The Senior Boom

Don't let your Candle burn out

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.

“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. At Z`ChiroMedspa we can do the same for the same considerations.

“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.

• Have your vision and hearing checked regularly.
• Limit your intake of alcohol.
• Use caution when getting up from sleeping or eating.
• Wear supportive (preferably lace-up shoes with a low heel), rubber-soled shoes.
• Use a cane or a walker to help maintain your balance if needed.
• Maintain a regular exercise program to improve muscle strength, tone and stability.
  

• Clear pathways of clutter and electrical cords.
• Attach rugs and carpets firmly with double-sided tape or rubber padding.
• Rearrange the furniture to avoid obstacles.
• Use a raised seat or change the toilet to a raised bowl.
• Install safety rails around the toilet and shower.
• Install a rubber bath mat or adhesive non-slip “stickers” to the tub floor.
• Install sturdy handrails on both sides of the stairways.
• Paint the top and bottom steps a contrasting color or use reflective tape for better visibility.
• Keep outdoor steps and walkways in proper repair.
• Provide adequate lighting inside and out.