Geriatric uses for Natural Medicines

Natural Medicine	Indications and Ratings	Safety Concerns	Dosing/Administration
Supplement
Acetyl-L-carnitine	POSSIBLY EFFECTIVE for… Age-related cognitive impairment	Theoretical potentiation of warfarin.^9878,12165 Might increase acetylcholine levels and interfere with anticholinergic drugs or increase adverse effects when used with cholinergic drugs.^{2437,8857,8858}	1.5 to 2 grams by mouth daily for three months.^3600,3601
Caffeine	POSSIBLY EFFECTIVE for… Age-related cognitive impairment	Intake of >400 mg caffeine might worsen symptoms of urinary incontinence.³⁶³⁸²	~175 to 375 mg daily.^91088,97458
Calcium	INSUFFICIENT RELIABLE EVIDENCE to RATE for… Fall prevention	Well tolerated in appropriate doses.	There is not enough reliable scientific evidence to recommend a dose that might have benefit. Continue recommending that patients get the daily recommended amount of calcium.
Vitamin D	INSUFFICIENT RELIABLE EVIDENCE to RATE for… Fall prevention	Well tolerated in appropriate doses.	There is not enough reliable scientific evidence to recommend a dose that might have benefit. Continue recommending that patients get the daily recommended amount of vitamin D.
Citicoline	POSSIBLY EFFECTIVE for… Age-related cognitive impairment	Might increase acetylcholine levels and either interfere with anticholinergic drugs or increase adverse effects when used with cholinergic drugs.^{2437,8857,8858}	1 to 2 grams daily for up to 90 days.¹²¹³⁰
Creatine	POSSIBLY EFFECTIVE for… Age-related muscle loss	Avoid in patients with reduced renal function or conditions like diabetes.⁴⁵⁷⁶	20 grams daily for 5-7 days (loading dose), followed by 2-10 grams daily (maintenance dose) for up to 2 weeks has been used along with resistance training.
Fish oil	INSUFFICIENT RELIABLE EVIDENCE to RATE for… Age-related muscle loss	Well-tolerated at doses of 2-3 grams daily.^89368,98244	There is not enough reliable scientific evidence to recommend a dose that might have benefit.
Ginkgo	POSSIBLY INEFFECTIVE for… Age-related cognitive impairment	Might increase bleeding risk if used with warfarin.⁹¹³²⁶	There is not enough reliable scientific evidence to recommend a dose that might have benefit.
Hydroxymethylbutyrate (HMB)	POSSIBLY EFFECTIVE for… Age-related muscle loss	Well tolerated in elderly patients.⁹⁶⁶⁴⁴	Calcium-HMB up to 3 grams daily for up to 24 weeks.⁹⁶⁶⁴⁵
Phosphatidylserine	POSSIBLY EFFECTIVE for… Age-related cognitive impairment	600 mg or more might increase risk of insomnia.⁷¹²¹ Might increase acetylcholine levels and either interfere with anticholinergic drugs or increase adverse effects when used with cholinergic drugs.^{2437,8857,8858}	100 mg from plant and bovine sources three times daily for up to six months.^{2440,2441,15539}
Whey protein	INSUFFICIENT RELIABLE EVIDENCE to RATE for… Age-related muscle loss	Whey protein is tolerated well, however higher doses (2.3 to 6.5 grams/kg) can cause gastrointestinal issues like diarrhea, nausea, and bloating.^{2640,85961,85702}	There is not enough reliable scientific evidence to recommend a dose that might have benefit.
Health and Wellness Modality
Alexander technique	INSUFFICIENT RELIABLE EVIDENCE to RATE for… Fall prevention	No known safety concerns when practiced appropriately.	There is not enough reliable scientific evidence to recommend a regimen that might have benefit.
Music therapy	INSUFFICIENT RELIABLE EVIDENCE to RATE for… Age-related cognitive impairment	No known safety concerns when practiced appropriately.	There is not enough reliable scientific evidence to recommend a regimen that might have benefit.
Pilates	POSSIBLY EFFECTIVE for… Fall prevention	No known safety concerns when practiced appropriately.	One hour two to three times weekly for up to 12 weeks.^93909,99464
Physical therapy	POSSIBLY EFFECTIVE for… Fall prevention	No known safety concerns when practiced appropriately.	Sustained practice at home is necessary to maintain reduced fall risk.⁹³⁹¹⁸
Tai chi	POSSIBLY EFFECTIVE for… Fall prevention	No known safety concerns when practiced appropriately.	Three times weekly practice seems to be more beneficial than once weekly. Yang style tai chi seems to work better than Sun style tai chi.⁹⁴¹⁶¹ Tai Ji Quan Moving for Better Balance; (TJQMBB) one hour twice weekly has also shown benefit.⁹⁸⁰⁰⁰

REFERENCES

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12130	Spiers PA, Myers D, Hochanadel GS, et al. Citicoline improves verbal memory in aging. Arch Neurol 1996;53:441-8.
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28837	Remington, R. Calming music and hand massage with agitated elderly. Nurs.Res. 2002;51(5):317-323.
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85702	Micke, P., Beeh, K. M., and Buhl, R. Effects of long-term supplementation with whey proteins on plasma glutathione levels of HIV-infected patients. Eur.J Nutr 2002;41(1):12-18.
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91326	Stoddard GJ, Archer M, Shane-McWhorter L, Bray BE, Redd DF, Proulx J, Zeng-Treitler Q. Ginkgo and Warfarin Interaction in a Large Veterans Administration Population. AMIA Annu Symp Proc. 2015 Nov 5;2015:1174-83.
93909	Irez GB, Ozdemir RA, Evin R, Irez SG, Korkusuz F. Integrating pilates exercise into an exercise program for 65+ year-old women to reduce falls. J Sports Sci Med. 2011 Mar 1;10(1):105-11. eCollection 2011.
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94161	Huang ZG1, Feng YH2, Li YH1, Lv CS1. Systematic review and meta-analysis: Tai Chi for preventing falls in older adults. BMJ Open. 2017;7(2):e013661.
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96645	Wu H, Xia Y, Jiang J, et al. Effect of beta-hydroxy-beta-methylbutyrate supplementation on muscle loss in older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr 2015;61(2):168-75.
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98000	Li F, Harmer P, Fitzgerald K, et al. Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling: A Randomized Clinical Trial. JAMA Intern Med. 2018;178(10):1301-10. doi: 10.1001/jamainternmed.2018.3915.
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Geriatric uses for Natural Medicines

Natural Medicine

Indications and Ratings

Safety Concerns

Dosing/Administration

Supplement

Health and Wellness Modality