Caring for Older Adults: Chiropractic Solutions for Musculoskeletal Problems | Podcast Ep. 445

Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Lengmaid. On today's episode we are back with more brand new research. This one is all around how chiropractors how we can care for older patients with musculoskeletal complaints. A lot of interesting insights in this study. A lot of interesting things to think about for yourself in your community. We're gonna dive into it and much more on today's episode. But before we get started, I want to say a few words about patient Pilot by the smart chiropractor. If you have been in practice more than five years, you probably have a lot of inactive patients in your EHR. Probably 90% of your total patients are actually inactive. How crazy is that? Let's reactivate some of them. Patient Pilot by the smart chiropractor is your patient reactivation system. Want to learn how we do it and how we help over 300 docs each and every month generate more patient reactivations for their practice than any other software and service on planet Earth. Head over and schedule a demo@the smartchiropractor.com again that is thesmartchiropractor.com I will drop a link down in the show notes but as I said at the top, today's episode all about research. The the title of the study is the Chiropractor's dilemma in caring for older patients with Musculoskeletal complaints. Collaborate, integrate, coexist or separate question mark on the end of that one. I will drop a link to this study down in the show notes so you can check it out. And it is a good one. And it made me take a moment, step back, consider and think about not only how we as chiropractors can address older adults as a profession worldwide and within our country, but also just at your local level like in your community. And there are some lessons to be learned. Some thought processes highlighted in this study I think are really important for us to highlight and we'll do so right now. This all starts with the global burden of disease, which estimates, believe it or not, 1.7 billion, that is a B 1.7 billion people are affected by musculoskeletal conditions. There is no shortage of opportunity. Who is better to take care of neuromusculoskeletal issues than a chiropractor? With rare exception, nobody. So there's infinite opportunity for you. Again I'll highlight this as I do in many of these episodes. The challenge is communication. If you're not Consistently and actively and effectively getting out there in your community, you're going to have patient flow issues. If you are, you're not going to have patient flow issues. Why? Because how we serve people, for most of us is not this supreme niche. We can take care of literally the most burdensome processes on planet Earth, neck pain, back pain, you open up, sports performance and things like that, the opportunities are just endless. And some of the good news is we've seen over the past decades that older adults today, compared to yesteryear, do have better overall health, better work environment, higher education than previous generations. We also know that nonspecific low back pain does have a peak in the sixth decade of life. And what we expect to see is the prevalence of what percentage of people at any given time the prevalence of back pain should be. We expect to see it rise really sharply and really fast due to an aging population that's occurring all around the world. So not only is there are there billions of opportunities for you right now, there's about to be a lot more as the coming years come to fruition. But one of the challenges that we've seen, and every challenge is an opportunity, do not mistake. That is, older adults with musculoskeletal challenges are not exactly the biggest users of chiropractic. For those musculoskeletal challengers challenges, they tend not to seek chiropractic care. Now, we're going to get into the reasons for that and how you can overcome it. But that gap, that is the literal gap of opportunity, there's a massive, massive number of individuals needing your care and many of them are not currently seeking it out. If you can connect those dots, that presents you with a massive opportunity. So we also have seen over the past two years have been a ton of guidelines. But the World Health Organization, the who, have also recently updated their guidelines for non surgical care and treatment for low back pain. And they have continued to focus on what they call holistic, patient centered, equitable, non stigmatizing, non discriminatory, integrated and well coordinated patient care. Is there anything that sounds more chiropractic than that? No. So that is why we are positioned in the guidelines. That is why we are positioned in the marketplace. We just have to enable good, solid communication. So us as chiropractors, we see a lot of people with musculoskeletal issues and they're highlighting the fact that, hey, we could be the primary contact points for these older adults with low back pain if we step up, if we make the right decisions. And despite the practice guidelines and the growing literature highlighting how effective spinal adjustments in chiropractic care can be. Older adults do tend to utilize chiropractic less than the general population. That is again, the gap of opportunity that's gonna present itself right now for you and will continue to present itself as a bigger and bigger opportunity as the population continues to age. I've said it before, age, load, gravity, undefeated. Time and gravity are undefeated. So everybody is consistently getting older. Everybody is consistently under increased load or at least duration of load because gravity is undefeated. Time is undefeated. And as we age and we've discussed here, we see the facets become loaded as the instantaneous axis of rotation moves posteriorly. We also know that dynamic, I'll say imbalances, dynamic asymmetries can cause challenge over time because unbalanced, imbalanced load over a significant period of time can affect biomechanics. That's going to affect movement patterns, that's going to affect how we interact, proprioception, it's going to affect everything. So as time progresses, these challenges become compounded and that is the real big deal. And that's a real big deal that we can help with as we position ourselves. So this was an interview, I'll say, or a survey of a lot of chiropractors to get this data. And the chiropractors in this study self estimated their patient load at 20 to 80% of their weekly volume were older patients with musculoskeletal issues. So 20 to 80%, pretty wide berth there. But that gives you an idea of the patient load from the chiropractors in this study. They also reported that a majority, 57% of their patients in the older population with musculoskeletal complaints were female. Now, most of the docs in this study envisioned