What is Integrative Geriatric Medicine?

Half of Americans over 65 struggle with more than one chronic disease, and almost 80% have one or more conditions. The western model of care often utilizes prescription medications to treat these conditions, with most older adults taking at least one drug.

Seniors looking for a different approach to care may be happy to learn about integrative medicine. Integrative medicine takes a non-pharmacologic approach to care in the geriatric population and emphasizes lifestyle modifications and other natural therapies to support health and well-being with aging. Read on for more information about integrative geriatric medicine, how it differs from western medicine, and an integrative medicine approach to diet and supplementation to support seniors' unique needs.

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What is Integrative Medicine?

Integrative medicine is an evidence-based, therapeutic approach to care that focuses on healing the whole person, addressing physical, mental-emotional, and spiritual aspects of health. Integrative medicine recognizes the importance of the connection between mind, body, and spirit when achieving optimal health and well-being.

In Integrative Medicine, emphasis is placed on the therapeutic relationship, with doctor and patient working together in the healing process. Empowering the patient to play an active role in their care is an essential feature of this type of medicine.

Integrative medicine focuses on identifying a root cause for the patient's concerns. It often utilizes functional laboratory testing and dives much deeper into understanding a patient's lifestyle and environmental factors in pursuit of the root cause. 

This care combines conventional and alternative treatments to promote health and well-being. It recognizes the importance of "integrating" traditional approaches, such as medications or surgery, when appropriate, with lifestyle modifications and complementary therapies, such as meditation or acupuncture. This well-rounded, patient-centered, integrative approach to care supports the best immediate and long-term health outcomes for the patient.

Geriatric Definition in Integrative Medicine

The term geriatric refers to the medical care of aging people. Integrative geriatric medicine takes a patient-centered, whole-person, non-pharmacologic approach to medical care for older adults. 

Current conventional geriatric care relies heavily on prescription medications and invasive procedures. Polypharmacy is the use of multiple drugs. In the United States, 34% of adults aged 60-79 took five or more prescription medications in the last 30 days, and 83% of this population took at least one medication. Integrative geriatric medicine reserves prescription medications and invasive procedures for when safer care methods are ineffective or unavailable. 

Integrative geriatric medicine offers older adults a type of care that emphasizes lifestyle modifications such as nutritional interventions, exercise and movement therapies, mind-body practices, and alternative treatments, such as acupuncture and chiropractic care. This approach provides older adults with non-invasive options and allows them to take on a more significant role in their health and well-being.

Difference Between Integrative Medicine and Western Medicine

There are several differences between integrative medicine and western medicine. Integrative medicine takes a whole-person, patient-centered approach to care and emphasizes the therapeutic relationship. In western medicine, the focus is placed on the symptom or disease. NIH describes western medicine as a system where healthcare providers "treat symptoms and diseases using drugs, radiation, or surgery." 

Another element that makes a whole-person approach difficult in western medicine is that it's segmented into various subspecialties. For example, a person may need to see several different doctors (i.e., a gastroenterologist and an endocrinologist) to address all their health needs. 

Integrative medicine utilizes both conventional and complementary therapies to provide the best possible outcomes for the patient's health and well-being. For example, an integrative care approach for a patient might include a prescription thyroid medication, dietary modifications, acupuncture, or yoga therapy to restore hormone health and promote a sense of well-being. Western medicine primarily utilizes conventional treatments to achieve patient goals. 

Common Functional Medicine Labs for Senior Citizens

Functional medicine labs can help practitioners understand some of the underlying causes of various conditions and symptoms. Below are some of the most beneficial functional labs for older adults:

Comprehensive Stool Test

As we age, it's common for gastrointestinal complaints to present, with certain gut conditions occurring more frequently in older adults. Comprehensive stool analysis thoroughly evaluates a patient's functional gastrointestinal health, making it a valuable test for senior citizens. 

