Integrative Medicine & Older Adults

1. Integrative Medicine & Older Adults Evie Kalmar, MD, MS UCSF Geriatrics & Palliative Medicine Fellow 10/24/2019

2. I have no disclosures.

3. Objectives • Define Integrative Medicine and discuss its potential to improve the health and well-being of older adults • Describe Integrative Medicine practices, including nutrition, mind-body, and exercise • List resources to learn more about Integrative Medicine

4. Roadmap • Overview of Integrative Medicine • Integrative Medicine Practices • How to apply Integrative Medicine to common symptoms • Summary & Resources

6. 1. What is Integrative Medicine? “Integrative Medicine is healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.” https://integrativemedicine.arizona.edu/about/definition.html

7. 1. What is Integrative Medicine? https://dukeintegrativemedicine.org/patient-care/wheel-of-health/

8. Terminology • Alternative Medicine = replaces conventional medicine • Complementary Medicine = complements conventional medicine • Integrative Medicine = complementary + conventional Medicine

9. Who uses Integrative Medicine? • 33.2% of U.S. adults use complementary health approaches • Most common complementary approach • natural products • used by 17.7% of adults https://nccih.nih.gov/research/statistics/NHIS/2012/key-findings

10. Who uses Integrative Medicine? • 33.2% of U.S. adults use complementary health approaches • Most common complementary approach • natural products • used by 17.7% of adults Natural products: dietary supplements other than vitamins and minerals https://nccih.nih.gov/research/statistics/NHIS/2012/key-findings

11. How Big is Integrative Medicine? • ~ 59 million Americans spend money out-of-pocket on complementary health • Total annual spending is $30.2 billion • Out-of-pocket spending for complementary health represents 1.1% of total health care spending https://nccih.nih.gov/research/statistics/NHIS/2012/key-findings

12. Why do people use Integrative Medicine? https://nccih.nih.gov/news/camstats/2010/findings2.htm

13. Why do people use Integrative Medicine? Prevent illness & For general wellness Reduce pain Treat specific health condition Supplement conventional medicine https://nccih.nih.gov/news/camstats/2010/findings2.htm

14. 2. Integrative Medicine Practices • Overview of Integrative Medicine • Integrative Medicine Practices • How to apply Integrative Medicine to common diseases • Summary & Resources

15. What are common Integrative Medicine Practices? Natural Products Deep Breathing Meditation Chiropractic & Osteopathic Massage Yoga Diet-Based Therapies Progressive Relaxation Guided Imagery Homeopathic Treatment https://nccih.nih.gov/news/camstats/2010/findings2.htm

16. What are common Integrative Medicine Practices? Natural Products Deep Breathing Meditation Chiropractic & Osteopathic Massage Yoga Diet-Based Therapies Progressive Relaxation Guided Imagery Homeopathic Treatment Exercise https://nccih.nih.gov/news/camstats/2010/findings2.htm

17. What are common Integrative Medicine Practices? • Nutrition • Mind body • Exercise

18. A. Nutrition - Barriers Dentition Access Malabsorption

19. A. Nutrition - Supplements • Americans spend $12.8 billion on natural products per year. • Fish oil was the #1 natural product among adults, with 7.8% using it in 2012. • ↑ use of fish oil, probiotics, and melatonin in recent years. https://nccih.nih.gov/research/statistics/NHIS/2012/key-findings https://nccih.nih.gov/news/camstats/2010/findings2.htm

20. A. Nutrition - Food Kogan, 2017 Kogan, 2017

21. A. Nutrition - Food Kogan, 2017 Kogan, 2017

22. A. Nutrition – Therapeutic Diets • High blood pressure • Dietary Approaches to Stop Hypertension (DASH) • Slow cognitive decline • Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) • Irritable Bowel Syndrome • Low FODMAP diet Kogan, 2017

23. A. Nutrition - Medications • Medications can impair absorption of nutrition • Diuretics • deplete nutrients like potassium, magnesium, calcium • Proton-pump inhibitor • block absorption of nutrients like vitamin B12

24. B. Mind body Massage Therapy Meditation Yoga Chiropractic Manipulation https://nccih.nih.gov/research/statistics/NHIS/2012/key-findings

