According to Statistics Canada, the number of people 80 years of age and older is expected to double in population size to 3.3 million by 2036. This growth will have an immense impact on the health care system. Declining functional independence and mobility are some of many reasons an older individual may go to a nursing home. Improving the function and mobility can delay this process, and is very important going forward with senior rehabilitation.The truth is that the reality of medical care for geriatric patients is, unfortunately, not ideal. According to a report by the Canadian Institute of Health Research, over two-thirds of seniors in Canada believe traditional healthcare has to improve. This belief is a by-product of a medical system designed in the 1950s that is now under the weight of the beginnings of the “silver tsunami,” and it’s cracking. There is a movement in eldercare to correct these wrongs. Let’s be part of it.
Chiropractors, physiotherapists, and our allies have a unique chance to help this demographic profoundly, and much of it comes down to two simple concepts: communication and education. In chiropractic, we hear about these two words regularly, since not everyone knows what we do. If we lead with communication and education, there are some very high impact areas we can assist with as chiropractors, physiotherapists, and manual therapists, and this surrounds general fitness, osteoarthritis/joint health, nutrition, cardiovascular health, and finally mental health/socialization.
Communication strategies and dispelling myths
Myth #1: I need an X-ray or MRI
Communication: Imagery and pain don’t always go together. More than 60 per cent have some kind of disc bulge past their 30s; MRI is more of a surgical preparatory tool than a diagnostic tool. Convey you will order a proper X-ray or MRI, with great care and consideration for the particular patient.
Myth #2: It’s arthritis, there’s nothing you can do.
Communication: Depending on the severity, often it’s the muscles, capsule, and tendons around the degenerating joint that once irritated, lead to some pain and level of impairment vs. the degeneration itself. “That’s why your pain took two weeks to show up, and your joints took 20 years to degenerate.” Also, when in doubt, refer back to #1.
Myth #3: It’s just old age
Communication: Foolishness! If we cloned you; clone 1 and clone 2; with clone 1 doing everything I asked, being active, eating well, and getting treated when appropriate, vs clone 2 who sat on the couch, ate Cheetos and said “woe is me,” who do you think would be better off after a year?
Myth #4: “Oh, I don’t know.”
Communication: This complex is a referential merger of myths 1-3, in a beautiful symbiosis that’s more complex than humanity itself. It’s the “I feel lost” or, “I’m not worthy,” or “I’m conflicted” comment from an elderly patient. The response is a good quality connection and explanation of what the problem is and what your plan is. Slow it down, keep it simple, rinse and repeat.
General fitness goals/ADLs
Rising from a chair and ascending/descending a flight of stairs are among the functional tasks that require a certain amount of power and strength. The ability to perform these tasks decline as a result of losses in muscle mass and strength. Muscular power (the combination of muscle strength and velocity of contraction) is linked to functional activities like climbing stairs more than strength is.
As therapists, we can have a significant impact on this natural decline in power and function, which declines earlier and quicker than muscular strength. Rehab for seniors should focus on what keeps them in their homes longer and ultimately, this links back to power and strength training to help these people stay fit and independent.
Since you’ve already explained the concept that imagery and pain don’t always match up, you can then continue to discuss how the absolute best treatment for osteoarthritis is movement.
Besides chiropractic adjustments, mobility and other ‘micro movement’ strategies, a fantastic exercise program that addresses this on a broad scale is the GLA:D program, based out of Denmark. According to Dr. Dionne Watson, of Rothesay, New Brunswick:
A recent study of patient’s utilizing this approach for osteoarthritis, using three-month follow up results. The study demonstrated:
- A 28 per cent reduction in pain intensity
- 35 per cent of participants increased their number of moderately active days
- They increased function as measured by walking speed and chair sits
- They significantly improved the quality of life
- 90 per cent of participants felt they benefited from the program
- 85 per cent said they continued to incorporate their new knowledge into daily life.
According to Statistics Canada, 34 per cent of the elderly population are malnourished – a huge area of concern as this can lead to several problems down the road. The biggest problem in their diets appears to be that of micronutrients. Deficiency in micronutrients (~40 essential minerals, vitamins and other biochemicals) is associated with increased aging and age-related diseases such as cancer, heart disease and osteoporosis. Unfortunately, many people will not realize they have a deficiency until old age, and by this time, it is even harder to reverse. Here are some of the many micronutrients that contribute to these problems: ACL (acetyl carnitine) and LA (lipoic acid) have been shown to prevent mitochondrial decay, which in turn prevents the decay of organs, including the brain. Magnesium deficiency is associated with increased risk of colorectal cancer, hypertension and osteoporosis. Vitamin D deficiency has been strongly linked to increased incidences of nursing home admissions, and consequently, mortality. Potassium, when added to the diet, decreases cardiovascular diseases by 40 per cent. Omega-3 fatty acid deficiency is associated with melanoma and cognitive dysfunctions. Vitamin B12 is also associated with cognitive decline and multiple sclerosis. Something as simple as adding a multivitamin (vitamin A free) to someone’s treatment plan could make a world of difference.
In a 2012 edition of The Physician and Sports Medicine, researchers took 40 recreational masters athletes between 40-81 and compared them to each other, and a 74-year-old sedentary man. The MRI transverse sections of the 70-year-old athlete and the 40-year-old athlete varied very little, while the scans of the 70-year-old athlete and the 74-year-old sedentary man varied dramatically, with the latter being atrophied and shrivelled. In its simplest terms, you need a healthy heart to support a strong body. Hence if you’re strengthening your body, you’re doing the same to your heart.
The leading mental illness in the geriatric population is depression. There are presently no well-designed treatments for the geriatric population when it comes to dealing with mental health problems. Some ways that chiropractors can better handle these issues would be to be more prepared for them. Ways this can be done would be through better education not only to the practitioner but for the patients themselves, so they have better tools to manage their mental illnesses. Some tools include preventing the onset of degenerative diseases, having better social support, and more social and health programs for the most vulnerable of the population (those living alone or living with mental/physical illnesses).
Our seniors have paid their dues, and they have the right to be treated with the utmost respect. We can step up our game and do this. Taking care of those who took care of us makes the best sense.