title: Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update.
abstract: The purpose of this study was to update evidence-based recommendations on the best practices for chiropractic care of older adults.
  
  
  
  The project consisted of a systematic literature review and a consensus process. The following were searched from October 2009 through January 2016: MEDLINE, Index to Chiropractic Literature, CINAHL (Cumulative Index to Nursing and Allied Health Literature), AMED (Allied and Complementary Medicine Database), Alt HealthWatch, Cochrane Database of Systematic Reviews, and Cochrane Registry of Controlled Trials. Search terms were: (manipulation, spinal OR manipulation, chiropractic OR chiropract*) AND (geriatric OR "older adult*"). Two reviewers independently screened articles and abstracts using inclusion and exclusion criteria. The systematic review informed the project steering committee, which revised the previous recommendations. A multidisciplinary panel of experts representing expertise in practice, research, and teaching in a variety of health professions serving older adults rated the revised recommendations. The RAND Corporation/University of California, Los Angeles methodology for a modified Delphi consensus process was used.
  
  
  
  A total of 199 articles were found; after exclusion criteria were applied, 6 articles about effectiveness or efficacy and 6 on safety were added. The Delphi process was conducted from April to June 2016. Of the 37 Delphi panelists, 31 were DCs and 6 were other health care professionals. Three Delphi rounds were conducted to reach consensus on all 45 statements. As a result, statements regarding the safety of manipulation were strengthened and additional statements were added recommending that DCs advise patients on exercise and that manipulation and mobilization contribute to general positive outcomes beyond pain reduction only.
  
  
  
  This document provides a summary of evidence-informed best practices for doctors of chiropractic for the evaluation, management, and manual treatment of older adult patients.
authors.affiliation: Texas Chiropractic College, Pasadena, TX. Electronic address: cherylkhawk@gmail.com.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Hawk
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schneider
authors.affiliation: University of Western States, Portland, OR.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Haas
authors.affiliation: Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL.
authors.forename: Paul
authors.initials: P
authors.lastname: Katz
authors.affiliation: New York Chiropractic College, Seneca Falls, NY.
authors.forename: Paul
authors.initials: P
authors.lastname: Dougherty
authors.affiliation: Canadian Memorial Chiropractic College, Toronto, ON, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Gleberzon
authors.affiliation: Palmer College of Chiropractic, Davenport, IA.
authors.forename: Lisa Z
authors.initials: LZ
authors.lastname: Killinger
authors.affiliation: Journal of Alternative and Complementary Medicine, Seattle, WA.
authors.forename: John
authors.initials: J
authors.lastname: Weeks
mesh_terms: D000368:Aged; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods* / Q000592:standards; D020393:Manipulation, Spinal / Q000379:methods / Q000592:standards; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000628:therapy*; D059352:Musculoskeletal Pain / Q000503:physiopathology / Q000628:therapy; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Aging; Chiropractic; Spinal Manipulation