Chiropractic care for older adults focus of CMCC symposium

Chiropractors have a huge role to play in successful aging among older adults, according to Dr. Cheryl Hawk, professor and director of clinical research at Logan College of Chiropractic in Chesterfield, Mo.

Dr. Hawk was a presenter at a recent symposium hosted by the Canadian Chiropractic Memorial College.

“Mobility and ability to stay active are essential to successful aging,” said Dr. Hawk. “Chiropractic has demonstrated effects on functional ability.”

According to Dr. Hawk, successful aging measures include both mortality – how long a person lived – and morbidity, which indicates years lived with disability. Successful aging is not only about staying alive; it’s about living a healthy life without disability, she added.

Most definitions of successful aging involve three components, Dr. Hawk said: low probability/presence of disease or disability; high cognitive and physical function; and active engagement in life.

A study of 34 countries in the Organization for Economic Cooperation and Development (OECD) showed Canada ranks 12th in life expectancy, at 81 years, and ranks 10th in healthy life expectancy (HALE), at 70 years. HALE takes into account both mortality and disability. This means that older adults in Canada may live up to an average of 81 years, but the average age they are living without a disability is only 70 years old.

This means that older adults are typically spending the last 10 years of their lives with some form of disability.

“What can we do as chiropractors to close that gap? My belief is we can do more than anybody,” Dr. Hawk said.

Keeping people out of nursing homes by helping them maintain their mobility is one way chiropractors can help with successful aging, said Dr. Hawk. The third leading cause of death in the U.S. is health-care acquired infection, she said. Keeping older people away from hospitals and nursing homes will help reduce these types of deaths.

“Physical activity is important in compressing morbidity, but that is only one part of what we can do as chiropractors,” said Dr. Hawk. Chiropractors can also play a significant role in helping geriatric patients achieve health literacy (i.e., knowing about the medications they take) and educating them about living healthy lifestyles and exercising good nutrition.

Dr. Hawk also encouraged increased research on geriatrics and successful aging. More research should be focused on mobility or the ability to function as well as fall prevention among older adults, she added.

Echoing Dr. Hawk, one chiropractor and professor at New York Chiropractic College has been doing his own research on chiropractic care for older adults.

“There is a need to change our focus in the management of chronic pain syndromes from a pain management perspective to a functional management perspective,” said Dr. Paul Dougherty, professor at New York Chiropractic College.

Pain is among the most common complaints reported by older patients. Typically, these patients also have multiple medical problems and multiple sources of pain, including joint, back and leg pains, said Dr. Dougherty. In addition, a U.S. survey of physician visits among patients 75 years and older showed back pain is the 3rd most commonly reported symptoms and the most common musculoskeletal problem.

The problem, according to the NYCC professor, is that while there are many treatment interventions for lower back pain, no one intervention has been identified as being superior to another.

“It is hypothesized that one of the reasons for this fact is the fundamental lack of understanding of back pain itself,” Dr. Dougherty told attendees at the CMCC symposium.

Identifying safe and effective interventions for chronic low back pain in the elderly population is critical in promoting quality of life and reducing risks associated with chronic medication use, said Dr. Dougherty.

Dr. Dougherty and his team conducted a placebo controlled RCT (randomized controlled trial) to compare the efficacy of routine chiropractic management versus an active placebo control group using a sham chiropractic treatment in older adults, 65 years and older, with chronic back pain.

The patients were randomized into one of two groups: chiropractic care, which involved flexion distraction and spinal mobilization/manipulation; and sham intervention, which involved 11 minutes of detuned ultrasound treatment. 

“The results of the study found statistically and clinically significant improvements in both groups in VAS (visual analogue scale) and ODI (Oswestry disability index) scores,” Dr. Dougherty said. “However, the patients undergoing ‘chiropractic care’ were found to have greater improvements in disability as compared to sham intervention.”

The fact everybody got statistically significant improvements – whether they underwent chiropractic care or sham intervention with ultrasound treatment – stressed the importance of doctor-patient interaction, according to Dr. Dougherty.

“All of the patients liked their treating chiropractor,” he said, emphasizing the need to pursue a biopsychosocial model of pain to improve function.

“We need to address the older adult as a whole person; we need to stop treating them as ‘disc patient’ or ‘low back patient,’” Dr. Dougherty said. He suggested engaging patients in the process of healing and get them to think differently about their pain.

Literature has indicated that cognitive behavioural therapy (CBT) is an effective component in the overall treatment of chronic low back pain. CBT has also been identified as an effective treatment for various conditions, including depression, anxiety, substance abuse, post-traumatic stress disorder and personality disorders.

Dr. Dougherty said he believes that by combining manual therapy with cognitive behavioural therapy in the same treatment for older adults may result in better outcomes, particularly for patients who are at “high risk for poor prognosis” and may require specialized approaches.

Dr. Dougherty’s team is embarking on a new study to assess the feasibility of delivering a “mind-body intervention” which combines manual therapy and CBT for pain in patients with chronic low back pain.

This study is currently being undertaken.

Geriatrics was not the only topic of discussion at the two-day CMCC symposium held on Oct. 26 and 27. Women’s health and pediatrics were also addressed.

Other speakers at the symposium included: Dr. Paul Gold, a graduate of the University of Toronto and the CMCC, who discussed assessment and chiropractic intervention for seniors; Dr. Michael Schneider, assistant professor in the department of physical therapy at the University of Pittsburgh, who presented on non-surgical management of spinal stenosis; Dr. Katherine Pohlman, a PhD candidate at the University of Alberta Department of Pediatrics, who delved into the evidence of chiropractic care for pediatrics patients; Dr. Elise Hewitt, who talked about full spine adjusting techniques for pediatric care; and Andrea Miller, a nutrition specialist, who discussed prevention and management of pediatric obesity.

Dr. Carol Ann Weis, a CMCC lecturer and researcher, discussed pregnancy-related low back pain, and Dr. Lisa Zaynab Killinger, director of diagnosis and radiology at Palmer College of Chiropractic, discussed health promotion and prevention for women.