Transcript of Introduction and General use Wadie Najm, MD, MEd.
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- Introduction and General use Wadie Najm, MD, MEd
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- 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 UC Irvine-
Reynolds Grant2
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- 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. US Census Bureau 3 UC Irvine-
Reynolds Grant
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- US Census Bureau 199 0 202 5 205 0 Age % Male % Female 4 UC
Irvine- Reynolds Grant
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- U.S. Administration on Aging 5 UC Irvine- Reynolds Grant
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- 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 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 UC Irvine- Reynolds Grant9
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- 10 CDC, National Center for Health Statistics, National Health
Interview Survey, 2006.
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- UC Irvine- Reynolds Grant 11 www.ahrq.govwww.ahrq.gov 2006
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- UC Irvine- Reynolds Grant 12 www.ahrq.govwww.ahrq.gov 2006
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- 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%) Literature10 (9%) Practice
it/involved with it 10 (9%) 18 Artus et al. BMC Family Practice
2007 8:26 doi:10.1186/1471-2296-8-26 UC Irvine- Reynolds Grant
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- The number of supplements taken by U.S. adult supplement users,
NHANES, 20032006, n = 9132. Bailey R L et al. J. Nutr.
2011;141:261-266 30 UC Irvine- Reynolds Grant
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- The prevalence of use of dietary supplements among U.S. adults
20 y by weight status, educational attainment, and race/ethnic
group, NHANES 20032006. Bailey R L et al. J. Nutr. 2011;141:261-266
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- 525 community-residing elderly completed a 7-page questionnaire
during a personal interview Questionnaires were done in the persons
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. UC Irvine- Reynolds Grant32
Altern Ther Health Med.Altern Ther Health Med. 2003
May-Jun;9(3):50-7.
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- UC Irvine- Reynolds Grant33 Altern Ther Health Med.Altern Ther
Health Med. 2003 May-Jun;9(3):50-7.
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- UC Irvine- Reynolds Grant34 Altern Ther Health Med.Altern Ther
Health Med. 2003 May-Jun;9(3):50-7.
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- 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. J ALTERN COMPLEM MED 2011,
17(6):487489 35 UC Irvine- Reynolds Grant
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- 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
Grant36
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- UC Irvine- Reynolds Grant J ALTERN COMPLEM MED 2011,
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- UC Irvine- Reynolds Grant J ALTERN COMPLEM MED 2011,
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- 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 Alzheimers disease- in older adults (75+; Age range
was 75 -79) At baseline, participants self-identified race: 95%
White, 3% B lack, 1% Asian, 1% O ther; 1.2% Hispanics UC Irvine-
Reynolds Grant39
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- 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%).
UC Irvine- Reynolds Grant 42 Ethn Dis 2006;16:723-731
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- UC Irvine- Reynolds Grant 43 Ethn Dis 2006;16:723-731
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- UC Irvine- Reynolds Grant 44 Ethn Dis 2006;16:723-731
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- 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 UC
Irvine-Reynolds Grant Loera J et al. 2007;13:224-231
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- 153 Chinese-American (NY) Self-administered questionnaires and
chart review. Mean Age: 44.816.2 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.
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Grant
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- 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. UC Irvine- Reynolds Grant 47
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- 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 UC
Irvine-Reynolds Grant
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- 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 Furler M, Abstract presented at CAHR
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- UC Irvine- Reynolds Grant 50 Saxe GA Integr Cancer Ther.
2008Integr Cancer Ther. 2008
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- UC Irvine- Reynolds Grant 52 Int Med 1998; 1(4)
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- UC Irvine- Reynolds Grant 53 Int Med 1998; 1(4)
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- A high number of older adults are using CAM People with chronic
health conditions and functional limitations might be higher users
of CAM Use of CAM is prevalent among all ethnic groups and ages.
Physicians need to educate themselves about CAM modalities and the
science Physicians need to ask patients about CAM use and help
guide them in their choices. UC Irvine- Reynolds Grant 55
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- National Center for Complementary and Alternative Medicine:
http://nccam.nih.gov/ http://nccam.nih.gov/ Dietary Supplements -
Adverse Event Reporting
http://www.fda.gov/Food/DietarySupplements/Alerts/ucm111110.htm
http://www.fda.gov/Food/DietarySupplements/Alerts/ucm111110.htm
National Cancer Institiute- CAM
http://www.cancer.gov/cancertopics/cam
http://www.cancer.gov/cancertopics/cam Office of Dietary Supplement
http://ods.od.nih.gov/http://ods.od.nih.gov/ The Cochrane Database
of Systematic Reviews http://www.cochrane.org/
http://www.cochrane.org/ Computer Access to Research on Dietary
Supplements (CARDS) Database
http://ods.od.nih.gov/Research/CARDS_Database.aspx
http://ods.od.nih.gov/Research/CARDS_Database.aspx UC Irvine-
Reynolds Grant 56
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- Natural Standard
http://naturalstandard.com/http://naturalstandard.com/ Natural
Medicine Comprehensive database
http://naturaldatabase.therapeuticresearch.com/home.aspx
http://naturaldatabase.therapeuticresearch.com/home.aspx American
Botanical Council (ABC)
http://abc.herbalgram.org/site/http://abc.herbalgram.org/site/
American Holistic Medical Association (AHMA)
http://www.holisticmedicine.org/http://www.holisticmedicine.org/
Bravewell Collaborative for Integrative Medicine
http://www.bravewell.org/http://www.bravewell.org/ Consortium of
Academic Health Centers for Integrative Medicine (CAHCIM)
http://www.imconsortium.org/ http://www.imconsortium.org/ UC
Irvine- Reynolds Grant 57