seamless collaboration. Wouldn't that be nice among healthcare professionals? Or the integration of chiropractic services into nationally funded healthcare systems. But there was a contrasting perception that we may either coexist alongside these healthcare systems or be disregarded by them entirely. Ooh, ominous. But let's take a look at why those statements were given. So, a couple things that are important to keep in mind here. One is there's often lack of use with older adults with chiropractic. And there's a variety of reasons for that at a adult decision making level, but also at a systematic level. From a systematic level, there are things like lack of general acceptance, lack of collaboration and insufficient communication between different healthcare professions. And that's a problem. Now here's the good news MD Connection, the referral program through the evidence based chiropractor literally was built over a decade ago to help you solve these issues at your practice level. So if you're interested in building relationships with other healthcare providers, there literally is no better system on planet Earth, I can tell you that. MD connection, it's always available at the evidencebasedchiropractor.com our flagship program. We've helped Thousand Docs plus build relationships with other healthcare providers not through magic tricks, but through simple, easy to implement systems and processes that get you the result that you want. So there is, here's the good news on that. There is a shared opinion that chiropractors can really significantly contribute to the health of these older adults through improved care and management, decreased expenditure and basically because there's just a lot of pressure on the healthcare system to take care of these individuals through what I'll call the traditional medical care model. It's just not working. So people are spending more with less result and it's just taxing the system. And as more people age into this group of older adults with musculoskeletal challenges, it's just gonna overload the system. So being able to take that stress and pressure off of the system at a practice level by taking care of these individuals can be meaningful. So let's take a look at some of the highlighted responses. So this was kind of a survey. Again I'm gonna touch upon some of the what they referred to as sub themes in terms feedback from some of these docs highlighting where are the strengths, weaknesses, challenges, opportunities in terms of being fully integrated. And number one was having a place and a role to fill within the healthcare system. So many of the docs surveyed believed that the musculoskeletal issues in older adults received either too little attention or that they had too little attention and that chiropractic could safely and effectively assess and manage these older individuals. I can't agree with, with that more. There's a lot of times where people have these issues as they become older and quite frankly they can get swept to the side. Now sometimes that's for good reason because there's other outstanding health challenges that take precedent that makes total sense. But just because you get older doesn't mean you need to live in abject pain with dramatically decreased mobility. It's just silly to believe that that's the case when you can look at and you can think about patients in your practice. Right now I'm sure you have 40 year olds that some of them move like they're 80 and some of them move like they're 20. I'm sure you have 60 year olds that some of them move like they're 80 and some of them Move like they're 40. I'm sure you have 80 year olds that some of them move LIKE they're 80 or 90 and some of them move like they'RE 60. What are the difference in factors there? Well, of course there's a genetic component, but there's also a lifestyle and a care component. Are they receiving care? Are they empowered? Are they motivated? Do they have good segmental motion? Do they have good regional motion? Do they have adequate in dynamic whole body motion? Well, guess who can help with that if they're struggling with it? We can. So being able to get out there and meaningfully and simply, that's kind of, I'm gonna say business to business communication, like I said, as I described it right then, but empowering people to move better is a universal theme. And helping people move better with less pain is a really simple way to state what we do without much pushback. And it's true. And that's the most important thing. So the bottom line is we can safely and effectively manage these people. And the bottom line is that many of these people are receiving too little attention. And it's through our communication, through our collaborative approach, through our ability to build referral relationships that that can change. There also are challenges of diverging patient groups. So there is. There's a variety of factors that play with this and I'll highlight a few of them right now. So some people focus on preventative treatment. That makes a lot of sense to me, right? The ability to decrease sick leave, disability, improve function and autonomy, reduce lifestyle diseases, obesity, diabetes, cardiovascular, by having preventative measures. I think that's one of the most important thing. I am a big fan of preventative care, maintenance care when done appropriately. And it's some of the most important care that anybody can receive is ongoing care when framed in the way that actually helps the patient in the best and most meaningful way possible. And some of that, quite frankly, does depend upon how you, the listener, approach your practice. We all approach our practice a little bit of a different way. We all have different tools, resources and skills at our disposal. The ethical way to do it is to look at it and say, well, what skills, tools, resources am I passionate about? Do I offer my patients? How, how can those help my patients live their highest quality of life? And what's the cadence that makes the most sense to maximize their Opportunity to be the best they can be. It's actually as simple as that. But many of us have not really taken the time to analyze that and I'd encourage you to do so. Another factor in feedback they received from the docs they surveyed was around valuing the pros and cons in different healthcare organizations. So as they kind of highlighted here, there are some docs, here's the gist of it. Balancing the opportunities, the strengths and shortcomings in the public sector versus facing the opportunities and obstacles in the private sector. Now, this is a little bit different for the US Docs because we don't have nationalized health care, so to speak. This is a little bit bigger of a deal in Canada, in Europe, where there's a nationalized health care, but even with Medicare, Medicaid, Calcare, whatever it might be here in the