Assessing The Older Patient

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NAME THAT TUNE
.you aint gettin no younger, your pain and your
hunger theyre drivin you home. And freedom, oh
freedom, well thats just some people talkin.
Your prison is walkin through this world all
alone.
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Assessing the (Aging) PatientA Chiropractic
Perspective

• Lisa Zaynab Killinger, DC
• Palmer Center for Chiropractic Research

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Successfully Negotiating The Age Wave...
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The Geriatric Population

• In last 100 years total population increased by
  5X, geriatric population increased by 15X.

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Morbidity

• Most frequent conditions occurring per 100
  elderly
• Arthritis (50)
• Hypertension (36)
• Hearing impairments (29)
• Cataracts (17)
• Orthopedic impairment (16)
• Sinusitis (15)
• Diabetes (10)

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Assessing Aging Patients Why?
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Assessment Overview

• Physical Assessment
• Functional Assessment
• Cognitive Assessment
• Nutritional/Oral Health Assessment
• Safety
• Others

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Physical Assessment

• History
• Physical Exam
• Ortho/Neuro Exam
• Chiropractic Exam
• Your Five Senses and the Patients!

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Functional Assessment

• How well does the patient care for him/herself?
• How well does the patient get around?

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Ways to Assess Functional Status

• Barthel Index
• Functional Status Index
• Get Up N Go
• Observation and other useful strategies

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Cognitive Status
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Mini Mental State Exam

• Orientation
• Registration
• Attention/Calculation
• Recall
• Language
• Part II

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Whats Important To Our Patients?

• Baseline assessment score
• Vigilance for marked or sudden changes!!
• Watch for polypharmacy! Drugs are confusing.

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Nutritional/Oral Health Status
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But We Are Chiropractors! Yes, and to our
patients, we are also doctors!!
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Assessing Nutritional Health

• Teeth, gums, lips, jaw, dentures
• Weight loss or gain gt 10 lbs?
• Have trouble affording enough or healthy foods?

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Safety !
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We Can Promote Safety

• Fall Hazard Checklist
• Home Safety Checklist
• Seatbelt Use/Driving Safety
• Prevention/Health Promotion

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Be A Team Player!!
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Promoting Wellness An Evidence-Based Plan

• 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.

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Promoting Wellness

• Maximize joint function,
• Prevent acute and sub-acute episodes of
  physiologic loss.
• Involve the patient in healthy behaviors.
• Activity/exercise must include flexibility,
  resistance, and endurance.

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• Appropriate Nutrition
• Do not get hung-up on cholesterol
• 3 day dietary survey vegetable and fruit intake
• Water intake important!
• Social and Mental stimulation.
• Clubs, volunteerism, work.

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Incorporate Prevention EARLY in Your Practice

• Habits
• Smoking
• Diet/Weight
• Activity
• Hobbies
• Reading
• Occupation
• Social Integration

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What About Osteoporosis?
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What Do We Know?

• Osteoporosis is the most common skeletal
  disorder.
• It is the second most common skeletal cause of
  disability (after arthritis).
• Osteoporosis costs 6 billion annually
• By 2010, the costs may exceed 60 billion
  annually in US alone!! (Holbrook, et al)

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What Else Do We Know?

• Exercise prevents and reverses!
• Hormones Help (HRT?)
• Diet Helps
• Caffeine/Soda/Alcohol/Tobacco Hurts

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Who Is At Risk?

• Females Small framed, thin, fair
• Sedentary
• Post Menopausal/Early Menopause/Hysterectomy
• Family history of osteoporosis

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Controllable Risks

• Dislike or avoid dairy products?
• Drink coffee or soft drinks?
• Drink alcohol or smoke?
• Dont exercise?
• Use steroids?

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So Doctors, What Can We Do?
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Low Force Techniques(you know this stuff!)

• Logan Basic
• AO
• SOT
• Activator
• Nimmo
• Other Soft Tissue Techniques?

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General Tips

• Watch for orthostatic hypotension.
• Support the patient.
• Use a lighter touch/technique.
• Take X-rays!
• Listen to/look at the patient.
• Talk about diet, exercise, lifestyle, etc.

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Which Leads Us ToInjury Prevention
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If Not Us, Then Who?
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Injuries

• Occur mostly at home
• More serious in older patients
• Are most often due to falls
• Kill even our healthiest patients

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Whos At Risk?

• Osteoporosis risks?
• On too many meds?
• Demented?
• Depressed?
• Visually or hearing impaired?

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Injury Prevention 101

• Know your patient.
• Assess and reassess your patient.
• Ask questions.
• Give advice sound advice.
• Follow up and follow through!

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Promoting Successful Aging
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Some Chiropractic Cases That Make You Think.
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Nel is a 68 year old red headed farm-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?
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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?
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• Take Home Messages
• You can promote successful aging.
• Assessment is key!
• Be a DOCTOR of chiropractic.
• Be a team player!

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THANK YOU !!!