J Manipulative Physiol Ther. 2000 Jan; 23(1): 10-9.

Maintenance care: health promotion services administered to US chiropractic patients aged 65 and older, part II.

Rupert RL, Manello D, Sandefur R.

Logan Chiropractic College, St Louis, MO, USA.

OBJECTIVE: Health promotion and prevention services provided by the chiropractic profession historically have been referred to as maintenance care (MC). The primary objective of this investigation was to obtain information regarding multiple health issues of patients age 65 years and over who have had a long-term regimen of chiropractic health promotion and preventive care. The study also sought to explore the nature of the interventions and methods that were most commonly used by chiropractors when administering MC and to determine whether there were differences between patients who have had long-term exposure to these preventive services versus those who have not. DESIGN: This descriptive study was accomplished by selecting chiropractic patients (age 65 years and over) who had received health-promotion and prevention services for at least 5 years, with a minimum of 4 visits per year. To enhance the probability of securing a more representative patient sample, selection was made through the participation of chiropractors from 6 diverse geographic locations across the United States. Doctors were asked to enroll the first 10 consenting patients who met the inclusion criteria. A battery of diverse assessment instruments were completed by each patient to provide a patient health profile. Information related to each patient included answers to the SF-36D survey, patient health habits, expenditures of health services, frequency of use of health providers, and perceived value of chiropractic prevention and health promotion services. RESULTS: A total of 73 chiropractors participated in this investigation from the 6 study sites. In addition to an average 1.9 manual procedures used per patient, it was common to recommend stretching exercises (68.2%), aerobic exercises (55.6%), dietary advice (45.3%), and a host of other prevention strategies, including vitamins and relaxation. The patients investigated in this study reported making only half the annual number of visits to medical providers (4.76 visits per year) compared with the national average (9 visits per year) for individuals age 65 years and over. CONCLUSIONS: On the basis of the response of participating chiropractors, this study describes the therapeutic components of MC for the elderly patient. For these patients, MC does not simply consist solely of periodic visits for joint manipulation, but it involves an eclectic host of interventions (e.g., exercise, nutrition, relaxation, physical therapy, and manipulation) that are directed at both musculoskeletal and visceral conditions.