The Genova Diagnostics GI Effects® Comprehensive Profile assesses inflammation, digestive function, immune function, and the intestinal microbiome. Zonulin is an optional add-on to this test to identify increased intestinal permeability (often called "leaky gut"). The unique benefit of this stool test is that it also offers microbe sensitivity testing to determine whether any identified pathogens will be resistant or sensitive to various prescription medications and natural products. This is helpful information, especially when treating older adults on multiple medications, ensuring the treatment is targeted and effective.

Inflammatory Markers

Inflammation is a core feature of most chronic diseases, including autoimmune disease, cancer, diabetes, cardiovascular disease, and many others. For this reason, it's vital to assess inflammatory markers in the elderly. An Inflammation Panel by Ayumetrix measures two important inflammatory markers.

Cardiovascular Testing

Cardiovascular disease is common among older adults, with over 70% of people over 70 experiencing this condition. When evaluating the elderly, it's vital to include cardiovascular health markers in a health evaluation. The CardioMetabolic test by BostonHeart Diagnostics can evaluate cardiac health and metabolic function in one test.

Micronutrient Testing

Malnutrition is common in the elderly, so it's vital to assess their micronutrient status to identify potential deficiencies or insufficiencies. The Micronutrient Test by SpectraCell Laboratories measures 31 essential nutrients to help practitioners identify and correct imbalances.

Hormone Testing

It's natural and common for hormone changes to occur with age. Hormone testing provides valuable insight into these changes in elderly patients. The DUTCH Plus™ is a simple urine test that seniors can easily collect at home. It offers a comprehensive assessment of sex and adrenal hormones and their metabolites. This particular hormone test can be valuable for seniors experiencing significant stress or suspected dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis, as it includes a test for the Cortisol Awakening Response (CAR). This test is also valuable for seniors with sleep disturbances, as it provides a daily free cortisol rhythm and melatonin measurement, two hormones intricately involved in the body's sleep-wake cycles, and the option to collect a cortisol sample during the night.

In some older adults, when thyroid hormone levels become elevated, it can increase the risk for serious issues, including death from cardiovascular disease.

Blood Workup

Comprehensive blood testing is a well-established way to gain valuable insight into the health of geriatric patients. A blood workup may include CMP, CBC, hemoglobin A1c (HbA1c), insulin, and anemia panel to assess overall health status.

How to Eat Healthy for Senior Citizens 

A well-balanced diet is integral to a healthy lifestyle as you age. Eating a healthy diet can help maintain a healthy weight, muscle mass and strength, and energy levels, and it provides the nutrients needed for optimal health. 

Older adults struggle to stay hydrated and often suffer from malnutrition, making hydration and eating healthy a critical focus. 

Dehydration can negatively impact energy, cognitive function, physical performance, and gastrointestinal, kidney, and heart function. To stay adequately hydrated, the National Council on Aging recommends older adults drink one-third of their body weight in ounces each day. For example, a 150-pound person should drink at least 50 ounces of fluids daily.

A healthy diet for seniors should include nutrient-dense, high-fiber foods and adequate protein, and they should limit or avoid processed foods, trans fats, and sugar. The Mediterranean Diet is an anti-inflammatory nutrition plan that's particularly well-suited for seniors. This style of eating is well-known for its health benefits. It has also been shown to reduce pain levels in older adults, prevent cognitive decline, and prevent the loss of muscle mass and bone density often seen in older adults. 

The anti-inflammatory, nutrient-dense foods that comprise the Mediterranean diet include olive oil, vegetables, fruits, legumes, nuts and seeds, fish, seafood, small amounts of dairy and red meat, and moderate red wine. The Mediterranean diet is a wonderful way for seniors to eat to promote a healthy aging process.

The Best Supplements for Seniors

Decreased appetite and eating poor-quality foods are just a few reasons malnutrition is widespread in seniors. This leads to certain micronutrient deficiencies, common in older people, including Vitamin D3, calcium, zinc, iron, Vitamin B6, Vitamin B12, folate, and magnesium. 

