title: The use of chiropractors by older adults in the United States.
abstract: BACKGROUND
  In a nationally representative sample of United States Medicare beneficiaries, we examined the extent of chiropractic use, factors associated with seeing a chiropractor, and predictors of the volume of chiropractic use among those having seen one.
  
  
  METHODS
  We performed secondary analyses of baseline interview data on 4,310 self-respondents who were 70 years old or older when they first participated in the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). The interview data were then linked to their Medicare claims. Multiple logistic and negative binomial regressions were used.
  
  
  RESULTS
  The average annual rate of chiropractic use was 4.6%. During the four-year period (two years before and two years after each respondent's baseline interview), 10.3% had one or more visits to a chiropractor. African Americans and Hispanics, as well as those with multiple depressive symptoms and those who lived in counties with lower than average supplies of chiropractors were much less likely to use them. The use of chiropractors was much more likely among those who drank alcohol, had arthritis, reported pain, and were able to drive. Chiropractic services did not substitute for physician visits. Among those who had seen a chiropractor, the volume of chiropractic visits was lower for those who lived alone, had lower incomes, and poorer cognitive abilities, while it was greater for the overweight and those with lower body limitations.
  
  
  CONCLUSIONS
  Chiropractic use among older adults is less prevalent than has been consistently reported for the United States as a whole, and is most common among Whites, those reporting pain, and those with geographic, financial, and transportation access.
authors.affiliation: College of Public Health, The University of Iowa, Iowa City, Iowa, USA. fredric-wolinsky@uiowa.edu
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Wolinsky
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Miller
authors.forename: John F
authors.initials: JF
authors.lastname: Geweke
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Cook
authors.forename: Barry R
authors.initials: BR
authors.lastname: Greene
authors.forename: Kara B
authors.initials: KB
authors.lastname: Wright
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.forename: Claire E
authors.initials: CE
authors.lastname: Pavlik
authors.forename: Hyonggin
authors.initials: H
authors.lastname: An
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ohsfeldt
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Richardson
authors.forename: Gary E
authors.initials: GE
authors.lastname: Rosenthal
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace