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June, 2014

Targeting a Specific Practice Population: Supporting Our Elders

By Tina Beaudoin, ND

What is it like to grow old? It is different for everyone and it is no surprise that how you lived the first 50 years will dramatically influence your golden years. Typically, most systems function less optimally; we see decreased digestive, immune, endocrine and cognitive function. However, aging varies considerably depending on lifestyle and nutrition and it is never too late to make some changes or add some supportive measures. If you are looking to develop a specialized practice focused on an aging population, here are some things to think about as you look to potentially develop this type of practice.

elders - Copyright – Stock Photo / Register Mark Exercise

I attended my first sprint triathlon last year as I thought it would be a good gauge to monitor my physical health on an annual basis. To my delight, there were people from every age category from 14 to 74 years of age. They give trophies to each age group and I clapped loudly for the last category when they gave trophies to three women in their 70's.

We know that exercise increases our metabolism and cognition, decreases our risk of stroke, heart attack and the development of many cancers. It is not surprising that research has shown that regular moderate exercise can help support the aging immune system. One study found that men over 60 years of age who engaged in regular exercise had significantly increased concentrations of NK-cells and a slower decline in neutrophilic phagocytosis activity than their sedentary counterparts. Since over one-third of Americans do not exercise at all, this represents an area of tremendous opportunity to improve the health of your patients. Be sure to start with recommendations that are appropriate for one's level of current function. Exercise is possible at all ages and can help protect our elders from the aggregate challenges we face with aging.

Omega 3's

Educating your patients about the fine points of supplementation is important. DHA and EPA are the omega-3 fatty acids in the spotlight when it comes to health benefits. One of the central benefits of omega-3's is that they support healthy inflammatory responses. Arthritis, diabetes, cancer and cardiovascular disease are some of the common diseases associated with chronic inflammation. An important consideration when selecting a fish oil supplement is dosage. You wouldn't take a sip of water and expect all the benefits that come with being well hydrated. There is significant variation in the amount of milligrams of EPA and DHA that you find in stores. A good rule to follow when seeking the benefits of fish oil is to make sure there are 1,000 milligrams combined of EPA and DHA per serving. Don't be fooled! There are many products that advertise 1,000 mg on the front of the bottle but when you read the label you will find that it has only 100 milligrams of EPA and DHA. When it comes to fish oil, you really are getting what you pay for and be sure to read labels and purchase products free of contaminants.

Probiotics

When I was growing up, we never heard about probiotics, let alone saw them mentioned in TV commercials, but now it is commonplace jargon and with good reason. Fortunately, we now have greater understanding of the importance and breadth of our digestive flora. Probiotics offer a variety of benefits: aiding in digestion and absorption of food, cholesterol metabolism and immune system function. A recent study among hospitalized elderly patients found that probiotic administration significantly reduced the need for laxatives and lowered the incidence of diarrhea. Constipation promotes re-absorption of waste materials and toxins. This study illustrates how probiotic supplementation can support immune function by decreasing total body burden caused by sluggish bowels, a common complaint in the geriatric population. Probiotics provide a variety of health benefits and offer another option to consider when looking for ways to support the aging immune system.

Drug-Induced Nutrient Depletions

It is incredible to digest the statistic that 48.5% of Americans reported using at least one prescription in the past month, but that is nothing next to the stats on elders prescription medication use. The NHANES study found that 9 out of 10 older Americans reported using at least one prescription drug while a third reported taking five or more prescription drugs. One in three elders takes five or more prescriptions on a daily basis! In addition, the data tells us that these numbers rise every year. Cholesterol lowering medications are the most commonly prescribed drugs in adults aged 60 and older. Beta-blockers and diuretics trail statin medications as the most popular elder prescriptions.

As it is highly likely that your elder patients are taking a statin or hypertensive medication, it is important to know the common drug-induced nutrient depletions that can occur with these medications. HMG-CoA reductase inhibitors (statins) impede cholesterol synthesis by blocking the conversion of HGM-CoA to mevalonic acid, which in turn also inhibits CoQ10 production. Put on your biochemistry helmets and recall the electron transport chain (ETC) and the essential role that CoQ10 plays in our mitochondria to produce ATP, the energy currency of our cells. Which cells in our bodies have an increased density of mitochondria because they are very hard-working cells? You guessed it, cardiac myocytes!

Not surprisingly, myopathy is one of the most common side effects for patients taking statin medication. In the American Journal of Cardiodiology, a randomized control trial was published of adults on statins with myopathic pain found that oral doses of 100mg of CoQ10 had a 40% reduction in pain severity after just 30 days. If a patient is on a statin medication, supplementing with CoQ10 is necessary to replete this important compound. Antihypertensive medications can result in a wide variety of nutrient deficiencies and it is dependent on the class of medication. For example, certain ACE-inhibitors are associated with lower levels of zinc, whereas potassium sparing diuretics may result in lower levels of calcium, folate and zinc. Encouraging a nutrient rich diet, monitoring for signs of nutrient deficiencies and repleting accordingly should be part of the protocol for every elder patient.

There are a variety of ways to support your elder patients. Helping seniors develop safe and effective exercise plans should be central to your treatment plans. Robust digestive flora is another great way to support digestion and immune function. Be sure to be on watch for any potential nutrient deficiencies and address as needed. These recommendations are fundamental to support aging and also central to enhancing the quality of life for our elders.


Dr. Beaudoin is a medical educator for Emerson Ecologics, a distributor of professional nutritional supplements to healthcare practitioners. She also enjoys maintaining a naturopathic family practice and is the president of the New Hampshire Association of Naturopathic Doctors. She can be reached at .

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