Senior Care

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

Senior Articles & Research

	Impact of Musculoskeletal Pain on Balance and Concerns of Falling in Mobility-limited, Community-dwelling Danes over 75 Years of Age: A Cross-sectional Study Aging Clin Exp Res. 2017 (Dec 11) [Epub] ~ FULL TEXT Intense neck pain in mobility-limited older adults is associated with significant changes in postural balance, and intense low back pain is associated with significantly higher concerns of falling.
	Patient-centered Professional Practice Models for Managing Low Back Pain in Older Adults: A Pilot Randomized Controlled Trial BMC Geriatr. 2017 (Oct 13); 17 (1): 235 ~ FULL TEXT Professional practice models that included primary care and chiropractic care led to modest improvements in low back pain intensity and disability for older adults, with chiropractic-inclusive models resulting in better perceived improvement and patient satisfaction over the primary care model alone.
	Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update J Manipulative Physiol Ther 2017 (May); 40 (4): 217–229 ~ FULL TEXT A total of 199 articles were found; after exclusion criteria were applied, 6 articles about effectiveness or efficacy and 6 on safety were added. The Delphi process was conducted from April to June 2016. Of the 37 Delphi panelists, 31 were DCs and 6 were other health care professionals. Three Delphi rounds were conducted to reach consensus on all 45 statements. As a result, statements regarding the safety of manipulation were strengthened and additional statements were added recommending that DCs advise patients on exercise and that manipulation and mobilization contribute to general positive outcomes beyond pain reduction only. This is an update of the 2010 Consensus Document titled: Recommendations for Chiropractic Care for Older Adults: Results of a Consensus Process
	Do Older Adults with Chronic Low Back Pain Differ from Younger Adults in Regards to Baseline Characteristics and Prognosis? Eur J Pain. 2017 (Mar 14) [Epub] ~ FULL TEXT Small baseline differences exist in older people with chronic low back pain compared to middle aged and younger adults referred to secondary care for chronic low back pain. Older adults present with slightly less intense low back pain but slightly more intense leg pain. Changes in pain intensity and disability over a 12 month period were similar across all age groups.
	Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People: A Randomized Controlled Trial J Manipulative Physiol Ther. 2016 (May); (39) 4: 267–278 ~ FULL TEXT Sensorimotor function and multisensory integration associated with fall risk and the physical component of quality of life improved in older adults receiving chiropractic care compared with control. Future research is needed to investigate the mechanisms of action that contributed to the observed changes in this study and whether chiropractic care has an impact on actual falls risk in older adults.
	Adverse Events Among Seniors Receiving Spinal Manipulation and Exercise in a Randomized Clinical Trial Man Ther. 2015 (Apr); 20 (2): 335–341 ~ FULL TEXT Non-serious AE were reported by 130/194 participants. AE were reported by three times as many participants in supervised plus home exercise, and nearly twice as many as in SMT with home exercise, as in home exercise alone. The majority of AE were musculoskeletal in nature; several participants associated AE with specific exercises. One incapacitating AE occurred when a participant fell during supervised exercise session and fractured their arm. One serious adverse event of unknown relationship occurred to an individual who died from an aneurysm while at home. Eight serious, non-related AE also occurred. Musculoskeletal AE were common among elderly participants receiving SMT and exercise interventions for NP. As such, they should be expected and discussed when developing care plans.
	Spinal Manipulative Therapy for Chronic Lower Back Pain in Older Veterans: A Prospective, Randomized, Placebo-Controlled Trial Geriatric Orthopaedic Surgery and Rehab. 2014 (Dec); 5 (4): 154–164 ~ FULL TEXT This is an interesting, but disappointing study. On a quick read-through, it appears to suggest that chiropractic adjusting (spinal manipulative therapy, or SMT) is no more effective than a placebo. My first reaction (OH NO!) was that this is just another study to fall into the black hole of previous placebo studies, in which both groups improved (and in this case, SMT did fare slightly better) but are difficult to distinguish between groups at 12-weeks. (8-weeks after the care had ended). On closer examination, the actual breakdown of treatment was: Of the 69 patients randomized to the SMT group, 19   (28%)   underwent HVLA spinal manipulation, 57   (83%)   underwent flexion distraction, and 29   (42%)   underwent mobilization. A-Ha! So, LESS THAN 1⁄3 of these patients actually received SMT, while one-half of then received mobilization.   That means that this paper should have concluded that mobilization (or flexion distraction) of the spine appears to be no more effective than placebo.
