The Profile of Older Adults Seeking Chiropractic Care: A Secondary Analysis

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SOURCE:   BMC Geriatrics 2021 (Apr 23);   21 (1):   271


Katie de Luca, Sheilah Hogg-Johnson, Martha Funabashi, Silvano Mior & Simon D. French

Department of Chiropractic,
Faculty of Medicine,
Health and Human Sciences,
Macquarie University,
Sydney, Australia.

Background:   Musculoskeletal conditions are the primary reason older adults seek general medical care, resulting in older adults as the highest consumers of health care services. While there is high use of chiropractic care by older adults, there is no recent, specific data on why older adults seek chiropractic care and how chiropractors manage conditions. Therefore, the purpose of this study was to describe the demographic characteristics of older adults seeking chiropractic care, and to report problems diagnosed by chiropractors and the treatment provided to older adults who seek chiropractic care.

Methods:   A secondary data analysis from two, large cross-sectional observational studies conducted in Australia (COAST) and Canada (O-COAST). Patient encounter and diagnoses were classified using the International Classification of Primary Care, 2nd edition (ICPC-2), using the Australian ICPC-2 PLUS general practice terminology and the ICPC-2 PLUS Chiro terminology. Descriptive statistics were used to summarize chiropractor, patient and encounter characteristics. Encounter and patient characteristics were compared between younger (< 65 years old) and older (≥65 years old) adults using ?2 tests or t-tests, accounting for the clustering of patients and encounters within chiropractors.

Results:   A total of 6,781 chiropractor-adult patient encounters were recorded. Of these, 1,067 encounters were for persons aged > 65 years (16%), from 897 unique older patients. The most common diagnosis within older adult encounters was a back problem (56%), followed by neck problems (10%). Soft tissue techniques were most frequently used for older patients (85 in every 100 encounters) and in 29 of every 100 encounters, chiropractors recommended exercise to older patients as a part of their treatment.

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Conclusions:   From 6,781 chiropractor-adult patient encounters across two countries, one in seven adult chiropractic patients were > 65 years. Of these, nearly 60% presented with a back problem, with neck pain and lower limb problems the next most common presentation to chiropractors. Musculoskeletal conditions have a significant burden in terms of disability in older adults and are the most commonly treated conditions in chiropractic practice. Future research should explore the clinical course of back pain in older patients seeking chiropractic care and compare the provision of care to older adults across healthcare professions.

Keywords:   Aging; Back pain; Chiropractic; Elderly; Health services; Low back pain; Musculoskeletal conditions; Neck pain; Observational study.

From the FULL TEXT Article:


Ageing of the population is a global phenomenon and high-income countries, such as Australia and Canada, are currently experiencing rapid growth of older age groups [1]. It is predicted that in both Australia and Canada, 22% of the population will be aged over 65 years by 2042 [2, 3] and globally there will be a threefold increase in persons aged over 80 years by 2050 [1]. The prevalence and socioeconomic burden of musculoskeletal conditions, and resulting disability, increases with age [4]. In Australia, musculoskeletal conditions contribute to 9% of total disability adjusted life years for those aged over 65 years [5]. Globally musculoskeletal conditions contribute to 8% of total disease burden in those aged over 60 years [6, 7]. Low back pain in older adults is more likely to be moderate to severe, and is more likely to be incapacitating, when compared to younger adults [8]. Older adults with low back pain, with or without accompanying leg pain, are twice more likely to face increased difficulty in lifting, walking or bathing themselves [9, 10] and lifting objects, housework, climbing stairs and walking, than older patients without pain [11]. Musculoskeletal conditions have a negative effect on an older person’s health and quality of life [12]; decreasing mobility, reducing social participation, increasing isolation and creating feelings of helplessness and frustration [13]. Economically in 2018, musculoskeletal conditions cost the Australian health system $9.3 billion, while in Canada, older adults account for approximately 45% of provincial health care expenditures [14].

Chiropractic is a health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health [15]. Globally, the median annual utilisation of chiropractic services is 9% [16], which increases to 15% in older adults [17]. In Australia, 73% of chiropractors report regularly treating adults aged older than 65 years [18] and, of patients who present to a chiropractor, 12% are aged older than 65 years [19]. In Canada, there is a higher proportion of older chiropractic patients and 19% of patients are older than 65 years [20]. While there is a high use of chiropractic care by older adults, and there is a high proportion of older adults as chiropractic patients, information about why older people seek chiropractic care and what care chiropractors provide are either nearly 20 years old [21, 22], or limited as they were collected using administrative databases from the United States [17]. In terms of treatment, consensus, evidence-based statements regarding an appropriate approach to chiropractic care in older adults [23], which include the safety of manipulation and advice on exercise for older patients [24], exist. A limitation is however that best practice recommendations must rely heavily on multidisciplinary, expert opinion due to sparse scientific evidence for the management of musculoskeletal conditions in this special population.

The Chiropractic Observation and Analysis STudy (COAST) was a cross-sectional, observational study, that described 4464 clinical encounters from chiropractors in Victoria, Australia [25]. Subsequently, O-COAST collected similar data on 3523 clinical encounters from chiropractors in Ontario, Canada [20]. As no recent studies have specifically analysed older patient data, the purpose of this study was describe demographic characteristics of the older chiropractic patient, report the extent of problems diagnosed in this population and report treatment provided by the chiropractor to older adults. We also compared problems diagnosed and the provision of treatment between younger (< 65 years) and older (≥65 years) adult chiropractic patients.

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