ABSTRACT
PURPOSE: There has been a growing interest in meeting the health care needs of the anticipated "age wave." In order to prepare for the current demographic trends, we sought to describe the status of geriatrics curricula in the 18 North American English-speaking chiropractic colleges by reviewing geriatric course syllabi. METHODS: A cross-sectional survey was conducted using syllabi and catalog information solicited from each English-speaking chiropractic college in North America, collected from January 1, 2007 through June 30, 2007. Information was then summarized. RESULTS: As of June 30, 2007, roughly 78% of colleges submitted their current geriatrics course syllabi. The remaining 4 colleges were estimated using online course catalog information. Sixty-one percent of colleges offered a course that was solely dedicated to the topic of geriatrics. Additionally, 37.5% of syllabi indicating credit load offer 4 or more credits to the course containing the geriatrics component. Also, 31.3% of courses include non-classroom clinical experience, while 50% require an independent study project that provides further geriatrics experience. Furthermore, 41.2% of reported courses classify the teaching strategies as lecture only. CONCLUSIONS: These results warrant a proposal for improved curricula in this specialty population. It is proposed that more time be dedicated for this topic, more experiential learning be required, and more clinical focus be given on the needs of this population. A restructure of curricula will provide more clinical experiences for students to better equip future doctors of chiropractic for the increase in geriatric health care needs.
ABSTRACT
OBJECTIVES: This study examines (a) the feasibility of continued research with an older population; (b) the variety of hand-wrist conditions presented by older patients; (c) the accommodations to standard chiropractic treatment for older patients; and (d) the validity, reliability, responsiveness of measures, and preliminary estimates of outcome of treatment for general hand-wrist pain. METHODS: A cohort of 55 volunteers, first evaluated over a 5-week natural-history baseline period, was offered 5-week chiropractic treatment and then interviewed at 6 months posttreatment. Descriptive and preliminary inferential analyses are reported. Start values for power analysis are offered. RESULTS: The project recruited a sample of 55 and retained 47 (85%) participants over 8 months, indicating feasibility of a larger project. Participants provided strong self-reported, albeit preliminary, evidence of benefit. Mean values and SDs of pain and strength measures are provided for future power calculations. CONCLUSIONS: Clinical research with older participants presenting with hand-wrist pain and dysfunction is feasible. Validity, reliability, and responsiveness of self-reports are demonstrated. The research presents preliminary evidence of the benefit of chiropractic treatment for older patients presenting with hand-wrist symptoms.
ABSTRACT
INTRODUCTION: Conditions of the hand and wrist often occur in older patients, but decision-making algorithms and manual treatment protocols for this age group have not been developed or assessed. Further, effects of age-related co-morbidities are poorly understood. OBJECTIVE: To build an understanding of an appropriate treatment protocol from the ground up that does not assume that generic spinal or extremity manipulative therapy is indicated. METHODS: The project was conducted in two phases, involving (1) interviews with chiropractors (reported here) and (2) a single cohort, longitudinal design, identifying the conditions of the hand and wrist and concomitant comorbidities as well as promising accommodations and chiropractic treatments of these symptoms in older people. In the first phase, data were gathered, through in-person focus group and telephone interviews, from 58 chiropractors treating older patients presenting with hand and wrist symptoms. RESULTS: Chiropractors indicated they accommodated treatments to the health status and co-morbidities of their older patients and considered "management," rather than "cure," a more realistic concept in treating chronic conditions. With older patients, chiropractors recommended using a lighter touch, rehabilitative passive stretching, traction, nutritional counseling, soft-tissue work, and home exercises. Chiropractors also cautioned providers to take extra time in history-taking and extra diligence with older patients, identifying use of medications, and conducting blood pressure, bone density, blood clotting assessments, if indicated, before treatment. CONCLUSIONS: Chiropractors provided valuable orientation, indicating that caring for older patients requires careful history-taking and treatment plans that accommodate to presenting co-morbidities and the patients' general health statuses.
