Integration of Complementary and Alternative Therapies in Geriatric Care

What Does Complementary and Alternative Medicine Offer Older Adults?
Complementary and alternative medicine (CAM) has caught the attention of many older adults and their caregivers, and for good reason. CAM often offers gentler and safer approaches to addressing common health conditions of seniors, a significant concern when the challenges of medication use in older adults are considered. CAM practitioners are likely to encourage good health practices to strengthen the body’s defenses and healing abilities, which offer benefits beyond symptom management.

The unique composition of body, mind, and spirit guides CAM and promotes care that is individualized. In an era of abbreviated office visits and hospital stays, CAM practitioners provide older adults with the time and attention that they need. Also important to geriatric care, CAM emphasizes self-care and empowers older individuals with the knowledge, skills, and encouragement that support it.

Although they have many benefits as complements or alternatives to conventional therapies, CAM products and services are not without their risks to older adults. For example, improper use of herbal remedies can create a host of problems for older persons, who may have different responses to these products when compared with younger adults. It would not be unusual for older clients to be unaware of the adverse effects of herbs or herb-drug and herb-herb interactions. For example, older adults have a higher risk of developing serotonin syndrome when taking the common alternative herbal antidepressant St. John’s wort. The symptoms of this syndrome (eg, fever) can be mistaken for an infection, leading to the adverse reaction being missed or mistreated. A serious adverse effect from the popular tonic ginseng is Stevens-Johnson syndrome, which can cause the skin to peel off. Ginkgo biloba and several other popular herbs that are used by the older population have anticoagulant effects.

Likewise, some “hands-on” therapies pose a unique risk to seniors if age-related differences are not considered, as may be the case with chiropractic therapies. Older bones are more brittle than younger ones and can fracture under stress. As an example, although this wouldn’t be a concern for younger adults, tissue fragility and reduced muscle mass warrant special consideration when massaging older adults to avoid injury.

Not all risks relate to physical complications. Older adults tend to have long faith traditions that have significant meaning for them. A CAM therapy that conflicts with one’s faith can result in spiritual distress. For example, a Christian who believes that Jesus Christ is the source of all healing and the highest spiritual power can react negatively to energy healing that calls on a universal power or other spirits.

It is important to ask clients about the use of CAM during every assessment. Keep in mind that some clients may not think of the supplements they’re using or the magnetic mattress that they’re sleeping on as CAM, so specific questions must be asked: For example, “what other types of things do you do for your health?” “Are you seeing an acupuncturist, chiropractor, or other type of practitioner?”

Obtain a full history before recommending CAM. Although the client may be seeking your advice for CAM recommendations for joint pain, he or she also may be treated for a psychiatric problem that could influence your recommendations. Keep in mind that poor memory and the stress of being in a practitioner’s office or hospital could cause older persons to omit essential pieces of health history, so make an extra effort to ask many questions that could trigger recall.

Instruct clients in the proper use, precautions, and adverse effects of the CAM therapies that are recommended and used. Like other adults, seniors often gather advice from peers, the Internet, or sources who may offer partial or even erroneous information. Assist clients to weigh the advantages and disadvantages of conventional against CAM therapies. There are times when medications are safer, less costly, and more appropriate than herbs and other CAM therapies. Also, guide clients in locating competent, credentialed practitioners.
Risks for CAM CAM and Patient Assessment Suggested Reading

What Does Complementary and Alternative Medicine Offer Older Adults? Risks for CAM CAM and Patient Assessment
Navigating the healthcare system can be a challenge even for those not of advanced age with multiple health conditions. CAM has the potential for many beneficial uses in the older population, but it is not without risks. Professionals can offer considerable assistance to older adults by assisting them to use CAM wisely and appropriately.

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