Even Old Surfers Need Even Old Surfers Need Chiropractic Care! Chiropractic Care!

Adjusting the “Boomers”Adjusting the “Boomers”

Lisa Z. Killinger, DCLisa Z. Killinger, DC

Palmer College of Palmer College of ChiropracticChiropractic

The Facts...The Facts...

• * 33% of chiropractic patients are * 33% of chiropractic patients are 50+ (Job Analysis of Chiro; 2000)50+ (Job Analysis of Chiro; 2000)

• 16-17% of chiro. patients are 65+16-17% of chiro. patients are 65+(Goertz, 1996, Hawk, 2000)(Goertz, 1996, Hawk, 2000)

• 6.5% of people aged 65+ used 6.5% of people aged 65+ used chiropractic in 1994 (Paramore, chiropractic in 1994 (Paramore, 1994)1994)

The “Boomers” are Coming!The “Boomers” are Coming!

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

• Now, 6,000 people/day turn 65Now, 6,000 people/day turn 65

• By the year 2010, over 10,000 By the year 2010, over 10,000 people/day will turn 65 !! people/day will turn 65 !!

(Alliance for Aging (Alliance for Aging Research, 2002)Research, 2002)

They Really Are!They Really Are!

• By 2020 there will be 50 million older By 2020 there will be 50 million older AmericansAmericans

• By 2030 there will be 70 million!!By 2030 there will be 70 million!!

• ***The US has a HUGE shortage of ***The US has a HUGE shortage of health professionals trained in health professionals trained in geriatric care; geriatric care; Chiropractors can help Chiropractors can help fill that gapfill that gap!!

The trends…as hippies turn 60 The trends…as hippies turn 60

• The ‘turned on’ generation’s use of The ‘turned on’ generation’s use of complementary/alternative care complementary/alternative care (including chiropractic) is rapidly (including chiropractic) is rapidly increasing. increasing. ((Eisenberg)Eisenberg)

• Collaboration between health care Collaboration between health care providers is increasing (“ID” care)providers is increasing (“ID” care)

• Health care teams are including Health care teams are including more ‘non-traditional’ providers, more ‘non-traditional’ providers, like chiropractors (Integrative care)like chiropractors (Integrative care)

Our Roles as Chiropractors...Our Roles as Chiropractors...

• HealersHealers: : HelpHelp facilitate the facilitate the body’s natural healing processbody’s natural healing process

• Teachers:Teachers: Educate our patients Educate our patients to participate in & achieve to participate in & achieve optimal health optimal health

• Professionals:Professionals: Utilize our Utilize our professional ethic & abilities for professional ethic & abilities for the good of the patientthe good of the patient

Goals of an Aging ‘Boomer’Goals of an Aging ‘Boomer’

– To remain independent !!!To remain independent !!!– To remain active (Do what we To remain active (Do what we

like)like)– To have less painTo have less pain– To take fewer medsTo take fewer meds– To stay tuned in, turned on, To stay tuned in, turned on,

and as far out as possible!and as far out as possible!

Goals of the Chiropractor:Goals of the Chiropractor:Condition Based CareCondition Based Care– To To or eliminate pain and compress morbidity or eliminate pain and compress morbidity– To To patients’ reliance on medications patients’ reliance on medications

Health CareHealth Care– To To patient health and patient health and – To To patient’s patient’s controlcontrol over health (HPP)over health (HPP)

Wellness/Development CareWellness/Development Care– To educate/empower patient to achieve To educate/empower patient to achieve

optimal wellness over the life span (HPP)optimal wellness over the life span (HPP)

““Health” Care (Re)-Defined:Health” Care (Re)-Defined:

•Health is a state of Health is a state of physical, mental, physical, mental, andand spiritual well-being and spiritual well-being and notnot merely the absence of merely the absence of disease.disease.

After all… After all…

these are the children of the 60’s!these are the children of the 60’s!

Encourage the “boomers” (and all Encourage the “boomers” (and all patients) to make patients) to make real “real “health”health”

their goal. their goal. ☺ ☺ ☺ ☺☺ ☺ ☺ ☺

Chiropractic care Chiropractic care can help aging persons can help aging persons

(all of us!)(all of us!) achieve that goal.achieve that goal.

(Health Promotion & Prevention is key!)(Health Promotion & Prevention is key!)

““Normal” Aging*Normal” Aging* (It impacts (It impacts how we adjust the Boomers !)how we adjust the Boomers !)

• ** muscle mass muscle mass

• ** bone density bone density

• ** ligament/tendon elasticity ligament/tendon elasticity

• ** capillary/skin/bone fragility capillary/skin/bone fragility• ** vascular plaque/atherosclerosis vascular plaque/atherosclerosis

(Souza, Soliman; Normal (Souza, Soliman; Normal Aging.TICC; 1996)Aging.TICC; 1996)

““And above all, do no harm”And above all, do no harm”CCommon chiropractic ommon chiropractic malpractice claims (older pts)malpractice claims (older pts)

– Failure to diagnoseFailure to diagnose– Rib fracture (Rib fracture (post-menopause females)post-menopause females)

– Hip fracture/dislocation/injuryHip fracture/dislocation/injury– Rotator cuff/shoulder injuriesRotator cuff/shoulder injuries– Falls off of tablesFalls off of tables– Burns from ice/heat/modalitiesBurns from ice/heat/modalities

(NCMIC)(NCMIC)

Ger. Care Considerations:Ger. Care Considerations:

• Orthostatic hypotension (often Orthostatic hypotension (often caused by medications or caused by medications or atherosclerosis)atherosclerosis)

• Adjust with Adjust with muscle mass/bone muscle mass/bone density, lig. elasticity in minddensity, lig. elasticity in mind

• Consider pathology odds Consider pathology odds

• Evaluate pt’s overall clinical pictureEvaluate pt’s overall clinical picture

• **ThenThen, develop your care plan , develop your care plan accordingly!accordingly!

