1. NAME THAT TUNE ….you ain’t gettin no younger, your pain and your hunger they’re drivin’ you home. And freedom, oh freedom, well that’s just some people talkin’. Your prison is walkin’ through this world all alone.

2. PROMOTING HEALTHY AGING: A Chiropractic Perspective Lisa Zaynab Killinger, DC Palmer College of Chiropractic

3. Successfully Negotiating The Age Wave...

4. Why should we care about ger? • Now, 1/3 of chiro pts. Aged 50+ • 1/2 of those are 65+ • Soon… 1/2 of chiro practice will be patients over 50 (Christiansen; Job Analysis of Chiropractic 2000)

5. The Geriatric Population • In last 100 years total population increased by 5X, geriatric population increased by 15X. • Fastest growing populations subset = 85 years old and older! • Now 4 million; by 2050-19 mil! • First time in history; Aged are fastest growing group!

6. Avg. lifespan increased from 47.3 in 1900 to 76.1 in 1997. • Centenarians now around 100,000, in 2050 will = over 1 million. • Now, 6,000 people/day turn 65 • In 2010, 10,000 people/day will turn 65 (Alliance for Aging Research, 2002)

7. By 2020 there will be 50 million older Americans • By 2030 there will be 70 million!! • The US has a huge shortage of health professionals trained in geriatric care; Chiropractors can help fill that need!

8. Living Situations • < 5% of people >65yrs old live in nursing homes. • Of those in nursing homes, vast majority are dementia patients, mostly of the Alzheimer’s type. • Most elders live with family, spouses, or on their own.

9. Functional Ability • 85% 65-69 y.o. no problem with self care. • 66% 80-84 y.o. no problem with self care. • 51% over 85 no problem in self care. • 10% in this group are still extremely active and functional.

10. Mortality (top causes of death) • Heart disease • Cancers (lung and gender related) • Stroke

11. Morbidity • Most frequent conditions occurring per 100 elderly: • Arthritis (50) • Hypertension (36) • Hearing impairments (29) • Cataracts (17) • Orthopedic impairment (16) • Sinusitis (15) • Diabetes (10)

12. Effect of Aging Population • Dychwald: “We are aging, and this may be the most unique social phenomenon of the 20th century.” • The most significant shift in health care = HEALTH PROMOTION. (That’s where we come in!)

13. What’s Normal

14. Normal Neurologic Changes • Slowing down = ¯ nerve cells & brain weight. • ­ Sleep disorders -¯ stage 3 and 4 patterns. • Perceptual changes: taste, vision, hearing, touch, etc.

15. Normal Aging of Muscle • ¯ total muscle mass. • Atrophy in all areas - lower ext. more than upper ext. or back. • ¯in isometric mm. strength. • Acceleration may occur b/c of disuse. (Patients have control over their muscle mass. We should empower them to build muscle, and prevent disability!)

16. Normal Aging of Bone • Loss of trabecular bone - greater loss than in cortical bone. • Loss in bone mass: 1% / year Pre-menopause, then 2-3 %/yr. Post-m.p. • By 80yrs. Women may have lost 43% of trabecular bone, men 27%. (Patients can increase their bone density! Teach them how !!)

17. Normal Aging of GI System • ¯ Carbohydrate-splitting enzymes. • ¯ Basal gastric HCL • ¯Gastric intrinsic factor. • ¯Ca absorption • ¯Vit. D absorption (Encourage use of natural “Papaya enzyme”, supplements, nutrient dense diet!)

18. Normal Aging - Circulatory System • ¯ Vascular compliance. • ¯ Organ perfusion due to inc. peripheral resistance and¯cardiac output. • ¯ Cardiac reserve (Aerobic exercise combats these aging changes.)

19. Pulmonary Changes • Reduced chest wall compliance. • Reduced lung tissue compliance. • ¯alveolar size with resultant¯in ability for exchange. • Age related collagen changes cause¯ in vital capacity. (Guess what combats these changes ?)

20. Assessing Older Patients

21. Geriatric Assessment • Physical Assessment • Functional Assessment • Cognitive Assessment • Nutritional/Oral Health Assessment • Safety • Others

22. Physical Assessment • History • Physical Exam • Ortho/Neuro Exam • Chiropractic Exam • Your Five Senses and the Patients’!

23. Functional Assessment • How well does the patient care for him/herself? • How well does the patient ‘get around’?

24. Ways to Assess Functional Status • Barthel Index • Functional Status Index • Get Up ‘N Go • Observation and other useful strategies

25. Cognitive Status

26. Mini Mental State Exam • Orientation • Registration • Attention/Calculation • Recall • Language • Part II

27. What’s Important To Our Patients? • Baseline assessment score • Vigilance for marked or sudden changes!! • Watch for polypharmacy! Drugs are confusing.

28. Nutritional/Oral Health Status

29. But We Are Chiropractors!

30. Yes, and to our patients, we are also ‘doctors’!!

31. Assessing Nutritional Health • Teeth, gums, lips, jaw, dentures • Weight loss or gain > 10 lbs? • Have trouble affording enough or healthy foods?

32. Safety !

33. We Can Promote Safety • Fall Hazard Checklist • Home Safety Checklist • Seatbelt Use/Driving Safety • Prevention/Health Promotion

34. Who Might You Have To Talk To? • An MD • A Social Worker • A Nursing Professional • A Psychologist • How, When, and Why

35. Be A Team Player!!

36. Aging and the SpineorAre all Subluxations Equal?

37. Normal Aging of the Spine • Clinical consideration given to muscle, bone and joint connective tissues. • What is “normal aging” and what changes exist as a result of disease processes.

38. Disc • Nucleus decreased proteoglycan content, decreased shock absorption. • Disc cell; dramatic alteration in nutrient content. • ECM requires nutrients through end plates. • Motion increases dispersion. • End plate function = calcification and decreased nutrient transport.

39. Ligament • Tensile properties of ligaments become reduced. • Mechanical stresses can cause favorable or adverse integrity of lgts. • Ligaments and tendons: Increase in collagen (cross linking), increase in fibril size and aggregation, decrease in water, elastin, and proteoglycan content.

40. Ligaments and tendons increase stiffness and decrease max. length at which rupture occurs. • Loss of passive ROM slowly progressive • Postural changes cause joint deformity, less efficient, greater effort and more fatigue.

41. Cartilage • Cartilage has decreased water content. • Balance of synthesis and degradation • Reduced formation or increased catabolism cause pathologic changes. • Increased fibrillation and decrease capacity to absorb shock.

42. Lumbar Spine • Models of Degeneration: Kirkaldi Willis • Dysfunction, Instability, Stabilization. (We need to design our chiropractic care plans with these stages in mind!)

43. Dysfunction

44. Instability

45. Stabilization

46. Progression of Cervical Disc

47. Cervical Spine McCarthy and Milus TICC 5;2 1998

48. Spinal Health Inhibitors • Adaptation to pain and trauma. • Lack of understanding of the power of activity/exercise. • Activity Inhibitors • Falls, medication, depressive illness, stressful life situations. FEAR!

49. Promoting Spinal Wellness • Assessment Strategies • Establish base-line, screen for risk factors or problems, develop care goals, monitor course. • ADL assessment (Functional status) • Physical exam must seek to establish base-line sense of patient strength, ROM.

50. Promoting Wellness • Maximize joint function, • Prevent acute and sub-acute episodes of physiologic loss. • Involve the patient in healthy behaviors. • Activity/exercise must include flexibility, resistance, and endurance.