Supplementing with at least 1,000 IU Vitamin D3 daily is the recommended dosage by the American Geriatrics Society. 

The Recommended Dietary Allowance (RDA) for iron for men and women over 50 is 8 mg daily; however, the RDA is the amount needed to prevent disease, not necessarily to achieve optimal levels. For seniors with lab results indicating iron deficiency, a 10 mg iron supplement may be a good starting point when enough iron is not obtained through the diet. Iron bisglycinate is a form of iron that is well absorbed and has fewer gastrointestinal side effects than other forms of iron. It's essential to retest iron status to determine if and when the supplement should be discontinued, as too much iron in the body is unhealthy.

Supplementing with 200 mg/day of magnesium decreases the risk of dementia, and 300 mg/day improves physical performance in older adults, according to this review article. 

Vitamin B6 deficiency is commonly associated with Vitamin B12 and folate deficiencies, so these B vitamins should be taken together in a B-complex formula to reduce the number of pills a patient takes. 

Calcium is best obtained from food sources, such as dark leafy greens, salmon, sardines, black beans, nuts, and seeds. If micronutrient testing indicates low calcium levels and supplementation is necessary, 500 mg of calcium citrate is an acceptable starting point. 

Regarding supplementing with zinc, studies indicate that 25 to 45 mg per day of supplemental zinc provides immune benefits and improves antioxidant status.  

Evidence also indicates taking antioxidants such as carotenoids, Vitamin E, and selenium supports health and prevents chronic diseases that can occur with aging.

Omega-3 supplements are an excellent way to support healthy inflammation levels and promote overall health. The NIH reports adequate intake for Omega-3 fatty acids is 1.6 grams per day for men over 51 and 1.1 grams per day for women over 51. 

Probiotic supplements can be extremely helpful in supporting a healthy microbiome. Seniors should consider probiotic supplements with strains of Lactobacillus and Bifidobacterium strains of good bacteria.

What Vitamins Should I Take Daily?

A high-quality multivitamin and multimineral supplement may contain many nutrients noted in the section above and is an excellent way to pack several vitamins and minerals into one supplement. Multivitamins and multimineral supplements should be taken with food to improve absorption and minimize symptoms such as nausea and stomach ache that some people experience when taking supplements on an empty stomach.

Multivitamins often contain Vitamin D3; however, an additional supplement may be necessary to get the adequate amount needed for optimal Vitamin D3 status.

Daily probiotics, Omega-3 supplements, and antioxidants are a great way to round out a daily vitamin intake that supports optimal health and well-being.

Depending on what your micronutrients and other functional lab testing indicate, your integrative medicine practitioner may recommend additional daily vitamins to support your best health.

Complementary and Alternative Medicine

Seniors can benefit from various complementary and alternative medicine treatments to support their well-being and a healthy aging process. 

Acupuncture, tai chi, aromatherapy, meditation, massage therapy, and music therapy are therapies helpful for palliative care for older adults. 

Yoga, massage, meditation, mindfulness-based stress reduction, acupuncture, spinal manipulation, and physical therapy can help seniors manage pain.

Additional mind-body therapies, including relaxation therapy, mindfulness-based stress reduction, cognitive behavioral therapy (CBT), and abdominal breathing, can promote overall wellness and improve various conditions that older adults struggle with, including memory and mental health. 

Summary

Integrative geriatric medicine is a type of medicine dedicated to supporting the health and well-being of older adults. This care utilizes a patient-centered, whole-person approach emphasizing the therapeutic relationship, identifying a root cause for the patient's complaint, and employing lifestyle modifications and non-pharmacologic treatments.

An integrative medicine approach to care for seniors includes diet and lifestyle modifications to support their unique needs and avoid common issues in the elderly such as malnutrition, dehydration, and loss of muscle mass. 

If you are a senior looking for a holistic approach to your care to support your health and well-being, talk to your integrative medicine practitioner to get started on a path toward healthy aging.