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117-461: Geriatrics , or geriatric medicine , is a medical specialty focused on providing care for the unique health needs of the elderly . The term geriatrics originates from the Greek γέρων geron meaning "old man", and ιατρός iatros meaning "healer". It aims to promote health by preventing , diagnosing and treating disease in older adults . There is no defined age at which patients may be under

234-549: A 'dietary supplement', though the FDA may withdraw a product from sale should it prove harmful. Canadian regulations are described by the Natural and Non-prescription Health Products Directorate which requires an eight-digit Natural Product Number or Homeopathic Medicine Number on the label of licensed herbal medicines or dietary supplements. Some herbs, such as cannabis and coca , are outright banned in most countries though coca

351-507: A 2018 study, the FDA identified active pharmaceutical additives in over 700 analyzed dietary supplements sold as "herbal", "natural" or "traditional". The undisclosed additives included "unapproved antidepressants and designer steroids", as well as prescription drugs , such as sildenafil or sibutramine . Researchers at the University of Adelaide found in 2014 that almost 20 percent of herbal remedies surveyed were not registered with

468-503: A basis as herbal remedies, including artemisinin , digitalis , quinine and taxanes . In 2015, the Australian Government's Department of Health published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by health insurance ; herbalism was one of 17 topics evaluated for which no clear evidence of effectiveness was found. Establishing guidelines to assess

585-1285: A combination of physiologic, pathologic, psychologic and socioeconomic factors, it can be difficult to identify effective interventions. Physiologic factors include reduced smell and taste, and a decreased metabolic rate affecting nutritional food intake. Unintentional weight loss can result from pathologic factors, including a wide range of chronic diseases that affect cognitive function, directly impact digestion (e.g. poor dentition, gastrointestinal cancers , gastroesophageal reflux disease) or may be managed with dietary restrictions (e.g. congestive heart failure, diabetes mellitus, hypertension ). Psychologic factors include conditions including depression, anorexia, and grief. Functional abilities, independence and quality of life issues are of great concern to geriatricians and their patients. Elderly people generally want to live independently as long as possible, which requires them to be able to engage in self-care and other activities of daily living . A geriatrician may be able to provide information about elder care options, and refers people to home care services, skilled nursing facilities , assisted living facilities , and hospice as appropriate. Frail elderly people may choose to decline some kinds of medical care, because

702-528: A community, including cooking, housekeeping, managing one's finances and medications. Routine monitoring of ADL and IADL is an important functional assessment used by clinicians to determine the extent of support and care to provide to elderly adults and their caregivers. It serves as a qualitative measurement of function over time and predicts the need for alternative living arrangements or models of care, including senior housing apartments, skilled nursing facilities, palliative, hospice or home-based care. Falls are

819-455: A condition marked by serious mental and physical debilitation. Therefore, rather than lumping together all people who have been defined as old, some gerontologists have recognized the diversity of old age by defining sub-groups. One study distinguishes the young-old (60 to 69), the middle-old (70 to 79), and the very old (80+). Another study's sub-grouping is young-old (65 to 74), middle-old (75 to 84), and oldest-old (85+). A third sub-grouping

936-1004: A consensus was reached on minimum competencies (learning outcomes) that graduating medical students needed to assure competent care by new interns to older patients. Twenty-six (26) Minimum Geriatric Competencies in eight content domains were endorsed by the American Geriatrics Society (AGS), the American Medical Association (AMA), and the Association of Directors of Geriatric Academic Programs (ADGAP). The domains are: cognitive and behavioral disorders; medication management; self-care capacity; falls, balance, gait disorders; atypical presentation of disease; palliative care; hospital care for elders, and health care planning and promotion. Each content domain specifies three or more observable, measurable competencies. Changes in physiology with aging may alter

1053-416: A continuity of self-concept. In their interviews, Johnson and Barer found that 24% of the 85+ had no face-to-face family relationships; many have outlived their families. Second, that contrary to popular notions, the interviews revealed that the reduced activity and socializing of the over-85s does not harm their well-being; they "welcome increased detachment". Third, rather than a continuity of self-concept, as

1170-465: A customer should inform a herbalist of their consumption of actual prescription and other medication. For example, dangerously low blood pressure may result from the combination of a herbal remedy that lowers blood pressure together with prescription medicine that has the same effect. Some herbs may amplify the effects of anticoagulants. Certain herbs as well as common fruit interfere with cytochrome P450, an enzyme critical to much drug metabolism. In

1287-503: A fifth dimension: developmental. Chronological age may differ considerably from a person's functional age. The distinguishing marks of old age normally occur in all five senses at different times and at different rates for different people. In addition to chronological age, people can be considered old because of the other dimensions of old age. For example, people may be considered old when they become grandparents or when they begin to do less or different work in retirement. Senior citizen