25. B. Mind Body - Trends

26. B. Mind Body - Yoga • > 85 % of U.S. adults who practice yoga felt ↓ stress. • 6 in 10 people motivated to exercise more regularly. • 4 in 10 motivated to eat healthier. • More likely to report feeling better emotionally than users of dietary supplements or spinal manipulation. https://nccih.nih.gov/research/statistics/NHIS/2012/key-findings

27. C. Mind Body - Meditation • Use of meditation is increasing. • 14.2% of adults practiced it in 2017. • Involves: • quiet location • specific, comfortable posture • focus of attention • open attitude • Benefits – pain, blood pressure, anxiety, irritable bowel syndrome Charles, 2018

28. C. Exercise - Types Flexibility Training Aerobic Exercise Resistance Training Lifestyle Modifications Balance Training Kogan, 2017

29. C. Exercise - Benefits • Improves blood pressure, heart failure, cholesterol • Decreases fall risk, maintains healthy bones • Improves depression, sleep, cognition • Decreases risk of obesity, diabetes, improves symptoms of hot flashes • Decreases mortality Kogan, 2017

30. 4-7-8 Breathing • Empty lungs • Inhale through nose for 4 seconds • Hold breath for 7 seconds • Exhale through mouth for 8 seconds

31. 3. How to apply Integrative Medicine to common diseases • Overview of Integrative Medicine • Integrative Medicine Practices • How to apply Integrative Medicine to common diseases • Summary & Resources

32. Which conditions inspire use of Integrative Medicine? • Back pain • Neck pain • Joint pain • Arthritis • Cholesterol • Cold • Other Musculoskeletal • Severe headache • Insomnia https://nccih.nih.gov/news/camstats/2010/findings2.htm

33. Which conditions inspire use of Integrative Medicine? • Back pain • Neckpain • Joint pain • Arthritis • Cholesterol • Cold • Other Musculoskeletal • Severe headache • Insomnia https://nccih.nih.gov/news/camstats/2010/findings2.htm

34. Symptom-specific approaches • Pain • Insomnia https://nccih.nih.gov/news/camstats/2010/findings2.htm

35. Pain

36. Pain • 11.2% of adults have daily pain • Common causes: • Arthritis • Bone and joint diseases • Chronic pain conditions https://nccih.nih.gov/research/statistics/NHIS/2012/key-findings

37. Pain is associated with • Worse health • Depression • Anxiety • Social isolation • Sleep disturbance • Impaired mobility & disability • ↑ health care utilization and $ https://nccih.nih.gov/research/statistics/NHIS/2012/key-findings

38. Pain - Nutrition • Minimal evidence to support though low risk side effects • Supplements with potential benefit • SAMe (S-Adenosylmethionine) • Glucosamine • Chondroitin • Oral herbal therapies • Boswellia • Tumeric + Black Pepper TowheedT, 2005

39. Pain - Nutrition • Dr. Weil Anti-Inflammatory Diet • Aim for variety. • Include as much fresh food as possible. • Minimize consumption of processed foods and fast food. • Eat an abundance of fruits and vegetables. www.drweil.com

40. Pain – Mind-body • Acupuncture • Small but statistically significant benefit • Ice massage • ↑ ROM, function, and knee strength • Meditation • Yoga • Tai chi Manheimer, 2018

41. Pain - Exercise • Can reduce pain and improve physical function Fransen, 2005 & Fransen, 2014

42. Insomnia

43. Insomnia • Occurs in up to 30% of older adults. • Can impair mood, energy, performance, quality of life. • May lead to depression, cognitive impairment, caregiver stress, and increased healthcare costs. • Most common treatment for insomnia is medication.

44. Insomnia - Nutrition • Limited evidence for supplements • Melatonin • Valerian root Matheson, 2017 Bent, 2006

45. Insomnia – Mind-Body • Cognitive behavioral therapy - mild effect • Listening to music - may support sleep • Acupuncture – no evidence to support • Guided imagery • Meditation Cheuk, 2012 Jespersen, 2015 Montgomery, 2003

46. Insomnia - Exercise • Regular brisk walking and moderate weight training • Improvement in total sleep duration, sleep onset latency and global sleep quality Kogan, 2017 Montgomery, 2002

47. 4. List Resources • Overview of Integrative Medicine • Integrative Medicine Practices • How to apply Integrative Medicine to common diseases • Summary & Resources

48. Summary Integrative Medicine

49. Summary Integrative Medicine Practices

50. Summary Integrative Medicine Practices Symptoms