	Perceived Value of Spinal Manipulative Therapy and Exercise Among Seniors With Chronic Neck Pain: A Mixed Methods Study J Rehabil Med. 2014 (Nov); 46 (10): 1022–1028 ~ FULL TEXT Participants placed high value on their relationships with health care team members, supervision, individualized care, and the exercises and information provided as treatment. Change in symptoms did not figure as prominently as social and process-related themes. Percpetions of age, activities, and co-morbities influenced some seniors' expectations of treatment results, and comorbidities impacted perceptions of their ability to participate in active care.   Relationship dynamics should be leveraged in clinical encounters to enhance patient satisfaction and perceived value of care.
	Perspectives of Older Adults on Co-management of Low Back Pain by Doctors of Chiropractic and Family Medicine Physicians: A Focus Group Study BMC Complement Altern Med. 2013 (Sep 16); 13: 225 ~ FULL TEXT Low back pain (LBP) is a leading cause of disability and disease burden. [1, 2] People age 65 years and older report a 25% monthly LBP prevalence rate [3, 4] with recurrent or debilitating LBP common in older populations. [4–6] Chronic LBP is linked to difficulties with activities of daily living (ADLs) [7, 8], depression [4, 7, 9, 10], sleep problems [7, 9], and decreased performance on physical function [7, 11] and neuropsychological tests. [11] An estimated 2.3% of annual physician visits in the U.S. are for LBP. [3] Persons with LBP and other spine conditions have increased healthcare expenditures for medications, spinal imaging, injections and surgery [3, 4, 9, 12–14]. Medicare charges among older adults with back disorders have demonstrated significant increases for patient visits, imaging and spinal injections [12, 15] without translation to better health outcomes for LBP patients. [13–15]
	Spinal Manipulative Therapy and Exercise For Seniors with Chronic Neck Pain   NCT00269308 Spine J. 2014 (Sep 1); 14 (9): 1879–1889 Spinal manipulative therapy (SMT) with home exercise resulted in greater pain reduction after 12 weeks of treatment compared with both supervised plus HE and HE alone. Supervised exercise sessions added little benefit to the HE-alone program.
	The Role of Chiropractic Care in Older Adults Chiropractic & Manual Therapies 2012 (Feb 21); 20 (1): 3 ~ FULL TEXT While there is already substantial published research to assist the evidence-based DC in his/her care plan for the older adult, there is a need for well designed clinical trials and large observational studies to identify the most beneficial treatments, particularly for complementary and alternative interventions such as manual therapy including, but not limited to, spinal manipulative therapy and acupuncture.
	Nutrient Biomarker Patterns, Cognitive Function, and MRI Measures of Brain Aging Neurology. 2012 (Jan 24); 78 (4): 241–249 ~ FULL TEXT Higher blood levels of omega-3 fatty acids, vitamin B, vitamin C, vitamin D and vitamin E are associated with better mental functioning in the elderly, a new study has found.
	A Longitudinal Study of Chiropractic Use Among Older Adults in the United States Chiropractic & Osteopathy 2010 (Dec 21); 18: 34 ~ FULL TEXT There is substantial heterogeneity in the patterns of use of chiropractic services among older adults. In spite of the variability of use patterns, however, there are not many characteristics that distinguish high volume users from lower volume users. While high volume users accounted for a significant portion of claims, the enforcement of a hard cap on annual visits by Medicare would not significantly decrease overall claim volume. Further research to understand the factors causing high volume chiropractic utilization among older Americans is warranted to discern between patterns of "need" and patterns of "health maintenance".
	Geriatric Chiropractic Care as a Health Promotion and Disease Prevention Initiative: Focus on Fall Prevention Topics in Integrative Health Care 2010 (Dec 30); 1 (2) ~ FULL TEXT The chiropractic profession is well positioned to align itself with the principles of health promotion and disease prevention championed by the World Health Organization. As a means to explain how chiropractic practice models and the WHO position statements can converge, this article will use the example of fall prevention. This article will discuss the epidemiology, risk factors, patient assessment tools and preventive strategies of falls prevention for older patients. There are more articles like this at our Vertigo, Balance and Chiropractic Page