Caring for Frail Patients:Caring for Frail Patients:• Lighter palpation and adjustmentLighter palpation and adjustment

• Choose your fulcrums wisely...Choose your fulcrums wisely...

• Use rotatory adjustments Use rotatory adjustments sparingly/cautiouslysparingly/cautiously

• Handle ribs and hips with care Handle ribs and hips with care

• Avoid “re-thrusting”Avoid “re-thrusting”

• Caution with heat/ice/modalities! Caution with heat/ice/modalities!

Caring For “Boomers” Caring For “Boomers” Responsibly….Responsibly….

• Take x-rays !! Use caution with Take x-rays !! Use caution with the osteoporotic or osteophytic the osteoporotic or osteophytic spinesspines

• Alter your technique choices in Alter your technique choices in pts. w/ heavily plaqued vessels.pts. w/ heavily plaqued vessels.

• Use lower-force techniques, or Use lower-force techniques, or modify techniques appropriatelymodify techniques appropriately

(demos later) (demos later)

Even More Specifically...Even More Specifically...

• Emphasize Emphasize mobilizationmobilization• Decrease thrust magnitudeDecrease thrust magnitude• Broaden contact pointsBroaden contact points• Protect patient from falls in your Protect patient from falls in your

officeoffice!!(Cooperstein/Killinger; Book chapter on (Cooperstein/Killinger; Book chapter on

technique in “Chiropractic Care of technique in “Chiropractic Care of the Older Patient”; )the Older Patient”; )

Sound clinical judgement Sound clinical judgement should prevent:should prevent:

• Post-adjustment stroke (very Post-adjustment stroke (very rare!)rare!)

• Post-adjustment discomfort (Pt & Post-adjustment discomfort (Pt & Dr)Dr)

• Rib or other fractures (easily Rib or other fractures (easily preventable)preventable)

• Soft tissue strains, pains, and Soft tissue strains, pains, and bruising (common, preventable)bruising (common, preventable)

Summary of General Summary of General Thoughts...Thoughts...

• Many technique and management Many technique and management options for chiro. ger. careoptions for chiro. ger. care

• We should design a care plan only We should design a care plan only afterafter considering the considering the entireentire clinical picture clinical picture

• We need to listen to, look at, and We need to listen to, look at, and thenthen touch our patientstouch our patients

• Your patient’s aging spine is changing; Your patient’s aging spine is changing; ‘adjust’ your care strategies too!‘adjust’ your care strategies too!

Demonstration:Demonstration:

☺☺☺☺☺☺

Chiropractic TechniquesChiropractic Techniques With Aging in Mind…. With Aging in Mind….

Is geriatric practice Is geriatric practice worthwhile? worthwhile?

YES!!!!YES!!!!

Most Older Patients:Most Older Patients:

• Have more disposable income than Have more disposable income than any in other times of their livesany in other times of their lives

• Are willing to pay out of pocket for Are willing to pay out of pocket for healthcarehealthcare

• Are a great source of referralsAre a great source of referrals

• Are great at keeping appointmentsAre great at keeping appointments

• Have the greatest need for careHave the greatest need for care

““Boomers” Are Great Boomers” Are Great Resources and Need Some Resources and Need Some Resources Too!Resources Too!

• Handouts available on ger Handouts available on ger resourcesresources

• What do you offer your older pts?What do you offer your older pts?

• What do your older patients have What do your older patients have to offer? (To other pts, to you, to offer? (To other pts, to you, and to the community)and to the community)

Some Advantages of Aging:Some Advantages of Aging:Hey, This Is Not So Bad!Hey, This Is Not So Bad!

• Boomers have more time,Boomers have more time,

• Less responsibility,Less responsibility,

• More security, stabilityMore security, stability

• Soon, Boomers will be the Soon, Boomers will be the MAJORITYMAJORITY

• (Man, how our society will (Man, how our society will change!)change!)

More advantages….More advantages….

WeWe can swear like sailors can swear like sailors and people just think we’re and people just think we’re being cute!being cute!

We can finally tell those stories We can finally tell those stories of our ‘wild and wooly’ days of our ‘wild and wooly’ days (without people trying to punch (without people trying to punch us or chase us)!us or chase us)!

We are more motivated to to We are more motivated to to develop a relationship with a develop a relationship with a Higher Power.Higher Power.

(Given the content of some of (Given the content of some of our ‘stories’, we had better our ‘stories’, we had better start praying!)start praying!)

““If you’re gonna get old, you If you’re gonna get old, you gotta dig it!” gotta dig it!”

Fred Van Dyke; Surfer, Age 70kFred Van Dyke; Surfer, Age 70k

•And….And….

Peace!!!Peace!!!