States, there's some overlap with this. And especially as more chiropractors are integrated more in the public sector, va, et cetera, this becomes more of a question, right? In the public sector, there are strengths and there are shortcomings. There's just no question about that. In the private sector, there's opportunities and obstacles. This is just very well said. Most people that are in private practice, it's like there's a lot of opportunity, but there's a lot of obstacle. Marketing my practice, patient compliance, staffing, recruiting, all of these are real issues with when you have a private practice. But on the other side, it's not a panacea to be in the public sector. Why? Because there's strength and shortcomings. What are the strengths? Well, the strengths are the institution. By definition, there is power in working for a large institution. What are the shortcomings about a gazillion. Often it's not net meritocracy pay. You're paid on a scale of seniority. That could be great for some people, but for me personally, that would be a dramatic shortcoming. I want the ability to earn. That does not typically happen in the public sector. There are also shortcomings just in terms of budgetary and fiduciary things. You can't control where funding goes in the public sector, whether or not your program gets cut, whether it gets funded. So you have very little self determination where in the private sector you have abject self determination. That's the obstacle and the opportunity on the private side. So that's an interesting sub conversation, probably to be elaborated on on a different day, but just interesting things to consider. So where they kind of wrapped this up was understanding that there really is a clinical dilemma for us as chiropractors, navigating our roles as individuals while yet not fully being integrated into the wider healthcare system. I'm going to say that challenge is the opportunity because it gives us that gap that provides a gap of opportunity, but it's a challenge on the same side. Not being fully integrated is and can be difficult and have its own set of challenges. So, bottom line is, when we look at healthcare systems, specifically some of these challenges related to the public sector, we can see inadequate funding being a primary challenge, staffing shortages and at times on the private sector, deficiencies regarding interdisciplinary collaboration and communication. So we know that chiropractic has had a really long history, over 125 years of holistic. And I've never seen that frame this before. They say holistic care, the contemporary model for that is biopsychosocial. Very interesting way. I've never seen that correlation. We also know that chiropractic, in what we do in general has aligned exceptionally well with recommendations by the World Health Organization. But there are several complicating factors regarding older adults. Comorbidities are a real issue, Chronic underlying disease is a real issue. But people who do, and older adults included, receive chiropractic care do exhibit better physical and social functioning. So as time goes on, we expect musculoskeletal conditions to continue to increase health expenditure. Why? Because of medication use, injections, surgery and that many people. This is fascinating. Many people stop consulting their general primary care provider, GP or physiotherapist. Why? Because of recurrent symptoms and or considerable pain, medication consumption. Therefore, a lot of times prime factors for people seeking chiropractic are actually dissatisfaction and perceived inefficiency with the care offered by general providers. That is fascinating. So their shortcomings are our opportunities. But let's get to these patients before they have these negative experiences. Let's continue to get out in our communities. So, in the US and the uk, generally speaking, patients do have a very positive attitude towards chiropractic and it. Why? Because flexibility in scheduling, accessibility, you know, adaptive consulting lengths. In other words, spending time with your doctor beyond 90 seconds in most chiropractors, most of the time, at least on that initial visit, is a real thing that really matters and helps us connect with people, guide people and understand what they're going through. Now, historically, over time, we've seen communication and collaboration between chiropractors and other healthcare professionals has clearly not been ideal. There has been skepticism, mistrust, belief that chiropractic is ineffective all of those things have played a role, but times have changed. But that does not take the onus off of you. The onus is on you as a listener to get out there, communicate and coordinate care. Again, I'll harken back to MD Connection. That is why we focus sending case notes, sending research, taking meetings. We'll give you the entire easy to follow system and process that's been proven by over a thousand chiropractic practices around the world to help you generate referrals. If you'd like, you can get access to that. I'll drop a link down in the show notes, but of course at the evidence basedchirofractor.com, that's the MD connection program referral program. If you would like to break that mold, get out there and build meaningful relationships with people in your community. So the conclusion here is quote, Chiropractors from Great Britain, Norway, Netherlands and Sweden emphasize that they perceive to be well positioned to fill an identified gap regarding the care and management of older adults with musculoskeletal complaints and end quote. I could not agree more. It's going to take some work, it's going to take some time, but the opportunity is there if you would like to take it. It's about bridging gaps, it's about building relationships and it is about getting out there to your patients directly and helping them understand how they can make the right decision from the get go. Now, as we wrap today's episode, I want to say a few words about neck care. If you are into objective assessments and if you're listening to this podcast, you probably are, head over to neccare.com they have the best objective assessment tool, the cervical spine I've ever seen. Reliable assessments and exercises for neuromusculoskeletal control, proprioception, range of motion and sensory motor integration. Awesome tool. Check it out@neckcare.com and finally, if you are looking to bring Shockwave into your clinic, I can't recommend stemwave enough. Go stemwave.com the evidence based chiropractor. It is the tool that I use in the practice that I own. Cannot recommend it enough. Go stemwave.com the evidence basedchiropractor. Other than that, I hope you have a fantastic week in practice and I will talk to you soon. Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit the evidencebasedchiropractor.com and join our MD Marketing membership today.