Many people are discussing the future of the chiropractic profession. Some say we will not survive health care reform, and others believe chiropractic will be able to exist as it is now, indefinitely. We are not sure what the future holds for our profession, but we are convinced of one thing: Chiropractic will not be able to sustain itself in our current model. We believe chiropractors, as individuals and as a profession, need to expand their vision. A wise colleague once stated that until we (chiropractors) stop being so worried about chiropractic and instead worry about public health issues, we will never progress as a profession. Thinking about public health is not something most of us do on a regular basis. However, in our experience, when we have moved from an introspective perspective to a more community-based perspective, it has been helpful for both our individual practices and for the image of chiropractic in our communities.
Therefore, we believe our colleague was correct - when we chiropractors address public health in our community, we have a great opportunity to progress, not only as individual practitioners but also as a profession. You might be asking right now, "What is public health and how can I address it in my practice?" Public health has many definitions, but one is "the approach to medicine that is concerned with the health of the community as a whole." This definition includes specific areas such as "health promotion and disease prevention services." These are areas every health care professional has the ability to address and should be addressing.
One specific opportunity to address public health issues in chiropractic practice is with older patients. Between 2010 and 2030, the age-65-and-over population will increase by more than 70 percent. Chiropractors have a great opportunity to address public health issues in this population. One specific area chiropractors can address is prevention of falls in older adults.
More than one-third of adults 65 and older suffer injuries from falls each year in the U.S. Falls are the leading cause of injury deaths among older adults. In 2003, more than 13,700 people 65 and older died from injuries related to falls. In 2003, nearly 2 million people 65 and older were treated in emergency departments for nonfatal injuries from falls.
One of the injuries associated with falls and fall-related morbidity and mortality is hip fracture. The cumulative mortality associated with a first hip fracture is 9 percent at one month, 26.5 percent at one year and 36.2 percent at two years. As disturbing as these figures are, more alarming is that the rate of fall-related deaths among older adults has risen significantly over the past decade.
Many factors contribute to falls in older adults including balance, gait, cognition, vision and strength issues, as well as use of four or more prescription medications, postural hypotension, depressive symptoms and painful arthritis. Although doctors of chiropractic might be prevented by scope of practice from addressing all of these factors directly, they may address these issues through education every day in practice. As a chiropractor, you can assess balance and gait in your patients and make suggestions. You also can discuss issues of strength with your patients and suggest exercise programs, such as tai chi, that have shown some evidence for preventing falls in older adults.
At New York Chiropractic College, we are involved in a collaborative project with the State University of New York at Brockport to deliver an evidence-based fall-prevention program to a group of older adults at an independent-living facility. This program has met great acceptance among the older adults. This simple educational program informs seniors about the risks of falls and about fall prevention. We also see that there may be nutritional factors which could help improve hip strength. These are just a couple of things we can be addressing as doctors of chiropractic.
However, prior to initiating these preventative strategies, the typical chiropractor would need to familiarize themselves with the current evidence and also might want to consider attending some lectures on these topics. Another important thing they may want to do is become a part of an organization that specializes in addressing public health issues and has scientific sessions each year that may further educate the provider on areas they can address in their practices. Patient and public education is one simple way chiropractors can begin to address the issue of fall prevention in older adults. While not all chiropractors might be comfortable addressing these issues in a public-speaking format, we as a profession should be addressing these issues with patients every day as we assess older adults in our practices.
Over the next 10 to 20 years, the number of older adults in the U.S. will grow substantially. As this segment of the population increases, it will become critical to address their unique health needs. We, as chiropractors, are well-positioned to begin to address some of the public health needs of older patients, and one good example is fall prevention.
Now is the time for us all to improve our knowledge about these issues and to find better ways to address them. One way you can become involved is through the American Public Health Association (APHA). The APHA has a specific section dedicated to chiropractic health care, made up of a small group of dedicated professionals committed to putting public health to work and seeing chiropractic become an integral part of mainstream public health today. Within the APHA structure, members also can select secondary section memberships. For those particularly interested in the issues discussed in this article, APHA has both a Gerontological Health section and an Injury Control & Emergency Health Services section. These options are great examples of what a wealth of multidisciplinary information, network contacts, information exchange and collegiality is available for chiropractors within APHA's structure.
It is imperative that chiropractors begin to address these issues, because until we begin to look outside of our own concerns and consider the big picture of public health, we will never progress as a profession.
When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
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A central challenge in creating our identity is that chiropractic is a method of care, not a technique or procedure. This is an important concept for us to promote. Our patients are treated with lifestyle modification, exercise, nutritional supplements, diet and a whole-body approach to accelerate the natural healing process. We are not simply CMT providers.
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