Healthspan has been described as the period of life spent in good health, free from diseases and disabilities.(1) The concept of healthspan can be confusing. For example, good health has different meanings to different people. And, because health exists in multiple dimensions, finding where good health ends and poor health begins is challenging at best. It may be more practical to focus on improving or maintaining health, regardless of whether it qualifies for any one person as “good health.” Achieving these goals is a fundamental way we can help people live more meaningful lives.
The idea of enhancing or improving health is consistent with fundamental intentions of chiropractic care. For example, the ACA mission speaks of empowering members to elevate the health and wellness of their communities, and a core value includes serving patients in the interest of public health. However, moving from a purpose or value toward real-world application isn’t always clear, leading to questions like:
- Is there evidence suggesting chiropractic care can promote and support the concept of healthspan?
- And, if so, how can this be implemented on a practical level?
Evidence of Reduced Healthspan Relevant to Chiropractic Care
The American Chiropractic Association (ACA) describes chiropractic as “…a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health.” Based on this description, there is clear evidence that problems addressed with chiropractic care are prevalent. A report for the 2015 World Health Organization suggested the high prevalence and impact of impaired musculoskeletal health is a threat to healthy aging.(2)
In 2020, an estimated 203 million people globally experienced neck pain. By 2050, estimates project an increase to 269 million.(3) In 2020, low back pain was the largest global contributor to years lived with disability with 619 million people affected. By 2050, estimates project the number will rise to 843 million.(4)
A calculation that partially measures the loss of healthspan is a disability adjusted life year (DALY), which calculates the loss of 1 year of health accounting for premature death and years lived with a disability. In 2010 low back pain was the 12th leading cause of DALYs globally. By 2020, low back pain rose to #8, ahead of problems like malaria and depressive disorders.(5) Years lived with disability (YLD) is another measure accounting only for time with a disability or ill-health. In 2021, low back pain was the #1 cause of YLD globally. The 3rd leading cause was headache disorders. Neck pain ranked #15, ahead of stroke and COVID-19.(5)
Older Adults Carry Higher Risks
Estimates project far more people will be affected by musculoskeletal conditions in the next few decades largely because of aging populations. Pain related to musculoskeletal conditions can have a substantial impact on the quality of life for older adults. A study of more than 7,000 older adults in Korea reported 36% with back pain and 61% experienced some form of musculoskeletal-related pain. Adults reporting moderate or severe pain were more likely to have difficulty performing basic activities of daily living such as dressing, getting out of bed, and bathing.(6) Combined with other conditions more prevalent with age (e.g., cardiovascular disease), older adults experience higher risk for living with a variety of diseases and disabilities that reduce quality of life.
How Can Chiropractic Care Contribute to Improving or Maintaining Health?
When chiropractic care is effective in helping people with musculoskeletal conditions, there is a relatively obvious and direct contribution toward improving health. There are also other ways to contribute. For example, promoting healthy habits, like regular exercise, healthy diet, and activities that promote psychological well-being can also contribute to improved health.(7)
Screening for risk factors or common conditions outside the traditional chiropractic domain is another way to contribute. Several methods can be employed with minimal time-burden. For example, screening for tobacco use involves only a few short questions, screening for osteoporosis fracture risk can be accomplished with an online tool called a FRAX (Fracture Risk Assessment Tool) calculator, and the Centers for Disease Control and Prevention has several printable resources to prevent falls and decrease fall risk in older adults, including a home fall prevention checklist.(8,9) Connecting patients with community resources when financial, spiritual, or social needs are recognized also carries potential health benefits.
Promoting exercise, especially for older adults, offers several benefits beyond improving or maintaining a musculoskeletal condition, cardiovascular fitness, and strength. One potentially less known benefit is the upregulation of intracellular nicotinamide phosphoribosyltransferase, a key enzyme linked to aging and produced in smaller amounts as we age. In most people, exercise training increases levels of this enzyme in skeletal muscles.(10) There is also a body of evidence strongly suggesting regular physical activity in older adults is associated with delayed onset of cognitive impairment and a longer life expectancy.(11)
Beware of Exaggerated Claims
Though there is indirect evidence that effective chiropractic care can positively influence healthspan, the concept itself is difficult to clearly define and measure. We should avoid broad claims that chiropractic care increases healthspan because such claims overgeneralize what current research evidence offers. But there is likely great value in thinking about our care from the standpoint of aspiring to increase healthspan for every patient. Doing so reminds us to ask ourselves simple questions such as:
- What else can I do to help with a physical need?
- How can I help people learn to better self-manage a problem? And,
- Can I connect people with resources or others who can help with a need outside my area of expertise?
The more ways we can positively influence a person’s health either directly through specific care and education, or indirectly through activities like referral, or connecting someone with a needed resource, the more likely we are to have a positive impact.
Dr. Vining is associate dean of clinical research, and a professor, at the Palmer Center for Chiropractic Research in Davenport, Iowa.
References
- Kaeberlein M. How healthy is the healthspan concept? GeroScience. 2018 Aug 6;40(4):361–4.
- Briggs AM, Cross MJ, Hoy DG, Sànchez-Riera L, Blyth FM, Woolf AD, et al. Musculoskeletal Health Conditions Represent a Global Threat to Healthy Aging: A Report for the 2015 World Health Organization World Report on Ageing and Health. The Gerontologist. 2016 Apr;56 Suppl 2:S243-255.
- GBD 2021 Neck Pain Collaborators. Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2024 Mar;6(3):e142–55.
- GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023 Jun;5(6):e316–29.
- GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Lond Engl. 2024 May 18;403(10440):2133–61.
- Singh A, Akkala S, Nayak M, Kotlo A, Poondla N, Raza S, et al. Impact of Pain on Activities of Daily Living in Older Adults: A Cross-Sectional Analysis of Korean Longitudinal Study of Aging (KLoSA). Geriatr Basel Switz. 2024 May 20;9(3):65.
- Hawk C, Amorin-Woods L, Evans MW, Whedon JM, Daniels CJ, Williams RD, et al. The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain: A Clinical Practice Guideline. J Altern Complement Med N Y N. 2021 Oct;27(10):850–67.
- Fracture Risk Assessment Tool [Internet]. [cited 2024 Aug 10]. FRAX. Available from: https://frax.shef.ac.uk/FRAX/tool.aspx?country=9
- CDC. STEADI – Older Adult Fall Prevention. 2024 [cited 2024 Aug 10]. Patient & Caregiver Resources. Available from: https://www.cdc.gov/steadi/patient-resources/index.html
- Sun X, Su L, Bu T, Zhang Y. Exercise training upregulates intracellular nicotinamide phosphoribosyltransferase expression in humans: a systematic review with meta-analysis. Front Public Health. 2023;11:1287421.
- Yoneda T, Lewis NA, Knight JE, Rush J, Vendittelli R, Kleineidam L, et al. The Importance of Engaging in Physical Activity in Older Adulthood for Transitions Between Cognitive Status Categories and Death: A Coordinated Analysis of 14 Longitudinal Studies. J Gerontol A Biol Sci Med Sci. 2021 Aug 13;76(9):1661–7.
