Chiropractic and geriatrics: a review of the training, role, and scope of chiropractic in caring for aging patients.

Chiropractors may be well-positioned to play an important role in health promotion, injury and disease prevention, and on geriatric care teams, due to their practice style and holistic philosophy. The bottom line in aging care is that someone in the health-care world must provide health promotion and preventive services to older patients before the wave of aged patients profoundly overwhelms our health-care system. Chiropractic services are safe and relatively low-cost, and patient satisfaction with them is very high. In the managed-care environment, time pressures on allopathic providers may preclude them from spending sufficient time discussing health promotion and illness prevention with their patients. Chiropractic, when paid for out-of-pocket, is not as affected by these extreme pressures. With the hands-on nature of chiropractic care, a strong doctor-patient relationship is forged in which health and lifestyle recommendations may be comfortably and effectively discussed. Relative to musculoskeletal care in elderly patients, chiropractic adjustments (spinal manipulative therapy) are recommended by the Agency for Health Care Policy and Research for the care of acute low back pain, and the American Geriatric Society Panel Guidelines for the Management of Chronic Pain state that non-pharmaceutical interventions such as chiropractic may be appropriate. Most geriatric health-care providers have a limited number of options to offer patients with these complaints. Various lower-force chiropractic techniques are available as safe alternatives to drugs and surgery for musculoskeletal complaints in the older patient. Due to the prevalence of these conditions in older patients, and the success of chiropractic in caring for these patients, interdisciplinary geriatric health care teams should include the doctor of chiropractic. Chiropractors, well trained in health assessment, diagnosis, radiographic studies, health promotion, and illness prevention, are well-positioned to provide many primary health-care services to aging patients. This is particularly important to a nation that is straining to provide adequate geriatric health care in rural areas and areas with a shortage of health-care professionals. Continued improvements in geriatric education, and an increase in research and publication on chiropractic care of the aging patient are essential. As stated by Montes and Johnston in the Journal of Health Education: Training, as well as continual upgrading of the competencies for health educators, must include ways of dealing with the great disparities in health among populations, especially those most vulnerable and underserved. Faculty too must be prepared in ... this ever-changing health care delivery system. In a rapidly aging society, chiropractors, (along with all health professions)must prepare themselves to provide optimal health care to this important segment of our society, through excellence in chiropractic education, training,and practice.