Taking chiropractic care to seniors is in your future—Here’s
what you need to know about this coming boom.
By Pattie Stechschulte
Over the next 15 years approximately four million people from the Baby Boomer
generation will become senior citizens. That is roughly 30 percent of the population
of the United States.
And right now, the fastest growing subset of the population is people over 85
years old. Did you also know that there are about 100,000 people over the age
of 100?
Faced with these staggering numbers, the question of whether you are going to
be seeing more senior patients is mute.
Research Proves Chiropractic Benefits Seniors
Recently, research studies have been published that prove the cost-saving impact
that chiropractic care has on senior patients. In 1999, Muse & Associates,
a Washington, D.C.-based firm, released a data study of Medicare cost which
suggested that chiropractic care could play a significant role in reducing costs
of Medicare reform and a new prescription drug benefit. The patients who received
chiropractic care had fewer claims than patients not receiving chiropractic
care.
Another study, which was published in Topics of Clinical Chiropractic, reported
chiropractic patients have better overall health, spend fewer days in hospital
and use fewer prescriptions.
“In the recent scientific literature on osteoarthritis, it has been discovered
that two things can improve a patient’s prognosis if they have arthritis,”
says Lisa Killinger, D.C., assistant professor at Palmer College of Chiropractic
and aging researcher. “Doing some focused physical activity that
involves the joint or area of concern and keeping the muscles that cross
the affected joint strong.”
“Doctors of chiropractic should provide care and recommendations that are
consistent with the science. Advise patients to get involved with some
regular physical activity and to stay adjusted.
Reaching out to Seniors
“Caring for the aging patient is not the same as caring for younger patients.
Chiropractors must, through continuing education programs, educate themselves
on the aging process and the finer points of chiropractic elder care. First,
and most important, every chiropractor needs to learn to avoid “ageism,”
explains Killinger.
“The word ‘geriatrics’ carries a negative connotation, and
insinuates that ‘they’ are other than ‘us.’ We are all
aging and the best attitude is to realize that we are all in this together.
Sometimes, chronological age has little to do with liveliness and functional
abilities.”
In fact, according to Matthew McCoy, D.C., a clinician at Life University who
practiced in South Florida for 10 years, seniors are looking for the same quality
of life that their younger counterparts are seeking.
“Quality of life is really the big issue for senior citizens,” says
McCoy. “Somebody can come to you with advanced arthritis, you are not
going to cure their arthritis, but maybe what you are going to do is improve
mobility, keep the joints moving and decrease some of the pain. If it is hard
for you to get dressed in the morning, that is a big deal. After you have some
chiropractic care, now you are able to get yourself dressed and take care of
your personal hygiene independently.”
Chiropractors
need to keep these things in mind when they give education talks at senior civic
groups and meetings. They need to promote chiropractic as a safe, natural health
care alternative to medications and surgery.
“Chiropractors should become active and vocal promoters of the concept
of healthy aging in their communities. Sponsoring health-related activities
geared towards aging persons, and volunteering care to underserved seniors are
great ways to become an advocate for those who are in need of care the most—our
elders. [Persons in] the chiropractic patient population [are] the best candidates
to enjoy healthy aging,” says Killinger.
When educating senior patients, chiropractors need to judge their level of understanding
on a patient-to-patient basis. Although some seniors may not keep up with technology
and the latest health news, many seniors are very Internet savvy and are becoming
quite knowledgeable about their health concerns.
“If you can simply demonstrate to them in an X-ray where they see a problem,
explain to them in simple terms how that can be affecting the pain they are
having, generally they will feel very comfortable with proceeding and will actually
look forward to the treatment,” notes Jerry Gerard, D.C., a practitioner
in Mesa, Ariz., whose patient base is 50 percent seniors and who chairs the
ACA’s Senior Citizens Committee and Medicare Committee.
Taking a Thorough Case History and Starting Care
“Caring for an aging patient requires a special understanding of the
normal age-related changes that occur in the musculoskeletal system in later
years,” explains Kissinger. “Ligament elasticity, disc height and
fluidity, muscle mass and bone density may all decrease, while
capillary and skin fragility and stiffness may be increased. These changes should
impact our expression of the art of chiropractic: the chiropractic adjustment.”
“The biggest challenge is to go through a proper diagnostic workup so
you know the patient’s physical condition and how much you can work with
them or can not,” says Gerard. “After you go through that point,
you determine if they have osteoporosis or not, what kind of a technique you
will have to use, how you will have to modify that technique in order to fit
the patient’s condition.”
It’s not business as usual according to John Vilkelis, D.C., a New York
City-based chiropractor.
“Generally senior patients have more health concerns than younger patients,”
Vilkelis says. “They are going to be more concerned with arthritis, osteoporosis,
cardiovascular disease, eye and ear issues—all of those things in their
own way relate back that they have to be more worried about taking falls, different
injuries to different joints, fractures. So there is a lot more to think about
when you start working on the elderly,”
Killinger notes that the multitude of concerns can even come down to the type
of technique used.
“A broad range of chiropractic technique options are available that
tailor chiropractic care more towards the specific needs of patients of all
ages,” says Killinger. “While I will not advocate for one particular
chiropractic technique over another, in general lower force is required, softer
tissue pulls should be used and a decrease in joint end-play means that
every adjustment delivered to the aging patient should be done with the
utmost skill and care.”
Taking the time to use the right technique extends the benefits of chiropractic
care to your senior patients.
