Unformatted text preview: 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. Assessing the (Aging)
A Chiropractic Perspective
Lisa Zaynab Killinger, DC
Palmer Center for Chiropractic
The Age Wave... The Geriatric Population
q In last 100 years total population
increased by 5X, geriatric
population increased by 15X. Morbidity
q Most frequent conditions occurring
per 100 elderly:
– Arthritis (50)
– Hypertension (36)
– Hearing impairments (29)
– Cataracts (17)
– Orthopedic impairment (16)
– Sinusitis (15)
– Diabetes (10) Assessing Aging
Patients: Assessment Overview
q Physical Assessment
q Functional Assessment
q Cognitive Assessment
q Nutritional/Oral Health
q Others Physical Assessment
q Physical Exam
q Ortho/Neuro Exam
q Chiropractic Exam
q Your Five Senses and the
Patients’! Functional Assessment
q How well does the patient care
q How well does the patient ‘get
around’? Ways to Assess
q Barthel Index
q Functional Status Index
q Get Up ‘N Go
q Observation and other useful
strategies Cognitive Status
Cognitive Mini Mental State Exam
q Part II What’s Important
To Our Patients?
Baseline assessment score
q Vigilance for marked or sudden
q Watch for polypharmacy! Drugs are
q Nutritional/Oral Health
Status But We Are
Yes, and to our patients,
we are also ‘doctors’!!
we Assessing Nutritional
q Teeth, gums, lips, jaw, dentures
q Weight loss or gain > 10 lbs?
q Have trouble affording enough
or healthy foods? Safety !
Safety We Can Promote Safety
q Fall Hazard Checklist
q Home Safety Checklist
q Seatbelt Use/Driving Safety
q Prevention/Health Promotion Be A Team Player!!
Be q Promoting Wellness: An
Evidence-Based Assessment Strategies
– Establish base-line, screen for risk
factors or problems, assess, focus
rehabilitation goals, monitor course.
– ADL Scales commonly used, more
helpful in gross impairment screening.
– Physical exam must seek to establish
base-line sense of patient strength,
ROM. Promoting Wellness
Maximize joint function,
q Prevent acute and sub-acute
episodes of physiologic loss.
q Involve the patient in healthy
– Activity/exercise must include
flexibility, resistance, and
q q Appropriate Nutrition
q Do not get hung-up on
q 3 day dietary survey – vegetable
and fruit intake
q Water intake important! q Social and Mental stimulation.
– Clubs, volunteerism, work. Incorporate Prevention
EARLY in Your Practice
Social Integration What About
Osteoporosis? What Do We Know?
Osteoporosis is the most common
q It is the second most common
skeletal cause of disability (after
q Osteoporosis costs 6 billion annually
q By 2010, the costs may exceed 60
billion annually in US alone!!
(Holbrook, et al)
q What Else Do We Know?
q Exercise prevents and reverses!
q Hormones Help (HRT?)
q Diet Helps
Hurts Who Is At Risk?
q Females: Small framed, thin, fair
q Post Menopausal/Early
q Family history of osteoporosis Controllable Risks
q Dislike or avoid dairy products?
q Drink coffee or soft drinks?
q Drink alcohol or smoke?
q Don’t exercise?
q Use steroids? So Doctors,
What Can We Do?
What Low Force Techniques
(you know this stuff!)
q Logan Basic q AO
q Other Soft Tissue Techniques? General Tips
q Watch for orthostatic hypotension.
q Support the patient.
q Use a lighter touch/technique.
q Take X-rays!
q Listen to/look at the patient.
q Talk about diet, exercise, lifestyle,
etc. Which Leads Us To…
Injury Prevention If Not Us, Then Who?
q Occur mostly at home
q More serious in older patients
q Are most often due to falls
q Kill even our healthiest patients Who’s At Risk?
q Osteoporosis risks?
q On too many meds?
q Visually or hearing impaired? Injury Prevention 101
q Know your patient.
q Assess and reassess your
q Ask questions.
q Give advice; sound advice.
q Follow up and follow through! Promoting Successful
Aging Some Chiropractic Cases
That Make You Think….
That Nel is a 68 year old red headed farmNel
raised Iowa girl. She hates doctors.
(Healthy as a horse!) She comes to see
you for neck pain. She smokes, and so
she breathes laboriously. In her exam
you also notice a lesion on her nose.
She says she has had it for years. It
scabs over then is fine for months,
then scabs over again. She is annoyed
by your questions about her nose; She
just wants you to fix her neck!
OK, what next?
OK, Harry is a 70 year old diabetic
patient. He has seen many chiros.
for his low back pain and sciatica.
He comes in today with leg pain.
He said it started off as foot pain,
then started hurting higher up.
Now his whole leg hurts. His foot
appears kind of reddish. His leg is
really bothering him and he wants
an adjustment. What next?
an q Take Home Messages You can promote “successful aging”.
q Assessment is key!
q Be a DOCTOR of chiropractic.
q Be a team player!
q THANK YOU !!!
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- Summer '09
- Spinal disc herniation, Baseline assessment score