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Integrative Medicine Focus on Older Adults

Integrative Medicine Focus on Older Adults. Introduction and General use Wadie Najm, MD, MEd. Objectives. Aging Orientation to Complementary and Alternative Medicine (CAM) Use of CAM by the older adults Use of CAM in different cultures/communities Physician awareness of patient use.

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Integrative Medicine Focus on Older Adults

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  1. Integrative Medicine Focus on Older Adults Introduction and General use Wadie Najm, MD, MEd

  2. Objectives UC Irvine- Reynolds Grant Aging Orientation to Complementary and Alternative Medicine (CAM) Use of CAM by the older adults Use of CAM in different cultures/communities Physician awareness of patient use

  3. Population Changes US Census Bureau US Census Bureau projections: Elderly population will more than double between now and 2050, to 80 million. Much of this growth is attributed to the "baby boom" generation which is entering their elderly years between 2010 and 2030. Older adults are becoming more racially and ethnically diverse. UC Irvine- Reynolds Grant

  4. Aging of the U.S. Population 1990 2025 2050 Age % Male % Female UC Irvine- Reynolds Grant US Census Bureau

  5. Population 60 + by age: 1900 to 2050 UC Irvine- Reynolds Grant U.S. Administration on Aging

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  8. Chronic Diseases are the Leading Causes of Death and Disability in the U.S. UC Irvine- Reynolds Grant 7 /10 deaths each year are from chronic diseases. In 2005, 133 million Americans (almost 1/2 adults) had at least one chronic illness. Obesity has become a major health concern About ¼ people with chronic conditions have 1+ daily activity limitations. Arthritis is the most common cause of disability (nearly 19 million Americans). Diabetes is the leading cause of kidney failure, non-traumatic lower-extremity amputations, & blindness among adults. CDC.gov

  9. CDC, National Center for Health Statistics, National Health Interview Survey, 2006. UC Irvine- Reynolds Grant

  10. Health care cost www.ahrq.gov 2006 UC Irvine- Reynolds Grant

  11. www.ahrq.gov 2006 UC Irvine- Reynolds Grant

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  16. How do patients decide which therapy to choose? UC Irvine- Reynolds Grant

  17. Decision to use CAM Artus et al. BMC Family Practice 2007 8:26   doi:10.1186/1471-2296-8-26 Recommended by a friend or a relative. 55 (47%) Prescribed, or referred by a health professional 35 (30%) Media (TV, radio, newspapers, Internet) 27 (23%) Literature 10 (9%) Practice it/involved with it 10 (9%) UC Irvine- Reynolds Grant

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  29. The number of supplements taken by U.S. adult supplement users, NHANES, 2003–2006, n = 9132. Bailey R L et al. J. Nutr. 2011;141:261-266 UC Irvine- Reynolds Grant

  30. The prevalence of use of dietary supplements among U.S. adults ≥ 20 y by weight status, educational attainment, and race/ethnic group, NHANES 2003–2006. Bailey R L et al. J. Nutr. 2011;141:261-266 UC Irvine- Reynolds Grant

  31. Altern Ther Health Med. 2003 May-Jun;9(3):50-7. UC Irvine- Reynolds Grant 525 community-residing elderly completed a 7-page questionnaire during a personal interview Questionnaires were done in the person’s primary language of preference Respondents ranged in age from 65 to 95 years old, with an average age of 73.7 (± 6 years). Fifty-five percent were women. Two hundred and fifty-one (47.8%) reported using CAM during the previous year.