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1404-631: A herb that was known in Chinese medicine to treat fever. There is limited scientific evidence for the safety and efficacy of many plants used in 21st-century herbalism, which generally does not provide standards for purity or dosage. The scope of herbal medicine sometimes includes fungal and bee products, as well as minerals , shells and certain animal parts. Paraherbalism describes alternative and pseudoscientific practices of using unrefined plant or animal extracts as unproven medicines or health-promoting agents. Paraherbalism relies on

1521-500: A long and colorful history in Europe, associated with "sorcery", "magic" and intrigue. Although not frequent, adverse reactions have been reported for herbs in widespread use. On occasion serious untoward outcomes have been linked to herb consumption. A case of major potassium depletion has been attributed to chronic licorice ingestion, and consequently professional herbalists avoid the use of licorice where they recognize that this may be

1638-410: A lower ethanol percentage than tinctures. They are usually made by vacuum distilling tinctures. Dry extracts are extracts of plant material that are evaporated into a dry mass. They can then be further refined to a capsule or tablet. The exact composition of a herbal product is influenced by the method of extraction. A tea will be rich in polar components because water is a polar solvent . Oil on

1755-442: A medication schedule was reported by a striking one-third of the participants. Further development of methods that might possibly help monitor and regulate dosage administration and scheduling is an area that deserves attention. Another important area is the potential for improper administration and use of potentially inappropriate medications, and the possibility of errors that could result in dangerous drug interactions. Polypharmacy

1872-506: A mixture of pure ethanol with water) with the herb. A completed tincture has an ethanol percentage of at least 25% (sometimes up to 90%). Non-alcoholic tinctures can be made with glycerin but it is believed to be less absorbed by the body than alcohol based tinctures and has a shorter shelf life. Herbal wine and elixirs are alcoholic extracts of herbs, usually with an ethanol percentage of 12–38%. Extracts include liquid extracts, dry extracts, and nebulisates. Liquid extracts are liquids with

1989-403: A pioneering study of Life Beyond 85 Years by interviews over a six-year period. In talking with 85-year-olds and older, they found some popular conceptions about old age to be erroneous. Such erroneous conceptions include (1) people in old age have at least one family member for support, (2) old age well-being requires social activity, and (3) "successful adaptation" to age-related changes demands

2106-407: A pleasant time; children are grown, work is over, and there is time to pursue other interests. Many old people are also willing to get involved in community and activist organizations to promote their well-being. In contrast, perceptions of old age by writers 80+ years old tend to be negative. Georges Minois  [ Wikidata ] writes that the first man known to talk about his old age

2223-425: A risk. Black cohosh has been implicated in a case of liver failure. Few studies are available on the safety of herbs for pregnant women, and one study found that use of complementary and alternative medicines is associated with a 30% lower ongoing pregnancy and live birth rate during fertility treatment. Examples of herbal treatments with likely cause-effect relationships with adverse events include aconite (which

2340-664: A special " senior discount card " or other proof of age needs to be produced to show entitlement. In the United States , the standard retirement age is currently 66 (gradually increasing to 67). The AARP allows couples in which one spouse has reached the age of 50 to join, regardless of the age of the other spouse. In Canada , the Old Age Security (OAS) pension is available at 65 (the Conservative government of Stephen Harper had planned to gradually increase

2457-640: A specific profession of herb mixer and combiner (herbalist), called Acaraki . The book from Mataram dated from circa 1700 contains 3,000 entries of jamu herbal recipes, while Javanese classical literature Serat Centhini (1814) describes some jamu herbal concoction recipes. Though possibly influenced by Indian Ayurveda systems, the Indonesia archipelago holds numerous indigenous plants not found in India, including plants similar to those in Australia beyond

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2574-551: A topical. Salves , oils, balms , creams, and lotions are other forms of topical delivery mechanisms. Most topical applications are oil extractions of herbs. Taking a food grade oil and soaking herbs in it for anywhere from weeks to months allows certain phytochemicals to be extracted into the oil. This oil can then be made into salves, creams, lotions, or simply used as an oil for topical application. Many massage oils, antibacterial salves, and wound healing compounds are made this way. Inhalation , as in aromatherapy , can be used as

2691-558: A traditional Chinese treatment for intermittent fevers. In India, Ayurvedic medicine has quite complex formulas with 30 or more ingredients, including a sizable number of ingredients that have undergone " alchemical processing ", chosen to balance dosha . In Ladakh, Lahul-Spiti, and Tibet, the Tibetan Medical System is prevalent, also called the "Amichi Medical System". Over 337 species of medicinal plants have been documented by C.P. Kala . Those are used by Amchis,

2808-402: A treatment. It is a popular misconception that herbal medicines are safe and side-effect free. Consumption of herbs may cause adverse effects . Furthermore, "adulteration, inappropriate formulation, or lack of understanding of plant and drug interactions have led to adverse reactions that are sometimes life threatening or lethal." Proper double-blind clinical trials are needed to determine

