The Role of Chiropractic Care in Older Adults
SOURCE: Chiropractic & Manual Therapies 2012 (Feb 21), 20: 3
Paul E Dougherty, Cheryl Hawk, Debra K Weiner,
Brian Gleberzon, Kari Andrew, Lisa Killinger
There are a rising number of older adults; in the US alone nearly 20% of the population will be 65 or older by 2030. Chiropractic is one of the most frequently utilized types of complementary and alternative care by older adults, used by an estimated 5% of older adults in the U.S. annually. Chiropractic care involves many different types of interventions, including preventive strategies. This commentary by experts in the field of geriatrics, discusses the evidence for the use of spinal manipulative therapy, acupuncture, nutritional counseling and fall prevention strategies as delivered by doctors of chiropractic. Given the utilization of chiropractic services by the older adult, it is imperative that providers be familiar with the evidence for and the prudent use of different management strategies for older adults.
Introduction:
By 2030, nearly one in five U.S. residents is expected to be age 65 or older [1]. An estimated 14% of patients treated by doctors of chiropractic (DCs) are 65 and older [2]. The most common reason for an older adult to see a DC is musculoskeletal pain, most often lower back pain [3]. Although the most common reason for older adults seeking chiropractic care is for musculoskeletal symptoms, DCs may also provide a diverse range of services to these patients [4] .Given this fact, for the purpose of this manuscript chiropractic care will be defined as; “the provision by a doctor of chiropractic of services related to patient assessment, maintenance of health, prevention of illness, and treatment of illness or injury.” The focus of this manuscript is to describe the evidence for achievement of some of these goals in the older adult population. The purpose of this manuscript is to present an overview of information to the practicing chiropractor on utilization of specific management tools. This is not meant to be a systematic review of the literature or an evidence based guideline. The authors each have personal experience in evaluating and treating older adults as well as established expertise in research and publication in these areas. The authors recognize that there is a need for further research in the area of management of the older adult by DC’s and discuss in the conclusion future research considerations.
Although chiropractic encompasses many different treatment modalities, the authors have chosen to focus on five specific interventions that are commonly utilized by DCs: spinal manipulative therapy (SMT), acupuncture, physical activity/exercise, nutritional counseling and fall prevention [5,6].These have been chosen not only because they are commonly utilized treatments, but also because they align with certain goals of Healthy People 2020: 1) to reduce the proportion of older adults with functional limitations and 2) to increase the proportion of older adults with reduced physical or cognitive function engaging in physical activities; 3) to reduce the number of falls among older adults [7,8].
Many older adults utilize chiropractic services throughout the US and Canada. A recent longitudinal study reported 14.6% utilization over a 15 year period (1993–2007) with an annual prevalence rate of between 4.1%–5.4% [2]. The majority of older adults seek chiropractic care for back and/or neck pain, and treatment approaches for these conditions vary widely. Most DCs utilize some form of SMT. More than 90% provide nutritional advice and recommend nutritional supplements. Most also recommend therapeutic exercises and advise patients to engage in physical activity [5,6]. There is also a growing trend in the utilization of acupuncture in older adults [9]. Although few studies have specifically evaluated the role of chiropractic care in older adults, it is imperative that practicing DCs familiarize themselves with the unique nuances of dealing with older adults and understand the evidence for treatment approaches. The authors provide a brief overview of the current evidence for each of the interventions listed above as well as their commonly reported indications and contraindications.
Role of spinal manipulative therapy in older adults
Spinal pain is a significant musculoskeletal problem among older patients [10]. A recent report states the prevalence of disabling and non-disabling back pain in community-dwelling adults is 6% and 23%, respectively [11]. There are data that suggest that SMT may play an important role in the management of patients with spinal and peripheral joint pain and associated dysfunction [12]. From the perspective of the public, chiropractic care is most closely associated with SMT, which is traditionally high-velocity, low-amplitude (HVLA) maneuvers applied manually to spinal and peripheral joints [13]. These maneuvers move the joints from the end of their active and passive ranges of motion into the paraphysiological joint space, but not beyond their limit of anatomic integrity to deliver a therapeutic stimulus to the joint complex [14].
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As a chiropractor that is also certified in acupuncture I have seen many older patients over the past 30 years that became deconditioned and struggled with balance issues. A significant effort to avoid falling should be in everyone’s interest. Balance training and specific exercises can provide an alternative to becoming less active. Beginning a program to improve the patient’s stability and balance includes proprioceptive training. We use exercises like the “stork” or the swiss-ball to provide an approach to help build balance and decrease the likelihood of falling and becoming injured. We tell our patients if you want to keep moving as you get older, you need to keep moving as you get older which means working with chiropactic, acupuncture and balance exercises.
Chiropractic care is wonderful for those older adults looking to stay in shape as well as improve their quality of life. It’s really more beneficial than other type of exercise for older adults.