HEALTHY AGING

Maintenance Care

     Chiropractic maintenance care is an elective and long term care, which focuses on health promotion and disease prevention. Health promotion is a process, which enables people to increase control over, and to improve their health. These are actions that are taken with the goal and intend of moving an individual to a higher level of wellness. Three basic strategies to achieve this are through advocacy and to create conditions for health, through enabling or achieving full health potential, and through mediating between different interests in society to pursue health. Disease prevention is defined as the deferral or elimination of medical conditions through appropriate intervention with the goal of improving the health of the individual and quality of life. An example of disease prevention could be fall prevention. There are basically three levels to disease prevention [7,8,9,11]:
    

Primary : Actions that are taken to prevent a disease or injury like vaccination.
Secondary : Actions that are taken to identify a condition as early as possible like mammogram.
Tertiary : Actions to prevent or limit disability and restore optimal level of functioning like rehabilitation.
    

     There are basically three kinds of treatment options that chiropractors could offer: Crisis care, which is treating the patient only as long as they have symptoms and terminate the treatment once the symptoms are gone; Supportive care, which is defined as the kind of care that is needed to keep the patient symptoms free, or in other words, the kind of treatment that if withheld, symptoms reappear; and finally maintenance care, which is provided regardless of symptoms. Therefore, We can define the purpose of maintenance care as optimizing health, preventing conditions from happening, providing palliative care, minimizing recurrence or exacerbation of conditions [7,8,9,11].
        

     The majority of chiropractors believe that maintenance care is important and 79% of them recommend it to their patients. Furthermore, about 96% of elderly patients believed that maintenance care was either considerably or extremely valuable. This is the result of services provided such as SMT, exercise advice, dietary counseling, patient education and nutritional advice. Studies have also shown that chiropractic patients are less likely to be hospitalized, less likely to use nursing care facilities, report better health status, are more likely to exercise, are more mobile and use less medications, all of which not only promotes health and prevents diseases, it has a direct positive effect on the overall health cost [7,8,9,11].

Nutrition

     One of the important factors in health promotion and disease prevention in older population is maintaining good nutrition. As we get older we face the added risks of nutritional deficiencies and malnutrition. However, good nutrition has been shown to be a major factor in successful aging. A good dietary intake has also been shown to be an important component when it comes to prevention and management of many chronic conditions such as DM, CHD, and hypertension. A nutritional assessment could determine if the physiological requirements for essential nutrients are being met. The nutritional assessment involves determining the health status of the individual and helps in the development of an individualized nutritional plan. There are basically four primary components to the nutritional assessment [7,8,9]:
    

1) Anthropometric : This is basically to determine the amounts of various body components like muscles         and fat and is particularly useful in detecting if there is any protein-energy malnutrition, and hence we         can better assess risk for acute and chronic diseases. There are five components in this step: height             and      weight, BMI, circumference, skinfolds, and body composition.
2) Biochemical : This is to evaluate the intake of nutrients and their functional levels to be able to monitor       for nutrition-related diseases. Here we look at protein status, cholesterol levels, and vitamin and                   mineral status.
3) Clinical : This is to get a complete nutritional and medical history to determine any signs and symptoms       of nutritional deficiencies. The components of this step would include medical history, cognitive and             physical function, signs and symptoms, medication use, and oral health.
4) Dietary : This is to determine the consumption of food, beverages, supplements, and other dietary               patterns. The components of this step include : food and beverage intake, food security, supplement           use, food preferences, cultural practices and beliefs, rituals, and dietary preferences. 

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