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….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 !!!