While treatment modalities are almost intrinsically connected to diagnosis, there are still general treatment principles that are part of the infrastructure of Oriental medicine that are worthy options for this group of patients. If the practitioner has an opportunity to treat such patients he/she should realize that geriatric patients are different from the average person encountered in an outpatient setting. Because of their age, delicate condition, and clinical complexity, there are treatment adaptations that are critical in the care of the elderly person.

Additionally, a more generalized diagnostic approach to thinking about the older patient is presented, such as the complexity of their medical history, possible drug and herbal interactions, how to diagnose their pain, and classical and modern Oriental approaches to aging, which can illuminate treatment plans, acupuncture points, and herbal selection. Each of these parameters is discussed below.

The problems of the elderly are frequently compound and complex. Their problems can range from physical to mental, and some may have both. This is no surprise to the practitioner who sees the relationship between the physical and mental manifestations of the self. There is a preponderance of mental disorders such as senile dementia or Alzheimer’s disease and from a Chinese perspective, there can be complicated syndromes characterized by the secondary pathological products of stagnant blood and phlegm, which are pernicious and difficult to treat. Patients in nursing homes, assisted living centers or other similar environments are also confined due to a variety of reasons. Whether ambulatory, bedridden or wheelchair-bound, in general they require a degree of care they or their family cannot provide.

In directing treatment toward the elderly, combine compassion with realism. Consider their conditions to see what you can do. To a certain degree some of their symptoms can be addressed. Aid and comfort in the form of human interaction, appropriate professional touch, and the instruments of Oriental medicine, can go a long way, so while cure may not be attainable, the reconciliation of the condition, that is, healing, can occur. The specific guidelines for treatment that I have used to direct my treatment approach for the elderly are discussed below.

As with the administration of most acupuncture, a supine position is generally recommended for treatment. Especially with the elderly though, there are times when this is not possible due to their limitations. However, if a treatment must be administered in a sitting position such as in bed or a wheelchair use caution in needling chest points such as LU-1 (zhong fu) or CV-17 (shan zhong). In general, avoid abdominal needling such as CV-12 (zhong wan) in such patients. In these cases, if the patient moves in treatment or has a sagging posture, the needle could become displaced and possibly cause a pneumothorax, break, bend, or become deeply embedded in the tissues.

Be careful treating patients reclining on their stomachs when receiving acupuncture. Support their necks with a face cradle that is properly angled. This position may be contraindicated for patients with respiratory illnesses, back pain, severe abdominal distention or illnesses of the abdominal cavity, or for patients on oxygen.

Age 8 The kidney qi becomes abundant, the hair begins to grow longer, and the teeth begin to change.

Age 16 The kidney qi becomes more abundant, he begins to have his heaven cycle, he is full of jing-qi (semen), he can ejaculate and have a child; intercourse (yin/yang harmonization possible).

Age 24 The kidney qi is equal (i.e., kidney yin/yang are balanced), the tendons, muscles, bones, become strong; the wisdom teeth grow.

Age 32 All tendons, muscles, bones in top condition.

Age 40 The kidney qi weakens, the hair begins to fall off, and the teeth begin to wither.

Age 48 The yang qi in the upper part of the body declines, with the complexion looking withered, hair turns grey.

Age 56 The liver qi begins to weaken, the heaven cycle becomes exhausted, the jing-qi (semen) becomes scanty, and the kidney organs decline, and all parts of the body begin to grow old.

Age 64 All hair and teeth are gone.

Yan De-Xin, a contemporary Chinese physician, has revolutionized Chinese views on gerontology with his thesis that most modern day illnesses are caused by blood stagnation. It is his theory that static blood (yu xue), a causative factor of illness in and of itself, likewise is the etiological precursor, which can cause multiple qi and blood disorders.

Age 7 The kidney qi becomes abundant, the hair begins to grow longer, and the teeth begin to change.

Age 14 The ren mai begins to flow, the heaven cycle begins, and the chong mai begins to grow in abundance, menstruation begins, pregnancy is possible.

Age 21 The kidney qi becomes equal (i.e., the yin/yang are balanced), the wisdom teeth begin to grow.

Age 28 The tendons, muscles, bones become hard, the hair grows to the longest, the body and mind are in top condition.

Age 35 The yang ming channels begin to weaken with the result that the complexion starts to wither, the hair begins to fall off.

Age 42 The three yang channels of the hands and legs begin to weaken, the complexion looks even more withered, the hair turns grey.

