As doctors of chiropractic, we defend the primary health problem as being directly related to the vertebral subluxation complex and its component. But, our consultation, evaluation and management must include the mechanics that have caused the underlying condition(s) to develop that caused the patient to enter our office. This is true, regardless of whether the condition is acute, chronic or if the patient is seeking your expertise for developing and maintaining a wellness lifestyle. A very important part of our decision making involves recognizing how certain health issues and risk factors can be more specific to certain age groups, occupations, etc.
We all have a large percentage of our clientele who are elderly or geriatric. For many practitioners this patient category presents many challenges, including lack of regular exercise, proper nutrition, sedimentary lifestyles, and predisposed attitudes to what they think the problem is and what can be done about it. For this age group, the highest risk of a problem that leads to a major health concern is a fall. Falls can increase the risk of morbidity, mortality and disability. They commonly result in visits to emergency rooms, skilled nursing and rehabilitation facilities, and especially to the chiropractor. Falls are actually the leading cause of death from injury.1 Once an elderly patient has a significant fall, it starts a domino effect of problems. A fall often causes a sense of fear of future falls. This results in more decreased activities which, in turn, causes additional losses in strength, coordination and balance and even fear of socializing. A fall has a short-term effect which can lead to long-term dependence from others for self-care. Statistics from the Centers for Disease Control (CDC) estimate that approximately one third of people 65 years of age and older fall each year.2
In previous articles, we have talked about the importance of developing specific rehab or exercise programs that are specific to age groups. The common statement that "children are not just small adults" is analogous with "elderly people are more than just older adults."
Following a thorough consultation and evaluation/management, our decision making should include rehabilitation for pain control and support for the chiropractic adjustment in stabilizing the subluxation complexes. Muscular reeducation and normal patterns of movement should all be considerations for our treatment plan. But, is this enough? Are our treatment goals addressing activities of daily living or–another term you may be familiar with –instrumentation of daily living? These activities can include how someone is able to use a phone, computer and other mechanical devices.
Another important part of beginning a rehabilitation program is making sure the program is not initially too aggressive. This can cause a patient to not even begin the program because they feel it is too hard. It is an issue especially if our rehabilitation plan includes active rehabilitation procedures. We should consider passive rehabilitative procedures initially. This can be accomplished by supportive devices like the use of assisted walking devices (walkers, canes and crutches) properly. Use of flexible, custom-made orthotics is also important to assist in the improvement of proprioception and balance. Custom-made orthotics can assist in stabilizing the biomechanical movement of the foot, thus providing support and stability for the rest of the musculoskeletal system and improving gait. Custom-made cervical pillows also help patients by properly supporting the cervical curve.
An area of focus that is not always considered is teaching the patient how to get up from the floor properly in case of a fall. This is easily done while teaching a patient proper mechanics of getting up and down out of chair, out of bed, lifting and bending and other activities of daily living. One commonly overlooked aspect of improving our patients’ activities of daily living is discussing how to keep their home a safe area. It’s important to have a discussion about eliminating obstacles that can increase the risk of falls. Is this something you have not done before? The great news is that the work has already been done for you. The CDC has developed several brochures you can print in pdf form right from their website (www.cdc.gov/ncipc/pub-res/toolkit/brochures.htm). The brochures come in three languages. They are entitled "Check for Safety," which is a home fall-prevention checklist for older adults, and "What You Can Do to Prevent Falls." Happy reading!
A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan.
1. Centers for Disease Control. http://www2c.cdc.gov/podcasts/createrss.asp?c=50
2. Centers for Disease Control. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5709a1.htm