Helping Baby Boomers face aging concerns, such as diabetes, obesity, and osteoarthritis, can increase your patient base

Demographics play an enormous role in our lives. Government spending, pension arrangements, and food production are based on the predictability of demographics. When statistics are examined, a phenomenon known as the “pig in the python”1 can be observed. This phrase describes the passage of the Baby Boomer generation through its various stages of life. The implications of this rapid population growth have been felt for the past 5 decades.

At this time, the pig has passed through the python to a point where Boomers are now in their late-middle years. They are a pleasure- and comfort-seeking population, have had access to remarkable technologies, and are, therefore, fascinated with the benefits that lifestyle improvements can bring. Their parents’s generation had limited access to health care options and mostly learned to “put up with it”—not so with the Boomers. A 1998 study found that there were more visits to nonmedical practitioners than traditional Western medical doctors.2 This dynamic group is willing to explore more relevant options.

As Time Goes By
The Boomer generation is aging, and with aging comes the challenges and concerns associated with osteoarthritis, diabetes, and obesity. Each of these aging factors affects overall health and well being. Of special significance are the changes in motion and flexibility of the foot and ankle. Excessive strains on the foot alter the biomechanics of the entire weightbearing joint complex.

The foot is an area that is particularly sensitive to the effects of aging. As it is the first link between the ground and the body, an aging foot has increased demands on its flexibility and performance. Structural changes within the foot are more symptomatic and pronounced as patients enter into their middle and later years. This is mainly because of the repetitive impact forces that accumulate over time as the foot strikes a hard surface.3 Aging tissues lose their elasticity, and the cumulative strains and stresses place unusual forces into the plantar fascia and even the subchondral bone.4

A properly designed custom-made orthotic can restore a more balanced foot posture and also reduce the impact forces that enter into the foot.5 Extra cushioning can dampen the vibration forces that enter the foot during the gait cycle.6 The use of orthotics can greatly aid the aging foot to hold a more neutral posture and also to reduce the noxious forces entering the kinetic chain.

Boomers are also a generation with more disposable income and leisure time. Golf is a sport that has seen a dramatic rise in number of players. With earlier retirement options and more home-based business opportunities, golf has become a sport for this generation. Orthotics are a natural complement to this particular sport. The use of custom-made orthotics has been shown to have a significant, positive effect on pelvic rotation, stride length, and fatigue levels when worn by experienced golfers.7 Other recent studies8, 9 conclude that the golf swing and the golfer’s balance and proprioceptive symmetry can be significantly improved when custom-made orthotics are worn.

Along with degenerative changes of the joints comes the potential degeneration associated with diabetes. This insidious disease process is especially common to the Boomer age group. Diabetes affects the small vessel circulation of the extremities. Tissue breakdown and diminished sensation are consequences of the diabetic process, which means that shoe fit and the amount of cushioning within the shoe are important factors.

Repeated friction can go unnoticed and an ulcerative condition could erupt. Diabetes also slows the healing rate; tissue breakdown conditions can linger and become morbid for the patient. An orthotic with support and adequate cushioning can greatly aid in a diabetic foot. Extra care must be taken to ensure a proper orthotic fit when installing them. All friction points must be evaluated when the orthotics are inserted. The break-in period may need to be lengthened, so that any unusual skin irritations can be addressed.

Tipping the Scales
Obesity and aging are, sadly, nearly synonymous. The North American diet and exercise habits show a trend toward being overweight and even obese. In 1999, an estimated 61% of adults in the United States were classified as overweight, and obesity among adults has doubled since 1980.10

Excessive weight places unnecessary strain on the musculoskeletal system. There is noticeable change in the alignment and movements of the load-bearing joints. Altered pelvic posture, sacroiliac mechanics, Q-angle shifts, and foot and ankle dynamics are all changing when constant excessive loads are applied. Hyperpronation of the foot, foot flare on contact, and increased hip abduction are prevalent in the overweight Boomer.

In addition, overweight patients have a greater incidence of plantar fascitis, tendinitis, osteoarthritis, and sprains of their feet and ankles.11 A special style of orthotics may be needed for the obese patient, one which provides a firmer level of flexible support. Also, orthotics may need changing at more frequent intervals. The tendency is for obese individuals to break down their orthotics at a much faster pace.

Thorough examinations that exceed the confines of the spine are the perfect tools to demonstrate the connected nature of postural alignment and whole health. The prosperity and the technological advantage of these Boomers allow them to look far beyond a survival model of health care.

As the Boomer population ages, a growing need and desire to seek balance in health care and lifestyle become evident. Take a look at the demographics in your office and realize the special opportunity that exists to care for the Boomers. CP

David S. Fletcher, DC, FCCSS (C), a Fellow of the College of Chiropractic Sport Sciences (Canada), has been in private practice for 22 years at The Fletcher Clinic, Pickering, Toronto, Canada. He is recognized internationally for blending traditional chiropractic principles with contemporary technologies and strategies. Fletcher can be reached at 905-831-9696 or via email: fletch5@rogers.com.

References
1. Cork D. The Pig and the Python: How to Prosper from the Aging Baby Boom. Toronto: Stoddart Publishing; 1996.
2. Astin JA. Why patients use alternative medicine. JAMA. 1998;279(19):1548.
3. Radin EL. Effect of repetitive impulsive loading on the knee joints of rabbits. Clin Orthop. 1978;31:288–291.
4. Radin EL. Effect of prolonged walking on concrete on the knees of sheep. J Biomech. 1982;15:487–494.
5. Kuhn DR, Yochum TR, Cherry AR, Rogers S. Immediate changes in the quadriceps femoris angle after the insertion of an orthotic device. J Manip Physiol Ther. 2002; 25(7):465–470.
6. Nigg BM, Nurse MA. Stefanyshyn DJ. Shoe inserts and orthotics for sport and physical activities. Med Sci Sports Exerc. 1999;31(7 Suppl):S421–S428.
7. Stude DE, Gullickson J. The effects of orthotic intervention and nine holes of simulated golf on gait in experienced golfers. J Manip Physiol Ther. 2001;24(4):279–287.
8. Stude DE, Gullickson J. Effects of orthotic intervention and nine holes of simulated golf on club-head velocity in experienced golfers. J Manip Physiol Ther. 2000;23(3):168–174.
9. Stude DE, Brink DK. Effects of nine holes of simulated golf and orthotic intervention on balance and proprioception in experienced golfers. J Manip Physiol Ther. 1997;20(9):590–601.
10. US Department of Health and Human Services. Overweight and obesity threaten US health gains. HHS News (press release) 12/13/01:1-4. Available at: www.surgeongeneral.gov/news/pressreleases/pr_obesity.htm. Accessed October 30, 2002.
11. Frey C, Chan C, Carrasco N. Obesity: do weight gains lead to lower extremity pains? Biomechanics. 1996;3(1):30-34, 89.