Chiropractic Techniques in Care of the Geriatric Patient

1
Chiropractic Techniques in Care of the
Geriatric Patient

• Lisa Z. Killinger, DC
• Palmer Center for Chiropractic Research
• Kevin A. McCarthy, DC, MSEd
• Palmer College of Chiropractic-West

2
Some general considerations...

• Role of Chiropractic in Successful Aging
• Prevention of Iatrogenic Injuries
• Chiropractic Technique Choices
• Beyond the Adjustment

3
Many patient care strategies exist in
Chiropractic !!And, we all help people achieve
optimal wellness, through various expressions of
our healing art.
4
Some Chiropractic Geriatric Care Goals

• Increase wellness/quality of life
• Decrease pain
• Increase mobility and functionality
• Compress morbidity

5
Normal Aging(How it impacts our practice)

• Decreased muscle mass
• Decreased bone density
• Increased capillary, skin, bone fragility
• Orthostatic hypotension
• Vision and hearing loss
• Vascular plaque
• Decreased elasticity of ligaments/tendons

6
Preventing Iatrogenic Injuries

• Caution Orthostatic hypotension!
• Offer a helping hand
• Consider geriatric muscle mass
• Consider bone density (Take x-rays!)
• Consider pathology odds
• Choose your technique wisely

7
Due to decreased muscle mass

• Palpation can be done lightly
• Adjustments must be done lightly
• Decreased muscle decreased resistance
• Lower settings w/ physiotherapy modalities
• Caution in using heat/ice

8
At risk for osteoporosis?

• Fair-skinned, Caucasian or Asian
• Post menopausal/Early menopause
• Small-framed
• Family history of osteoporosis
• Hysterectomy at early age
• Allergy/aversion to dairy products
• Pop, coffee, alcohol or cigarettes
• High protein diet

9
So, what must we do differently?

• Assess for risks early!!
• Use lower-force techniques
• Emphasize mobilization, reduce thrust
• Broaden contact points
• Exercise caution with the ribs
• Protect patient from falls in your office
• Advise and empower patient to increase bone
  density!

10
Is your patient at risk for stroke?

• Plaqued arteries?
• Smoker?
• High BP and/or Cholesterol?
• Orthostatic hypotension?
• Previous strokes?
• Signs of stroke present?

11
So, what must we do differently?

• Take x-rays
• Avoid rotary adjustments
• Caution with deep manual thrust to lumbars
• Dont re-thrust (no double dipping)
• Advise and empower patient on stroke prevention
  lifestyle changes

12
Sound clinical judgement should prevent

• Post-adjustment strokes (exceedingly rare)
• Post-adjustment discomfort (patient)
• Spinal or rib fractures (rare/easily preventable)
• Disc injury (also exceedingly rare)
• Soft tissue strains, pains, and bruising (quite
  common with some techniques)

13
Top Causes of Successful Malpractice Claims
Against DCs

• Rib Fracture
• Failure to Diagnose (Usually heart or CA)
• Injury to or dislocation of hip/prosthesis
• Injury to shoulder/rotator cuff
• Burns with heat/ice, or PT modalities
• Falls from table/in office (source
  Director of Claims NCMIC)

14
Technique Considerations

• What do YOU do differently?
• Contact points (broad vs. specific?)
• Mobilization
• Soft tissue techniques
• Low-force techniques
• Instrument-assisted adjusting

15
Techniques A Closer Look
16
Advantages of Drop-Assisted Techniques

• Less force applied to patient (maybe)
• No need to take patient to tension
• Patient in prone/supine position (no twisting,
  minimal repositioning)
• Cant take joint past physiological ROM
• Easy on the DOCTOR !

17
Advantages of (Activator) Instrument-Assisted
Adjusting

• Choice of force applied
• No need to take it to tension
• Patient adjusted in prone/supine position (no
  twisting/rotational moves)
• Wide comfortable table with no sections
• Easy on the DOCTOR !

18
Advantages of Logan Basic

• Low force
• Non-osseous contact
• No side posture/rotary moves
• Gentle
• Addresses pelvis stability, in depth
• Addresses overall postural imbalance

19
Advantages of Pelvic Blocking(EG SOT)

• Gentle Uses gravity
• Lower force
• Perhaps least risk of fx. of all techniques
• Broader contact
• Addresses pelvic area in depth (if SOT, addresses
  occiput in depth)
• Easy on the DOCTOR !

20
Advantages of Distractive Techniques (EG Flexion
Distraction)

• Increases joint mobility
• Increases pliability of tissues
• Good option for mildly osteoporotic patients
• Mechanically-assisted table is easy on the DOCTOR
  !

21
Advantages Upper Cervical Techniques

• May be lower force
• No twisting of spine
• Very specific care of c-spine
• Safe when other areas of spine cannot be adjusted
• Variety of specific contacts/thrust types possible

22
Advantages Manual High Velocity (EG
Diversified, Gonstead) Techniques

• Introduces motion into joint spaces
• Frees up restrictions/ fixations
• Hands on aspect may be valuable
• Results may be quicker/ more dramatic

23
Contraindications to high-velocity manual
adjusting (in area of pathology)

• Highest risk
• Acute myelopathy or cauda equina
• Vertebrobasilar insufficiency
• Blood dyscrasias (cautionanticoagulant ther.)
• Active bone weakening disorders (perthes)
• Bone infections or tumors
• Unstable odontoid
• Acute fracture, dislocation, with lig. Instab.

24
General contraindication

• Inability for patient to assume the position
  required to receive that particular type of
  adjusting.

25
Contraindications to some manual adjusting
maneuvers

• Presence of aneurysms/stroke risk factors
• Presence of heavy vessel plaque
• Presence of anterior spurring in lumbars (caution
  with P-A lumbar thrust)
• Moderate to advanced osteoporosis
• Knee or hip pathology/instability/injury
• Bone or joint pathology/fracture

26
Some Take Home Messages
27
Interdisciplinary communication is essential

• Patient care plans
• Clinical goals, technique choices
• Polypharmacy concerns
• Changes in patient health status ( or -)
• Supportive measures, advice to patient, etc.
• Service as a part of the patient care team !

28
Technique Take Home Messages

• Many technique options for geriatric care
• Select techniques after considering the entire
  clinical picture
• Listen to, look at, and then touch patients
• Put prevention into practice
• We promote overall wellness !!!

29
Chiropractic, (responsibly applied), can play
an important role in promoting healthy
aging.
30
Thank You !