Senior Safety By John G. Vilkelis, D.C. Falls are one of the leading problems facing senior citizens because an injury resulting from a fall can often lead to permanent disability. One out of three people over the age of 60 will suffer a fall each year and fear of falling can often force seniors to curtail their activities. The risk of falling is caused by three major factors for seniors: the normal aging process, disease and the person’s environment. As people age there are normal alterations in gait, vision, posture hearing and cognition—all of which may contribute to an increased incidence of falls. Cardiovascular conditions, neurological impairments, psychological disorders and metabolic disorders may directly influence a person’s functional capabilities. Environmental factors include a person’s physical surroundings and medications that may put them at risk for falling. Many falls can be prevented with some simple changes, lifestyle changes and modifications to the home environment. Below are a few suggestions to make the home safer for seniors; it’s information that is also appropriate for your clinic. |
“Research shows that regular adjustments can make minor reversals in osteoarthritis.
There is pain and inflammation in the joint because the cartilage is degenerating,
so you don’t move that joint much because it hurts and you lose range
of motion. That is how arthritis progresses and makes it so that the joint is
the source of your problem,” says Vilkelis.
“I had a patient start with me who had never been to a chiropractor; she
was 91 years old. She was having sciatic pain and she had talked to somebody
who told her that a chiropractor helped her. She basically said to me ‘I
have this problem, can you do anything about it.’ After examining her,
having some X-rays and an exam, I told her that I thought we could fix it and
we did,” says Vilkelis. “Chiropractic pushes you the other way.
It makes it so it improves your range of motion, so you have less pain and you
can move more. You can’t go back to where you started, but it will be
better than it was.”
Gerard has had similar success with a senior patient. “We had a patient
in her early 80s who hadn’t been able to feel her legs or toes for almost
a year and a half. We started working with her, but her lumber spine was so
arthritic that I will not adjust it, but we could adjust the big bones of the
pelvis to influence the lumbar spine. She is now feeling her legs all the way
down to her mid-foot. She hasn’t felt that in over a year,” notes
Gerard.
Dealing with Medicare and Payment Plans
“When a new patient comes in that is a senior patient, most likely they
are on Medicare. One of the first things you want to do is clarify their Medicare
standing and/or their financial standing so that they are not caught off guard
with cost. Secondly, you have to take them through the HIPPA regulations and
have them sign off on the waiver for the HIPPA. Their concerns at that point
are two factors: ‘Doctor, how 
much
is it going to cost me?’ and ‘Doctor, can you help me?’”
said Gerard.
When McCoy worked in Florida, his practice was 50 percent cash, 50 percent insurance,
including Medicare. His staff developed cash payment plans for their senior
patients because many of them were on a fixed income. “We had a fixed-fee
type of a system that they paid for a certain amount per month. It seemed to
work best because they never know from day to day what kind of day they are
going to have in terms of their physical problems,” said McCoy.
“When you turn 65 you go on Medicare even if you are still working. A
lot of time Medicare takes over because their regular insurance won’t
carry them anymore,” said Vilkelis. “Somebody has to take care of
the old folks. They appreciate the fact that I accept Medicare.”
Of Special Concern: Prescription Drugs and the Senior Patient
Killinger stated that according to the U.S. government’s Healthy
People 2010 initiative, polypharmacy is the principle drug safety issue in the
United States, particularly in older persons. “Chiropractors have a golden
opportunity to become a part of the solution related to the problems of medication
errors, polypharmacy and drug toxicity,” she said.
| Lifestyle Changes
Home and Office Modification
|
She suggests that chiropractors team up with local pharmacists to sponsor educational
seminars for seniors to help identify dangerous or inappropriate drug interactions.
“Invite patients to bring all of their medications, supplements and
herbal remedies for evaluation. Identifying inappropriate prescriptions
or bad drug combinations can help save lives and help improve the lives of your
patients. They will appreciate your concern,” said Killinger.
McCoy instituted a related
policy in his office. “What I did was that I made sure that the patient
wrote everything down that they were taking and what they understood for the
reason why they were taking it, how often and the dosage. What was frightening
was that so many times they don’t know why they are taking it.”
They would look up the drugs, what there indications are and print it all out.
“Then I would sit with them and go over it with them and explain what
the literature said about why they are taking it and the side effects. A lot
of times the symptoms they are having are side effects of the drugs that they
are taking. After that, they tended to do was sit down with their medical doctor
at their next visit and ask if they needed to be taking all this stuff,”
said McCoy.
“I tell students that if you take the time, especially with senior patients,
to sit with them and explain to them, not just about chiropractic, but talk
to them about their other problems, they are going to love you because nobody
else does it.”
About the author: Pattie Stechschulte is a contributing editor and award-winning
writer for Today’s Chiropractic magazine.
References
Federal Interaging Forum on Aging-Related Statistics. Older Americans 2000:Key
Indicators of Well Being. Washington, D.C.: US Government Printing Office. August
2000.
National Center for Health Statistics. 2002.
McCarberg BH, Herr KA. Osteoarthritis: How to manage pain and improve patient
function. Geriatrics. 2001. 56(10):14-24.
Ettinger WH, Mitchell BS, Blair, SN. Fitness After 50: It’s never too
late to start! BCP Publications, Pasadena, CA. 1996. P. 63.
Hawk CK et al. Chiropractic care for patients aged 55 years and older: Report
from a practice-based research program. Journal of the American Geriatric Society,
2000;48:534-545.
US Dept. of Health and Human Services. Healthy People 2010: Understanding and
Improving Health. 2nd Ed. Washington D.C.: US Government Printing Office; November
2000.
Killinger LZ. Promoting health and wellness in the older patient: Chiropractors
and the Healthy People 2010 Objectives. Topics in Clinical Chiropractic 2001;8(4):58-63.
Killinger LZ. Prevention and Health Promotion in the Older Patient. Book
Chapter in Chiropractic Care of the Older Patient. Gleberzon editor. Butterworth-Heinemann
Publishers. Oxford. 2001.
© Copyright 2003 Today's Chiropractic