Abstract
Integrative Geriatric Medicine, edited by Dr. Mikhail Kogan, compiles valuable insights into the numerous behaviors, interventions, conditions, and care settings that play important roles in older adult well-being, yet do not solely abide by the biomedical model of health. As noted in the foreword by Dr. Andrew Weil, integrative medicine “addresses the whole person (body, mind, spirit, community member)” (p. x). This text succeeds in orienting the reader to the many approaches for addressing older adult health. The main audience for Integrative Geriatric Medicine is the health care provider. However, it is an informative reference for any professional who cares or advocates for elders. Importantly, the book does not set out to convince readers to employ alternative or complementary approaches; rather, it assembles considerable evidence, notes gaps or limitations in the current research base, and encourages the reader to appreciate the possibilities of care outside of conventional Western medicine. This practical approach makes the material accessible from start to finish.
Together, the chapters of Integrative Geriatric Medicine provide a handheld survey course, serving as an extensive primer on less traditional modes of promoting the health of older adults. The book is loosely organized into four broad sections. The first section covers “lifestyle aspects” of health—including nutrition, exercise, and the mind–body connection—and applies them to aging and older adulthood. The second reviews “alternative” methods or modalities of promoting health and wellness later in life. The third outlines the ways in which common geriatric medical conditions may be addressed using integrative approaches. The fourth section discusses the various settings and unique considerations for caring for older adults. On the whole, chapters are not ordered in a particular pattern, and the strength of linkages between them varies. However, each chapter on its own clearly introduces and packages diverse material relating to its central topic. The authors include case studies and references for further reading, which help to underscore the multifaceted nature of aging.
The first several chapters describe important behaviors that can promote health among older adults. Health care providers will likely find these chapters especially helpful when considering prescriptions of lifestyle interventions for preventive or therapeutic goals. The nutrition chapter provides overviews of food sources of various nutrients, nutrition assessment tools, and common therapeutic diets and applies them to the unique nutritional aspects of older age. The exercise chapter describes critical exercise physiology concepts and the benefits of exercise on an aging body. Authors of the spirituality and mind–body chapter outline ways in which spirituality intersects with aging and note the promise of mindfulness practices to improve well-being. Importantly, this chapter also discusses actions that the clinician can take to incorporate the older patient’s spiritual values and/or concerns into their care. Along with the section on preventive geriatrics, these chapters emphasize the importance of tailoring lifestyle recommendations to older adults, both as a population and as individuals. Together, they contribute to a whole-person approach to geriatrics.
The second grouping of chapters addresses alternative methods of treating conditions and preserving wellness. These practices range from the well known, such as osteopathy and acupuncture, to the less familiar, such as reiki (a form of energy therapy) and aromatherapy. The chapters describe the various modalities, discuss how they may apply to older adults, summarize existing research on their known effects, and offer information on the professionals that provide these types of care. Although the depth of information varies, the chapters provide insights into literature gaps or controversies associated with these alternative care methods. The authors are careful not to discount practices that do not offer curative effects or whose efficacy is less understood simply because they do not lend themselves to standard study methods (e.g., double-blind randomized control trials). To paraphrase one of the chapters, health care providers ought to have a basic appreciation for alternative modalities—even if they question their value—in order to be informed practitioners and provide person-centered care. Given the considerable population that engages in therapies outside of conventional Western medicine and the relief that many elders get from these practices, it behooves any health care provider to understand what they are, their associated benefits and risks, and how they may be integrated into patient care.
The next set of chapters discusses how integrative medicine can be leveraged for conditions and disorders common among older adults. Although this section includes chapters dedicated to overall men’s health and women’s health, it is largely organized by organ systems. As Dr. Kogan notes in his introduction, the integrative health perspective typically discourages focusing on one organ system at a time (p.8); however, this alignment with other medical teachings can help practitioners and students home in on particular areas of interest or patient need. Chapters in this section include case studies, descriptions of common conditions and pathologies, and applications of lifestyle interventions or alternative modalities associated with the focal organ system. Several chapters present detailed descriptions of nutritional supplements and other approaches that may work in conjunction with biomedical therapies. Authors explain how, in some cases, alternative methods can offset side effects of conventional therapies or replace them entirely (while noting critical caveats that the literature for some modalities remains mixed or insufficient). The integrative oncology chapter highlights the importance of identifying an integrative specialist who can aptly weigh the risks and benefits of these interventions while considering the patient’s circumstances and preferences. Overall, these chapters demonstrate the wide range of medical conditions that may benefit from integrative approaches; such diversity speaks volumes about the value of this perspective in medicine.
The latter chapters discuss various settings for—and perspectives on— aging and elder care and they provide insight into how integrative care can be applied in practice. Chapters addressing home care, long-term care, integrative palliative care, and care received through the Veterans Affairs system underscore the diversity of needs and preferences within the older population. Although some care settings are dictated by level of need, these chapters remind the reader that there are multiple options (e.g., residential and nonresidential, medical and nonmedical services) for older adults and their families to consider for obtaining care that is both appropriate and acceptable. For example, becoming whole (p. 523), rather than becoming well, can be a suitable goal for some older adults; having open and honest discussions about what that could look like is vital for providing informed and compassionate care. Although a broad spectrum of elder care exists, navigating health care and social service systems in the United States remains difficult for many. Integrative Geriatric Medicine offers an important foundation for understanding the range of services available, but providers and caregivers alike will likely require additional sources of information to assist older adults in accessing such care. Accordingly, some authors in this later section provide recommendations for supplementary reading. Further sections address team-based approaches to integrative geriatrics and the ethical considerations of incorporating alternative methods into patient care. These chapters highlight the complexity of applying integrative medicine in practice and the importance of educating providers, caregivers, and patients on what is known and unknown about alternative care methods. It is clear from this section that decisions on care appropriateness and acceptability are best made when they are shared. Only when an individual’s values, fears, and goals are considered along with their health status can care truly become person-centered.
Integrative Geriatric Medicine provides a critical understanding of the current evidence base and application of integrative approaches to elder care. It is a fitting member of Dr. Weil’s Integrative book series, and a valuable source of information to be referenced time and time again.