Age 49 The ren mai becomes deficient, the heaven cycle becomes exhausted, the chong mai becomes weakened and scanty, her body becomes old, she can not become pregnant

As they age, some patients will never regain full control over their bodies. Like them, we need to recognize these physical limitations. For instance, do not try to make a patient walk without a walker if the patient’s physician has required it or if the patient is incapable of walking. Likewise, check bone density levels in suspect patients to see if they have the weight-bearing capacity to allow them to walk. Ultimately, what we are trying to do in our treatment is to enhance the quality of life of the patient. Oriental medicine can assist in this goal because it is predicated on natural forces that promote proper physiological functioning.

The TDP lamp or the far infrared device are two superb tools for conferring therapeutic heat that can correct many conditions. Due to the size of the lamp they are not the most practical tools to bring to a nursing home on every trip, but if they can be stored there they are excellent choices for elderly patients. The heat of the lamp is relaxing, soothing, and comforting. The modality itself is non-invasive and able to treat large local areas such as the back or abdomen. The use of the lamp is suitable for a variety of conditions, especially yang vacuity that the elderly tend towards, by promoting increased metabolism and increased blood circulation.

Excellent results can be obtained both for musculoskeletal problems such as shoulder, back, or neck tension, or for internal problems such as frequent night-time urination, diabetes, insomnia, skin disorders, and neurasthenia. The lamp is effective for other problems such as arthritis, soft tissue injuries, sciatica, bedsores, or the rehabilitation and restoration of any diminished normal function following illness, injury, surgical intervention, or age-related degeneration. As with any treatment, frequency of treatment and length of application of the therapy vary according to the patient’s presentation.

Palpation is the process of examining the surface of the body by touch to detect the presence of disease. Sometimes it involves the use of pressure to certain points or areas to determine the patient’s reaction to that touch. This technique is usually not that effective if the patient’s vitality is low as is the case for many of the elderly. They tend not to be able to respond to the diagnostic palpation. Patients may also perceive the procedure as painful instead of as a message about their bodily condition. However, areas of heat, cold, tension, or flaccidity can be determined through palpation and interpreted by the practitioner. Be gentle.

Scalp acupuncture is a microsystem of Oriental medicine, which utilizes needling points on the scalp to treat a variety of disorders. It is highly effective for a subset of conditions such as musculoskeletal problems that include muscular atrophy, motor impairment, sequelae of post-stroke disorders, paralysis, involuntary movement problems, multiple sclerosis, and other difficult-to-treat conditions where there is nervous system involvement. The elderly in nursing homes may have many of these ailments.

Electrical acupuncture is a method by which electricity is applied to acupuncture needles in order to provoke a constant stimulus to the needles, which is difficult and even impossible to achieve by hand, or to impart an electrical charge to an acupuncture point. It can be employed for numerous conditions, most notably bi-syndromes, which are conditions characterized by obstruction with symptoms of pain, or inflammation. Electricity is useful in inducing analgesia because of its superior ability to stimulate the needles with a frequency that cannot be elicited by hand. It is the frequency of stimulation that disperses the obstruction causing the pain or inflammation.

Personally, I do not employ electricity to any patient due to its cold nature. Additionally, because many symptoms of the elderly can be categorized as yang vacuity, it may be incompatible with their conditions. The stimulus can also be very jarring and unpleasant, particularly to a delicate older person. The use of electricity is contraindicated for patients with heart conditions and pacemakers.

Needles of course are the primary instrument of Oriental medicine. They are used to regulate the flow of qi and blood in the channels. Needles may be employed to treat the elderly, however, keep the following points in mind when treating these patients:

• Their vital qi may be weak, hence it becomes difficult to get the de qi stimulus.
  
• Due to decreased vital qi, use few needles so as not to deplete the patient’s energy. In general, apply a mild stimulus if any and insert shallowly.
  
• All body parts may not be readily accessible to needling if the patient is in a wheelchair or bedridden so select points in consideration of the patient’s ability to move. Through the microsystem of the ear or the scalp however, all body parts and organs can be treated with needles. Both are excellent choices.
  
• Fine needles inserted with a tube should be used to prevent bruising, bleeding, or trauma to these delicate patients. I recommend using a #1 gauge, 30mm Seirin needle.

Note: Modify according to other signs and symptoms; i.e., add points for specific conditions or areas of pain such as prostate, low back, or hypertension.

Auricular acupuncture is a method of diagnosing and treating through the microsystem of the ear. It is one of the most useful methods of treatment for any patient regardless of age or condition. It has a high rate of efficacy in adjusting the flow of qi and blood in a relatively non-invasive manner, and is suitable for musculoskeletal, internal, emotional, chronic, and acute problems including pain and inflammation. The ear is easily accessible to treat.