  32. Altern Ther Health Med. 2003 May-Jun;9(3):50-7. UC Irvine- Reynolds Grant

  33. Altern Ther Health Med. 2003 May-Jun;9(3):50-7. UC Irvine- Reynolds Grant

  34. J ALTERN COMPLEM MED 2011, 17(6):487–489 anonymous questionnaire survey among German health insurants 5830 respondents mean age was 64.711.2 years; 70% were men; most were living with a partner (82%) and had a high school education (53%); 9% had acute diseases, 9% cancer, 14% other chronic diseases, and 68% were healthy. UC Irvine- Reynolds Grant

  35. Use • acupuncture/Traditional Chinese Medicine 21%, • Homeopathy 21%, • Movement therapies/physical exercises (MTPE) 19%, • Osteopathy 12%, • Herbs/phytotherapy 7%, • Specific diets/food recommendations 6%, • More women than men used herbs/phytotherapy (3.4X), 2.6 for homeopathy (2.6X), osteopathy (2.4X), • MTPE (1.5) and acupuncture (2.0) were of higher interest also in men. UC Irvine- Reynolds Grant

  36. J ALTERN COMPLEM MED 2011, 17(6):487–489 UC Irvine- Reynolds Grant

  37. J ALTERN COMPLEM MED 2011, 17(6):487–489 UC Irvine- Reynolds Grant

  38. The GEM Study is a double-blind, placebo-controlled, randomized clinical trial evaluating the effectiveness of Ginkgo biloba (240 mg/d) in reducing the incidence of dementia -particularly Alzheimer’s disease- in older adults (75+; Age range was 75 -79) • At baseline, participants self-identified race: • 95% White, • 3% Black, • 1% Asian, • 1% Other; • 1.2% Hispanics UC Irvine- Reynolds Grant

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  41. EthnDis 2006;16:723-731 UC Irvine- Reynolds Grant • Data from the 2002 National Health Interview Survey (NHIS) • 27.7% of older adults use CAM, with the highest level of use among: • Asians (48.6%), • Hispanics (31.6%), • Whites (27.7%), • Blacks (20.5%).

  42. UC Irvine- Reynolds Grant EthnDis 2006;16:723-731

  43. UC Irvine- Reynolds Grant EthnDis 2006;16:723-731

  44. Predictors of CAM use among Hispanics Loera J et al. 2007;13:224-231 UC Irvine-Reynolds Grant • Socio-demographics, • Acculturation factors, and • Medical conditions. • Independent predictors of higher CAM use were: • Female gender, • Being on Medicaid, • Frequent church attendance and • Higher number of medical conditions. • In contrast, subjects who were born in US and spoke either Spanish or English at interview had lower CAM use compared with subjects who were born in Mexico.

  45. Psychiatric Services 58:402–404, 2007 • 153 Chinese-American (NY) • Self-administered questionnaires and chart review. • Mean Age: 44.8±16.2 years; Females: 66% • 93% were foreign born • 94% used CAM: • Megavitamin therapy (70, or 46%), • Chinese herbal medicine (66, or 43%), • Massage therapy (40, or 26%), • Acupuncture (38, or 25%), and • Spiritual healing (36, or 24%). • Predictors: women; employed, poor function & Less acculturated. UC Irvine- Reynolds Grant

  46. Use of CAM by Rural Elderly UC Irvine- Reynolds Grant • Rural Health and Nutrition (RUN) project, a 3 year ethnographic study conducted in 2 rural, central North Carolina counties • 145 persons, aged 70 + included: • African American (33%), • European American (37%), and • Native American (30%). • The sample was 39% male and 61% female. • About 1/3 had more than a high school education, • 43% had less than a high school education, and • 23% had the equivalent of a high school education. • Almost 44% stated that their health was poor or fair. • About 48% took < than three prescription medicines.

  47. Use of CAM by Rural Elderly UC Irvine-Reynolds Grant Rural older adults regularly used home and folk remedies. Rural older adults regularly used vitamin and mineral supplements at levels higher than recommended for normal intakes. Men and women did not differ in CAM use. There were significant ethnic differences in CAM use. UC Irvine- Reynolds Grant

  48. Physician Awareness of Patient Use of CAM Furler M, Abstract presented at CAHR HIV Ontario Observational Database [HOOD] In person interviews Seventy subjects, 40 males and 30 females In patients using CAM, the physician was aware of only 37% of CAM agents used. In the 55% of cases where the physician was unaware of CAM use, 96% of the time the physician had not inquired about use. UC Irvine- Reynolds Grant

  49. Disclosure to physicians of CAM use by breast cancer patients Saxe GA Integr Cancer Ther. 2008 UC Irvine- Reynolds Grant

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