CMT in Geriatrics

Geriatrics

• Strength training and balance exercises improve function and reduces impairment

• Strong evidence to support

• Counseling for physical activity and exercise
• Counseling for general health
• Counseling for fall prevention

• Screen for fall risks factors

• Medication use (including polypharmacy)
• Blood pressure
• Balance and gait
• Heart health
• Home safety

• Tables included in the article

• Outlines geriatric red flags for immediate referral and those requiring co-management or appropriate referral
• “Agency for Healthcare Research and Quality (AHRQ) recommendations for screening and counseling for adults aged 65 and older”

• Hawk et al. provides “a general framework for what constitutes an evidence-based and reasonable approach to the chiropractic management of older adults”
• Dougherty et al. article focuses on SMT, acupuncture, physical activity/exercise, nutritional counseling and fall prevention
• Observational studies and RCTs “have reported improvement of spinal pain (acute, sub-acute and chronic) among seniors using SMT, BioEnergetic Synchronization Technique and Cox Flexion-Distraction technique”
• 2010 UK Report of Manual therapies:

• “SMT is effective in adults for: acute, subacute and chronic LBP; migraine and cervicogenic headache; cervicogenic dizziness”
• “Manipulation/mobilization is effective for several extremity joint conditions”
• “Thoracic manipulation/mobilization is effective for acute/subcute neck pain”

• Limited evidence for SMT for “COPD, constipation, depression (associated with back pain), Parkinson’s disease, MS, pneumonia, spinal stenosis, urinary incontinence, and OA pain and dysfunction, especially of the knee”
• Acupuncture and chronic MSK pain:

• Insufficient experimental evidence showing it benefit over other modalities

• Limited evidence for supplement use impacting health outcomes

• Most beneficial: Vitamin D and calcium as an “adjunct to pharmacologic regimen in treatment of osteoporosis and in the prevention of hip fractures and other non-vertebral fractures”

• Recommended 1,200 mg calcium; 1,000 IU of Vitamin D

• Other supplements have “inadequate evidence or evidence of significant side effects”

• Positive effects of aerobic exercise and strength training (strength, balance and physical functioning)

• Modest beneficial effect of resistive training on strength outcomes
• Strong evidence for improving gait speed and chair stands
• Decreased levels of arthritic knee pain with resistive training

• “DCs should collect falls history information, and provide treatment and exercises for musculoskeletal conditions”