In the 1990s, approximately one third of the patients in a typical chiropractic practice were over the age of 50, and one half of those were over age 65. ¹ On any given day in the United States, 6000 people celebrate their sixty-fifth birthday, and by 2010, nearly 10,000 a day are expected to reach that milestone. ² If current trends continue, by the year 2030, approximately one in every four Americans will be over the age of 65. ²

At the top end of the age scale, over 100,000 people in the United States are over the age of 100, and by the year 2050, estimates suggest that one million centenarians will be living in America. ² The most rapidly growing segment of the population is the over-85 age category, ³ a situation for which no historic precedent exists. With the graying of the population, the number of older patients seen in chiropractic practice is rising. People are living longer, living stronger, ⁴ and seeking alternative health care choices in growing numbers.^{56789 and 10}

Caring for an aging population is a major focus in chiropractic today, both in scientific literature and in practice. In recent years, several chiropractic journals have dedicated issues to the topic of aging.^{1112131415 and 16} Articles in a 2002 issue of Topics in Clinical Chiropractic highlight key areas of geriatric research and practice, with an interdisciplinary team of authors. This issue is a must-read for chiropractors interested in the care of aging patients. Other authors and journals have published articles on chiropractic geriatric practice, prevention and health promotion for the elderly, and skeletal conditions commonly seen in older people, such as osteoporosis and osteoarthritis.^{171819202122232425 and 26} Geriatrics is an area that will continue to grow as the age wave rolls across society, affecting everything in its path, including the chiropractic profession.

During the last decade, chiropractic, along with complementary and alternative health care in general, has grown in popularity^5,6 to the point at which chiropractic is increasingly viewed as a part of the health care mainstream.^{89 and 10} According to the Council on Chiropractic Education, chiropractors are trained to be primary contact providers. This role includes providing patient education in health promotion and prevention, health screening assessment, and managing common acute and chronic problems. ¹⁰ Aging chiropractic patients seek care primarily for musculoskeletal problems,^{56 and 7} but they may also benefit from the approach to care that more patient-centered chiropractors offer. In many cases, these benefits may be in areas not directly related to the symptoms that initially led them to seek chiropractic care.

Patients’ health and well being are of primary importance to both the chiropractor and the patient. The chiropractor, whatever his or her philosophic perspective, must engage in activities that will most effectively increase the patient’s wellness potential, whether the patient is 20 or 80 years of age. As Daniel David Palmer tellingly noted, “I have never considered anything below my dignity if it is for the good of the patient.” To achieve maximum benefits for their patients, doctors of chiropractic, similar to thoughtful health care providers of all professions, can enter into a partnership with each patient to establish a plan for achieving optimal wellness, as well as preventing disease.

Since its inception, chiropractic has sought to improve the quality of life and help patients achieve optimal wellness. ^27,28Healthy People 2010 (HP 2010) is the prevention agenda for the United States. This document is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats. With the development and publication of the HP 2010 objectives, ²⁹ the nation’s health care paradigm is shifting toward health promotion and prevention (HPP), rather than being strictly concerned with crisis intervention and reaction to chronic, debilitating disease. ²⁹ The HP 2010 document is available online at www.health.gov/healthypeople/. This wellness movement is gaining momentum, a trend also reflected in the health promotion–related articles becoming commonplace in chiropractic and other journals and publications. ^* Chiropractors currently participate in a significant amount of HPP activity, in addition to providing other primary care services.^{192021 and 33} In fact, chiropractors recommend exercises (one of the HP 2010 objectives) ²⁹ to nearly 70% of their patients. ^20,21,29 Chiropractic care, with adjustments and other manual procedures at its core, often includes recommendations about exercise, dietary counseling, and other related health promotion interventions, as appropriate in each patient’s case. ^20,21 Interestingly, patients under chiropractic care report a decreased use of nonprescription^20,21 and prescription drugs²⁶ and have fewer medical provider visits than the general population. ²⁶ Because prescription drug errors are exceedingly common (one in five older adults is prescribed an inappropriate drug or drug combination) and prescription drug errors are a leading cause of death in older adults, ³⁸ it may be time for the society to explore and use conservative, drug-free health care, such as chiropractic, as a viable choice for health and wellness in the care of the older patient.

In the first major descriptive study on chiropractic maintenance care (MC) for patients over 65, Rupert and colleagues²¹ compared patients seen by chiropractors and medical physicians to those seen only by medical physicians (Fig. 16-1). Defining MC as HPP care that includes chiropractic adjustments, along with a variety of interventions that may include adjunctive therapies, as well as education on exercise, nutrition, and relaxation, these investigators found that patients undergoing MC (over four visits per year for over 5 years) had annual health care expenditures of $3106 compared with $10,041 for non-MC patients. ²¹ Although the data do not allow the inference of a direct causal relationship between MC and the decreased health costs, Rupert and colleagues’ data do suggest value in conceiving chiropractic practice more broadly than the relief of musculoskeletal symptoms.

The statistics on the major causes of mortality and morbidity in older adults tell a tale of the need for better HPP. As the population ages, these demographic shifts will carry with them increasing health costs and an increasing prevalence of the common chronic conditions of the older patient. After all, the elderly population suffers the most disability and has the highest health care costs related to chronic diseases such as arthritis, heart disease, and osteoporosis.39^{40 and 41}

The three major illnesses causing death^4,37 for people over the age of 65 in America are:

In many cases, conditions can be prevented or their onset significantly delayed through HPP interventions involving changes in health habits and lifestyle.