….you ain’t gettin no younger, your pain and your hunger they’re drivin’ you home. And freedom, oh freedom, well that’s just some people talkin’.

Your prison is walkin’ through this world all alone.

NAME THAT TUNE

PROMOTING PROMOTING HEALTHY AGING: HEALTHY AGING:

A Chiropractic PerspectiveA Chiropractic Perspective

Lisa Zaynab Killinger, DC

Palmer College of Chiropractic

Successfully Successfully NegotiatingNegotiating

The Age Wave... The Age Wave...

Why should we care about ger?Why should we care about ger?

Now, 1/3 of chiro pts. Aged 50+

1/2 of those are 65+

Soon… 1/2 of chiro practice will be patients over 50

(Christiansen; Job Analysis of Chiropractic 2000)

The Geriatric PopulationThe Geriatric Population

In last 100 years total population increased by 5X, geriatric population increased by 15X.

Fastest growing populations subset = 85 years old and older!

Now 4 million; by 2050-19 mil! First time in history; Aged are

fastest growing group!

Avg. lifespan increased from 47.3 in 1900 to 76.1 in 1997.

Centenarians now around 100,000, in 2050 will = over 1 million.

Now, 6,000 people/day turn 65 In 2010, 10,000 people/day will turn

65 (Alliance for Aging Research, 2002)

By 2020 there will be 50 million older Americans

By 2030 there will be 70 million!!

The US has a huge shortage of health professionals trained in geriatric care; Chiropractors can help fill that need!

Living Situations < 5% of people >65yrs old live in

nursing homes. Of those in nursing homes, vast

majority are dementia patients, mostly of the Alzheimer’s type.

Most elders live with family, spouses, or on their own.

Functional AbilityFunctional Ability 85% 65-69 y.o. no problem with self

care. 66% 80-84 y.o. no problem with self

care. 51% over 85 no problem in self care.

– 10% in this group are still extremely active and functional.

Mortality (top causes of death)Mortality (top causes of death)

Heart disease

Cancers (lung and gender related)

Stroke

MorbidityMorbidity Most frequent conditions occurring

per 100 elderly:– Arthritis (50)– Hypertension (36)– Hearing impairments (29)– Cataracts (17)– Orthopedic impairment (16)– Sinusitis (15)– Diabetes (10)

Effect of Aging PopulationEffect of Aging Population

Dychwald: “We are aging, and this may be the most unique social phenomenon of the 20th century.”

The most significant shift in health care = HEALTH PROMOTION.

(That’s where we come in!)

What’s NormalWhat’s Normal

Normal Neurologic ChangesNormal Neurologic Changes Slowing down =nerve cells &

brain weight. Sleep disorders - stage 3 and 4

patterns. Perceptual changes: taste, vision,

hearing, touch, etc.

Normal Aging of MuscleNormal Aging of Muscle total muscle mass. Atrophy in all areas - lower ext. more than

upper ext. or back. in isometric mm. strength.

– Acceleration may occur b/c of disuse.(Patients have control over their

muscle mass. We should empower them to build muscle, and prevent disability!)

Normal Aging of BoneNormal Aging of Bone

Loss of trabecular bone - greater loss than in cortical bone.

Loss in bone mass: 1% / year Pre-menopause, then 2-3 %/yr. Post-m.p.

By 80yrs. Women may have lost 43% of trabecular bone, men 27%.

(Patients can increase their bone density! Teach them how !!)

Normal Aging of GI SystemNormal Aging of GI System Carbohydrate-splitting enzymes. Basal gastric HCL Gastric intrinsic factor. Ca absorption Vit. D absorption

(Encourage use of natural “Papaya enzyme”, supplements, nutrient dense diet!)

Normal Aging - Circulatory Normal Aging - Circulatory SystemSystem

Vascular compliance. Organ perfusion due to inc.

peripheral resistance and cardiac output.

Cardiac reserve(Aerobic exercise combats

these aging changes.)

Pulmonary ChangesPulmonary Changes

Reduced chest wall compliance. Reduced lung tissue compliance. alveolar size with resultant in

ability for exchange. Age related collagen changes cause

in vital capacity.(Guess what combats these changes ?)

Assessing Older PatientsAssessing Older Patients

Geriatric Assessment Geriatric Assessment Physical Assessment Functional Assessment Cognitive Assessment Nutritional/Oral Health

Assessment Safety Others

Physical AssessmentPhysical Assessment

History Physical Exam Ortho/Neuro Exam Chiropractic Exam Your Five Senses and the

Patients’!

