

Nails don’t adhere to the nail bed as well as people get older, so care must be taken to avoid loosening or separation of the nail from its bed (onycholysis). “Overly aggressive cleaning under the nails is a very common cause of onycholysis and an issue that predominates in the over-50 age group,” Stern says.

She advises, “If a client is prone to separation, no cleaning under the nail should occur. For those who are not prone to separation, when using an orangewood stick, always be very careful not to put upward pressure on the underside of the nail or to insert the tool too deeply under the nail. Avoid nail brushes which cannot be properly disinfected and can harbor organisms. Keeping the nails clipped short will keep them clean.”

 

Compromised Circulation

Clients can develop faulty circulation at the distal extremities — that is, the hands and feet. This can cause nail ridging (onychorrhexis), a clinical sign of brittle nails. “Interestingly, we see the effects of circulatory compromise in patients who are paralyzed on one side, and I have even observed this in patients who have one arm in a cast for an extended period. The extremity that has a compromised range of motion will often have brittle nails while the opposite, functional extremity will have normal nails,” Stern says.

Unfortunately, polish remover can make brittle nails worse, Stern says, and recommends a “nail polish holiday” (two or three weeks without nail color) be considered for these clients.

 

Dry Skin

Skin can lose its ability to retain moisture as the years go by. Robert Spalding, DPM, a Tennessee-based podiatrist and founder of MediNail Learning Center, says dry cracked skin “is a recipe for SMT, or ‘salon micro trauma,’ a term I had to coin in 2006 to scientifically explain the reason for so many infections in salons nationwide.” If bleeding is visible, Spalding says not to provide services without a written doctor’s clearance. Cracks, even without blood apparent, can let infections in. Spalding is an advocate of autoclaving in nail salons or using all disposable implements and tools to lower infection risk.

For clients lacking moisture but without cracks, a rich moisturizer offers benefits. Stern says, “Shea acts as a barrier for the skin and really helps to seal in moisture. Look for creams that contain ceramides and hyaluronic acid, both of which mimic the skin’s natural lipid barrier. The addition of salicylic acid will help to prevent callus from returning.”

Client Carol relaxes in an overstuffed recliner that is used as a pedicure chair at Z-Hills.
<p>Client Carol relaxes in an overstuffed recliner that is used as a pedicure chair at Z-Hills.</p>

Getting relevant medical history is important for all clients at their first appointment, particularly with the elderly and other at-risk groups. That will alert you to which adaptations are relevant. “Unless you ask basic questions about their medical conditions, you will not be properly informed,” Spalding says. He lists several examples: “Callus removers always pose potential burn problems, but the key is application time or previous history of chemical sensitivities. Less vigorous massage is important especially in the presence of varicose veins, frail skin, edematous [swollen] ‘shiny’ skin, or discolored blue or red skin with temperature changes either hot or cold. However, proper gentle touch effleurage vascular massage towards the head with the feet in a Trendelenburg position [supine with feet higher than the head by 15 to 30 degrees] can help promote lymphatic drainage. Do not provide deep tissue massage or petrissage.”

With appropriate protocols, caring for the elderly can be a win-win for nail techs and clients.

 

Senior Pedicure Step-by-Step

Vicki Malo, president of the North American School of Podology (NASP), and Katharin von Gavel, NASP CEO and Footlogix founder, recommend this pedicure protocol for elderly clients.

1. Soak the feet for no more than five minutes in tepid water using a pH-balanced hydrating foot soak, not a salt- or acid-based product. (If soaking the feet is not indicated, use warm moist towel compresses instead.)

2. Cleanse the foot gently, paying particular attention to the skin between the toes. Use a hydrating, urea-based callus softener.

3. Gently cut toenails and clean the nail groove and free edge. Reduce thick nails where applicable.

4. Do not push back cuticles. Use a fine grit file or buffer with a side-to-side motion on the surface of the toenails close to the cuticle area.

5. Gently smooth calluses on pressure points or areas of dry skin, being very careful not to over-file.

6. Apply a non-occlusive moisturizer (not a heavy sealing one that blocks transpiration).

7. Massage the foot and leg without applying any deep pressure. Use a light touch effleurage up the leg towards the knee.

8. Recommend a daily homecare product, if indicated.

9. Suggest different shoes or appliances such as toe props, cushions, etc., if indicated.

10. Make sure your clients know the benefits of routine pedicures and book them for their next appointment before they leave.

 

Doctor’s Notes

Older clients are more likely to have medical issues than younger clients, so consider developing referral relationships with one or more physicians in different specialties (such as dermatology, podiatry, and general practice) to refer questionable nail and skin concerns to. If there is any doubt about whether nail services are safe to perform or whether a client may spread an infection to the next client, request the client obtain a written medical clearance (doctor’s note) first.

About 50% of irregular looking nails (“dystrophic” nails) are fungal. “That means not every abnormal looking nail is fungus,” Stern says. “Given that onychomycosis and pseudomonas (a bacterial infection) are contagious, if a salon worker suspects that a client has these entities, it is advisable to refer. This will benefit the client in the long run.” 

