Roughly 15% of chiropractic patients are 65 years old or older. Similar to other age groups, musculoskeletal complaints are most common. With longer life expectancy, often comes the desire to increase or continue normal function, which may allow them to live independently for a longer period of time.
Health care endeavors that assist patients in overcoming activity limitations resulting from health conditions, such as chronic pain, should be a part of patient’s care plan. Chiropractors treat patients within this frame work both as a first-contact provider and as a member of a multi-disciplinary health care team. As medical improvements are made and additional research is conducted, it is important to conduct periodic reviews to ensure that the best practices are being promoted and utilized.
Researchers reviewed just over 200 articles dated October 2009 through January 2016 in order to update best practices guidelines for chiropractic care for older adults. A group of 31 DCs and six other health care professionals (including medical physician, acupuncturist, PhD psychologist, and physical therapist) reviewed the articles and reached a consensus on 45 separate statements regarding the safety of spinal manipulation, advice on exercise and that spinal manipulation positively effects the patient in addition to pain relief.
The project had a goal of answering 2 questions:
· “What is the effectiveness of chiropractic care, including spinal manipulation, for conditions experienced by older adults?”
· “What are the adverse events associated with chiropractic care including spinal manipulation among older adults?”
After the initial review, the panelists had an 80% or better consensus on 39 statements. They reached consensus on the other six statements within two more rounds.
Every patient is different. All healthcare providers are responsible for considering patient preference, previous experience, expected result and possible risk associated with any treatment in addition to research to determine what path of treatment is most appropriate for any given individual. This is especially true for older adults who may have multiple conditions.
Overall, they did not change any of the previous recommendations, but actually strengthened the case for a number of statements already in place since the last review of this nature in 2010.
They did however, add a few new statements related to the areas of “patient assessment, potential harm with manual therapy and disease prevention.” The new statements help provide additional direction for chiropractors treating older adult patients.
They reported: “No serious adverse events related to the intervention were reported in any of the studies. The articles on adverse events related to spinal manipulation in general (not specifically in older adults) found that serious adverse events are very rare and challenge a causal relationship with spinal manipulation.” The new document also provides support in the topics of cognitive impairment and preventative screening for chiropractors treating older adults.
While much research has been done since the previous guidelines and this report was able to reinforce some previous conclusions, there are still some topics for which additional research would be beneficial.
SOURCE: Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update; (Article in Press) http://www.jmptonline.org/article/S0161-4754(16)30227-5/fulltext