Functional AssessmentFunctional Assessment How well does the patient care

for him/herself? How well does the patient ‘get

around’?

Ways to Assess Ways to Assess Functional StatusFunctional Status

Barthel Index Functional Status Index Get Up ‘N Go Observation and other useful

strategies

Cognitive StatusCognitive Status

Mini Mental State ExamMini Mental State Exam

Orientation Registration Attention/Calculation Recall Language Part II

What’s ImportantWhat’s Important To Our Patients? To Our Patients?

Baseline assessment score Vigilance for marked or sudden changes!! Watch for polypharmacy! Drugs are

confusing.

Nutritional/Oral Health Nutritional/Oral Health StatusStatus

But We Are But We Are ChiropractorsChiropractors!!

Yes, and to our patients, Yes, and to our patients, we are also ‘we are also ‘doctorsdoctors’!!’!!

Assessing Nutritional Assessing Nutritional HealthHealth

Teeth, gums, lips, jaw, dentures Weight loss or gain > 10 lbs? Have trouble affording enough or

healthy foods?

Safety !Safety !

We Can Promote SafetyWe Can Promote Safety

Fall Hazard Checklist Home Safety Checklist Seatbelt Use/Driving Safety Prevention/Health Promotion

Who Might You Have ToWho Might You Have To Talk To? Talk To?

An MD A Social Worker A Nursing Professional A Psychologist How, When, and Why

Be A Team Player!!Be A Team Player!!

Aging and the SpineAging and the Spineoror

Are all Subluxations Are all Subluxations Equal?Equal?

Normal Aging of the SpineNormal Aging of the Spine

Clinical consideration given to muscle, bone and joint connective tissues.

What is “normal aging” and what changes exist as a result of disease processes.

DiscDisc

Nucleus decreased proteoglycan content, decreased shock absorption.– Disc cell; dramatic alteration in

nutrient content.– ECM requires nutrients through end

plates.– Motion increases dispersion.– End plate function = calcification and

decreased nutrient transport.

LigamentLigament Tensile properties of ligaments

become reduced. Mechanical stresses can cause

favorable or adverse integrity of lgts. Ligaments and tendons: Increase in

collagen (cross linking), increase in fibril size and aggregation, decrease in water, elastin, and proteoglycan content.

Ligaments and tendons increase stiffness and decrease max. length at which rupture occurs.

Loss of passive ROM slowly progressive

Postural changes cause joint deformity, less efficient, greater effort and more fatigue.

CartilageCartilage Cartilage has decreased water

content. Balance of synthesis and degradation

– Reduced formation or increased catabolism cause pathologic changes.

– Increased fibrillation and decrease capacity to absorb shock.

Models of Degeneration: Kirkaldi Willis–Dysfunction, Instability,

Stabilization.(We

need to design our chiropractic care plans with these stages in mind!)

Lumbar SpineLumbar Spine

DysfunctionDysfunction

InstabilityInstability

StabilizationStabilization

Progression of Cervical DiscProgression of Cervical Disc

Cervical SpineCervical Spine

McCarthy and Milus TICC 5;2 1998

Spinal Health InhibitorsSpinal Health Inhibitors

Adaptation to pain and trauma. Lack of understanding of the power

of activity/exercise. Activity Inhibitors

–Falls, medication, depressive illness, stressful life situations. FEAR!

Promoting Spinal WellnessPromoting Spinal Wellness Assessment Strategies

– Establish base-line, screen for risk factors or problems, develop care goals, monitor course.

– ADL assessment (Functional status)

– Physical exam must seek to establish base-line sense of patient strength, ROM.

Promoting WellnessPromoting Wellness Maximize joint function, Prevent acute and sub-acute

episodes of physiologic loss. Involve the patient in healthy

behaviors.

– Activity/exercise must include flexibility, resistance, and endurance.

Appropriate Nutrition– Zone Diet

Do not get hung-up on cholesterol

Micronutrient intake – 3 day dietary survey – how much vegetable and fruit intake.

Social and Mental stimulation.– Clubs, volunteerism, work.

Review of “Fitness” LevelReview of “Fitness” Level

Flexibility Strength Balance Cardiovascular Work out

Do not ignore...Do not ignore...

Patient’s posture Presence of external/internal

stressors Changes in Pt’s support network,

family circumstances, etc Patient’s coping skills, emotional

state, etc.

Incorporate Prevention Incorporate Prevention EARLYEARLY into Your Practice into Your Practice

Habits– Smoking– Diet/Weight– Activity– Hobbies – Reading

Social Integration

What About What About Osteoporosis?Osteoporosis?