Even if it turns out that the client isn’t contagious, early medical intervention can be beneficial. “Untreated onycholysis often persists and can become permanent and irreversible if not treated,” Stern says. “Subungual hemorrhage can sometimes be difficult to distinguish from melanoma.”

To develop relationships with physicians, you may need to prove your high standards to them. Remember that nail techs are able to refer to physicians, but are not legally allowed to make any diagnoses.

3 Specialists’ Success Stories

Client Carol enjoys a manicure at Z-Hills, where acrylics are not offered because the odor may irritate clients with respiratory disorders.
<p>Client Carol enjoys a manicure at Z-Hills, where acrylics are not offered because the odor may irritate clients with respiratory disorders.</p>

Nail tech: Amber Thomas, owner and natural nail specialist, Z-Hills Nail Salon, Zephyrhills, Fla.

Percentage of clients over 70: 35% in salon; 100% mobile (at assisted living facilities/nursing homes)

What inspired her to focus on this niche: In the United Kingdom, where Thomas completed her training, she realized nail techs are often the first to notice a client’s hand- or foot-related medical issue. Upon returning to the United States to care for her aging mother in Florida, where many residents are retirees, Thomas launched a nail business focused on the “over 55s.”

Design and service accommodations: Z-Hills Nail Salon is wheelchair accessible, the bathroom has a support bar, and services are done in an overstuffed recliner. The salon avoids products with potentially irritating odors, dry pedicures are offered to avoid risks associated with water, and a softened 100-180 grit file shortens toenails instead of a clipper. Clients also appreciate the salon’s use of fragrance-free 100% argan oil.

Most popular services for elderly: Dry pedicures, foot massages

How she handles potential medical concerns: She refers clients to podiatrist J.S. Bidelspach if she suspects a medical issue. Bidelspach also comes to the salon to do toenail fungus laser therapy on clients at a reduced price. She asks diabetic clients to bring in any prescribed medical creams so she does not use contraindicated products during massages.

 

Elderly clients have sought out Baich’s Pedicure Plus salon because of the easy-access lounger chairs that deliberately avoid risers or steps.
<p>Elderly clients have sought out Baich’s Pedicure Plus salon because of the easy-access lounger chairs that deliberately avoid risers or steps.</p>

Nail tech: Denise Baich, ANT/MNT/FNC, owner/operator of Pedicure Plus, St. Louis, Mo.

Percentage of clients over 70: 25% and growing due to a recent move into a building with medical offices

What inspired her to focus on this niche: When Baich did nails for a client who was in hospice care, she saw how she helped the client feel beautiful and provided much-needed emotional relief to the client’s family. Baich realized there was a need in her area for safe, quality salon care for the elderly and chronically ill.

Design and service accommodations: The building’s front curb is flush with the parking lot and wheelchairs are available for visitor use at the entrance. In the suite itself, doors are extra wide, scooters and large wheelchairs have room to maneuver, and services are performed in easy-access lounger chairs that deliberately avoid risers and are designed to comfortably hold clients who weigh up to 350 pounds. Services are soakless. Massage is gentle or avoided as indicated. Nail eponychium is not chemically treated or pushed back.

Most popular services for elderly: Routine foot care, upgraded pampering pedicures, some manicures.

How she handles potential medical concerns: Baich has a network of doctors to whom she refers, some of whom have suites in the same building. She is also moving into a different suite, where she will be located beside a podiatrist and will be performing services on the podiatrist’s well patients (those not in actual medical care) as the doctor’s practice grows.

Hardoon makes her own scrubs to pamper and protect her clients.
<p>Hardoon makes her own scrubs to pamper and protect her clients.</p>

Nail tech: Darlene Hardoon, nail blogger at gentleadorner.com and owner, Ethic Salon, Orlando, Fla.

Percentage of clients over 70: 25%

What inspired her to focus on this niche: Three factors drew Hardoon: Her location in Florida, census data showing a growing elderly population in general, and the knowledge that women generally outlive their male spouses.

Design and service accommodations: Hardoon is currently building out Ethic Salon; she has selected recliners for services and is avoiding rugs and other trip hazards. Products she will use include certified organic white sugar scrubs (not salt-based), jojoba oil, and paraffin. Services will be waterless. Disposable tools will be one-use-only and reusable tools will be sterilized in an autoclave.

Most popular services for elderly: Waterless manicures, traditional lacquer for nails

How she handles potential medical concerns: She requires a medical clearance note from a podiatrist and refunds the service deposit if the service risks falling outside of the nail tech scope of licensure. 

 

Continuing Education Options

> MediNail ANT/MNT programs (www.medinail.com)

> NASP Certified Master Pedicurist (www.northamericanschoolofpodology.com)

> Nailcare Academy ANT/MNT/FNT programs (www.nailcare-academy.com)

> CARES Certification by the Alzheimer’s Association (www.hcinteractive.com/basics)

 

 

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