Clinical Geriatrics: A Diagnostic Compendium
Clinical Geriatrics: A Diagnostic Compendium
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 8 from RC’s best-selling book:
“Basic Chiropractic Procedural Manual”
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Chapter 8: Clinical Geriatrics: A Diagnostic Compendium
The objective of this chapter is to focus attention on disorders witnessed in practice by those dealing with the geriatric patient. Following neurologic disorders, heart, vascular, and blood disorders are discussed. Digestive and gastroenterologic disturbances are then followed by disorders of the urinary system, skin, endocrines, and reproductive system. Next, eye, ear, and throat conditions are followed by orthopedic and respiratory considerations. The chapter concludes with information about the sexual aspects of aging, common complaints and symptoms, and other pertinent considerations.
The topics described in this chapter are not to be considered a complete reference for all geriatric conditions seen in practice. They have been chosen as those most likely to be encountered or because they present a unique situation necessary for differentiation and/or case management.
While some described disease states may not be commonly considered within the scope of chiropractic general practice, their diagnosis is. Thus, this general knowledge will help clarify when referral should be considered, thus serving the best interests of the patient and possibly avoiding a potential accusation of professional negligence.
It is the editor’s opinion that most errors in diagnosis or judgment do not occur from a lack of clinical knowledge. They occur as the result of a hurried history and examination. A clinician must be self-disciplined to give full attention to the patient at hand, without distracting concern for those patients waiting in the reception room.
In past years, it was a frequent fault of young practitioners of all disciplines to contribute age an important etiologic factor. It is emphasized that age alone is an inadequate factor in the cause of severe illness in the elderly. Careful examination, treatment of the whole individual, and prolonged follow-up is necessary for optimal results.
Most pathologists readily admit that disease is a process, not a state, but rarely is the process defined other than to say that disease of any tissue or organ is the result of disturbed function — normal physiology gone wrong.
According to most authorities, health is that condition when cells are stimulated (irritated) by nerve impulses that results in specialized cellular function to be increased or decreased so to adapt to environmental needs. While there are no new functions in disease, disease is that state where specialized functions are increased or decreased because some abnormal factor (mechanical, chemical, or psychic) is affecting the nervous system. Thus, disease is the result of abnormal or subnormal function or of normal function out of time with need. While health is the result of the organism maintaining a constant composition of the internal environment, disease results when abnormal function changes the internal environment and threatens cellular integrity.
Abnormal function is the result of perpetuated environmental, mechanical, or psychic irritation of the nervous system interfering with normal control of function for adaptation. As pain, muscle contraction, and visceral dysfunction are symptomatic of many diseases, most disease states are the result of excessive neural impulses rather than a reduction of impulses. In chronic states, for example, anoxia causes the nerve to lose its ability to transmit impulses properly. This results in analgesia, muscle flaccidity, and autonomic dysfunction.
Several pairs of nerves do not pass through movable spinal foramina and direct intervertebral pressure is not common except in severe trauma or advanced degenerative states. However, slight fixation of a vertebra producing neurologic insult can cause abnormal (mechanical, congestive, and/or metabolic) sensory irritation, motor spillover, and/or axoplasmic flow impediment. Thus, microscopic rather than macroscopic subluxation effects are more commonly witnessed clinically.
Symptoms indicate abnormal function; ie, normal function that has been increased or decreased out of time with individual needs. This function points to the organ or structure involved as well as the nerves or final common paths that would normally cause the same function when irritated by impulses initiated by normal controls.
Experience shows that manipulation, diet, counsel, physiotherapy, drugs, and surgery can relieve harmful irritation on the nervous system when used on the right patient at the right time and in the proper combination. As there are multiple causes in any disorder, no profession offers a panacea for any or all disease. The objective of any rational approach is to adjust the individual to better adapt to the environment or adjust the environment to the individual’s needs if possible.
FIXATION-RELATED ARTICULAR THERAPY
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