What Do We Know?What Do We Know? Osteoporosis is the most common

skeletal disorder. It is the second most common skeletal

cause of disability (after arthritis). Osteoporosis costs 6 billion annually By 2010, the costs may exceed 60

billion annually in US alone!! (Holbrook, et al)

What Else Do We Know?What Else Do We Know?

Exercise Prevents! May Reverse! Hormones Help (HRT?) Diet Helps Caffeine/Soft Drinks Hurt

Who Is At Risk?Who Is At Risk?

Females Small framed, thin Fair skinned Post Menopausal/Early

Menopause/Hysterectomy Family history of osteoporosis

Controllable RisksControllable Risks

Dislike or avoid dairy products? Drink coffee or soft drinks? Drink alcohol or smoke? Don’t exercise? Use steroids?

So Doctors, So Doctors, What Can We Do?What Can We Do?

Which Leads Us To…Which Leads Us To…Injury PreventionInjury Prevention

If Not Us, Then Who?If Not Us, Then Who?

InjuriesInjuries

Occur mostly at home More serious in older patients Are most often due to falls Kill even our healthiest patients

Who’s At Risk?Who’s At Risk?

Osteoporosis risks? On too many meds? Demented? Depressed? Visually or hearing impaired?

Injury Prevention 101Injury Prevention 101

Know your patient. Assess and reassess your

patient. Ask questions. Give advice; sound advice. Follow up and follow through!

Promoting Successful Promoting Successful AgingAging

Some Chiropractic Cases Some Chiropractic Cases That Make You Think….That Make You Think….

NelNel is a 68 year old red headed farm- is a 68 year old red headed farm-raised Iowa girl. She hates doctors. raised Iowa girl. She hates doctors.

(Healthy as a horse!) She comes to see (Healthy as a horse!) She comes to see you for neck pain. She smokes, and so you for neck pain. She smokes, and so she breathes laboriously. In her exam she breathes laboriously. In her exam you also notice a lesion on her nose. you also notice a lesion on her nose. She says she has had it for years. It She says she has had it for years. It scabs over then is fine for months, scabs over then is fine for months,

then scabs over again. She is annoyed then scabs over again. She is annoyed by your questions about her nose; She by your questions about her nose; She

just wants you to fix her neck!just wants you to fix her neck! OK, what next?OK, what next?

Harry Harry is a 70 year old diabetic is a 70 year old diabetic patient. He has seen many chiros. patient. He has seen many chiros. for his low back pain and sciatica. for his low back pain and sciatica. He comes in today with leg pain. He comes in today with leg pain. He said it started off as foot pain, He said it started off as foot pain,

then started hurting higher up. then started hurting higher up. Now his whole leg hurts. His foot Now his whole leg hurts. His foot appears kind of reddish. His leg is appears kind of reddish. His leg is really bothering him and he wants really bothering him and he wants

an adjustment. What next?an adjustment. What next?

Mr. B is an 87 y.o. self reliant long-time patient who presents today with a complaint of a catch in his low back. In addition his wife complains that it appears that his left shoulder is drooping forward and he is hunching forward. It has been 9 months since his last visit to you.

His gait has somewhat slowed, he does not exercise nor walk anymore, but is active about the house. He has lost about 10 pounds in the past year.

He has had vision problems in the past year, with his left eye vision being extremely poor.

He denies fatigue, but does have problems with falling asleep at almost any time during the day.

Mr. G if 73 years of age, is good health overall – active with low stress. He is approximate 5’10” and weight 210lbs. He has been under your care for over 10 years, and has been battling left hip arthritis for almost 4 years. He presents today discouraged. He is finding it hard to get around without pain, and come in today because of pain in his SI region.

It appears that he is in much more a flexed posture than he was the last you saw him 6 months ago. His hip ROM is still severely restricted with a very hard end-play. He also admits that he has been tired during the past month and not sleeping well.

Mrs. J. presents with neck pain and slight headache after taking a bit of a fall last week. She has been an off-and-on patient for many years, but has not been in for 18 months. She reports that yesterday she tripped getting into the bathtub, and struck her head on the side of the wall.

Her husband past away 2 years ago. Her gait is wide based and shuffling. She places a hand out against the wall as she comes to the room. She appears very agitated and nervous – not unusual for her.

Her head pain is locate at the base of the skull and radiates somewhat into her neck. The pain started a few hours after the fall. She appears 30-40 lb. overweight, and does not rise nor lower into her chair easily.

Take Home MessagesTake Home Messages

You can promote “successful aging”.

Be a DOCTOR of chiropractic. Be a team player!

THANK YOU !!!THANK YOU !!!