	Best Practices Recommendations for Chiropractic Care for Older Adults: Results of a Consensus Process J Manipulative Physiol Ther 2010 (Jul); 33 (6): 464–473 ~ FULL TEXT By 2030, nearly 1 in 5 US residents is expected to be 65 years or older. [1] Chiropractors commonly provide care to older adults in the United States, with approximately 14% of chiropractic patients being 65 years or older. [2] With musculoskeletal conditions cited as a leading cause of disability in this population, [3] it is important that the large body of evidence for the effectiveness of chiropractic care be examined for relevance to the geriatric population. This is particularly important given the statements made by the American Geriatric Society (AGS) in their clinical practice guidelines for the management of chronic pain in older adults. The 1998 AGS report made the following recommendation on chiropractic (based on the single study available at that time): [4] These recommendations have been updated by the 2017 article: Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update
	Chiropractic Care for Older Adults: Effects on Balance, Dizziness, and Chronic Pain J Manipulative Physiol Ther. 2009 (Jul); 32 (6): 431–437 ~ FULL TEXT This study is part of an avenue of research exploring the effect of chiropractic care on balance in older adults. The purpose of this study was to (1) assess the use of the 7-item version of the Berg Balance Scale, (2) explore possible effects of an 8-week course of chiropractic care on balance as measured by the 7-item Short-Form Berg Balance Scale (SF-BBS) in adults 65 years or older with impaired balance, and (3) collect preliminary information on the possible relationships of dizziness and/or chronic pain to poor balance.
	Older Adults Who Use Vitamin/Mineral Supplements Differ from Nonusers in Nutrient Intake Adequacy and Dietary Attitudes J Am Diet Assoc. 2007 (Aug); 107 (8): 1322–1332 ~ FULL TEXT A large proportion of older adults do not consume sufficient amounts of many nutrients from foods alone. Supplements compensate to some extent, but only an estimated half of this population uses them daily. These widespread inadequacies should be considered when developing recommendations for supplement use for clients in this age group. Modifying dietary attitudes may result in a higher rate of supplement use in this at-risk population.
	Health and Wellness Promotion For Older Adults Dynamic Chiropractic (August 27, 2007) ~ FULL TEXT As patients age, positive attitudes about lifestyle changes can vastly improve their quality of life. Older adults are seeking health promotion and wellness counseling more frequently from alternative practitioners. Chiropractors have much to offer this rapidly expanding demographic group, not the least of which is maintenance of spinal flexibility. Regular physical activity throughout life is important for maintaining a healthy body, enhancing psychological well-being, and preventing premature death. [6] Health promotion and wellness counseling offers an important service for older adults, and is in the patient’s best interest.
	Assessment of Balance and Risk for Falls in a Sample of Community-dwelling Adults Aged 65 and Older Chiropractic & Osteopathy 2006 (Jan 27); 14: 3 ~ FULL TEXT A total of 101 participants enrolled in the study. Advertising in the local senior newspaper was the most effective method of recruitment (46%). The majority of our participants were white (86%) females (67%). About one third (32%) of participants had a baseline BBS score below 46, the cut-off point for predicting risk of falling. A mean improvement in BBS scores of 1.7 points was observed on the second visit. For the subgroup with baseline scores below 46, the mean change was 4.5 points, but the group mean remained below 46 (42.5). There are more articles like this at our Vertigo, Balance and Chiropractic Page
	Chiropractic Patients in a Comprehensive Home-Based Geriatric Assessment, Follow-up and Health Promotion Program Topics In Clinical Chriopractic 1996 (Jun): 3 (2): 46–55 Coulter et al performed an analysis of an insurance database, comparing persons receiving chiropractic care with nonchiropractic patients. The study consisted of senior citizens >75 years of age. Recipients of chiropractic care reported better overall health, spent fewer days in hospitals and nursing homes, used fewer prescription drugs, and were more active than the nonchiropractic patients.

Senior Resources

	Chiropractors as the Spinal Health Care Experts A Chiro.Org article collection Enjoy these articles about chiropractors as first-contact Spinal Health Care Experts.
	Chiropractic Care For Veterans A Chiro.Org article collection Chiropractic care has been adopted by the military at veterans' centers and military bases around the country. Learn more now.
	Medicare Information Page A Chiro.Org article collection Although this section started by detailing proper billing and documentation issues, it has expanded into a collection of articles about the benefits of chiropractoc care for Seniors.
	The Vertigo, Balance and Chiropractic Page A Chiro.Org article collection Enjoy this collection of articles that detail how chiropractic care may support dizziness, vertigo and related balance disorders.

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Since 8-25-2017

Updated 6-30-2022