2925-465: A vis Old". Blind Spot: Hidden Biases of Good People , a book about the test, reports that 80% of Americans have an "automatic preference for the young over old" and that attitude is true worldwide. The young are "consistent in their negative attitude" toward the old. Ageism documents that Americans generally have "little tolerance for older persons and very few reservations about harboring negative attitudes" about them. Despite its prevalence, ageism

3042-438: Is a conspiracy to suppress safe and effective herbs, herbs cannot cause harm, whole herbs are more effective than molecules isolated from the plants, herbs are superior to drugs, the doctrine of signatures (the belief that the shape of the plant indicates its function) is valid, dilution of substances increases their potency (a doctrine of the pseudoscience of homeopathy ), astrological alignments are significant, animal testing

3159-734: Is a common euphemism for an old person used in American English , and sometimes in British English . It implies that the person being referred to is retired. This in turn usually implies that the person is over the retirement age , which varies according to country. Synonyms include old age pensioner or pensioner in British English, and retiree and senior in American English. Some dictionaries describe widespread use of "senior citizen" for people over

3276-447: Is a distinction between geriatrics and gerontology . Gerontology is the multidisciplinary study of the aging process, defined as the decline in organ function over time in the absence of injury, illness, environmental risks or behavioral risk factors. However, geriatrics is sometimes called medical gerontology . Geriatric providers receive specialized training in caring for elderly patients and promoting healthy aging. The care provided

3393-642: Is associated with an acquired difficulty in performing basic everyday tasks resulting in an increased dependence of other individuals and/or medical devices. These tasks are sub-divided into basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and are commonly used as an indicator of a person's functional status. Activities of daily living (ADL) are fundamental skills needed to care for oneself, including feeding, personal hygiene, toileting, transferring and ambulating. Instrumental activities of daily living (IADL) describe more complex skills needed to allow oneself to live independently in

3510-546: Is banned in the European Union), St. John's wort , khat , betel nut , the restricted herb ephedra , and guarana . There is also concern with respect to the numerous well-established interactions of herbs and drugs. In consultation with a physician, usage of herbal remedies should be clarified, as some herbal remedies have the potential to cause adverse drug interactions when used in combination with various prescription and over-the-counter pharmaceuticals, just as

3627-650: Is bewildered: They refuse to follow her advice, they are obsessed with the past, they avoid risk, and they live at a "glacial pace". In her The Denial of Aging , Dr. Muriel R. Gillick, a baby boomer , accuses her contemporaries of believing that by proper exercise and diet they can avoid the scourges of old age and proceed from middle age to death. Studies find that many people in the 65–84 range can postpone morbidity by practicing healthy lifestyles. However, at about age 85, most people experience similar morbidity. Even with healthy lifestyles, most 85+ people will undergo extended "frailty and disability". Early old age can be

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3744-458: Is common for elderly adults to be managing multiple medical conditions, or, multi-morbidity. Age-associated changes in physiology drive a compounded increase in susceptibility to illness, disease-associated morbidity, and death. Furthermore, common diseases may present atypically in elderly patients, adding further diagnostic and therapeutical complexity in patient care. Geriatrics is highly interdisciplinary consisting of specialty providers from

3861-563: Is context-sensitive. The United Nations, for example, considers old age to be 60 years or older. In contrast, a 2001 joint report by the U.S. National Institute on Aging and the World Health Organization [WHO] Regional Office for Africa set the beginning of old age in Sub-Saharan Africa at 50. This lower threshold stems primarily from a different way of thinking about old age in developing nations. Unlike in

3978-719: Is forgetful and cannot recall yesterday. The bone suffers old age. Good is become evil. All taste is gone. What old age does to men is evil in every respect. Minois comments that the scribe's "cry shows that nothing has changed in the drama of decrepitude between the age of the Pharaoh and the atomic age" and "expresses all the anguish of old people in the past and the present". Lillian Rubin , active in her 80s as an author, sociologist, and psychotherapist, opens her book 60 on Up: The Truth about Aging in America with "getting old sucks. It always has, it always will." Dr. Rubin contrasts

4095-464: Is happening to them, whether this is due to long-term dementia or to a short-term, correctable problem, such as delirium from a fever. Geriatricians must respect the patients' privacy while seeing that they receive appropriate and necessary services. More than most specialties, they must consider whether the patient has the legal responsibility and competence to understand the facts and make decisions. They must support informed consent and resist

4212-446: Is informed by these age-related changes. Geriatric syndromes is a term used to describe a group of clinical conditions that are highly prevalent in elderly people. These syndromes are not caused by specific pathology or disease, rather, are a manifestation of multifactorial conditions affecting several organ systems. Common conditions include frailty, functional decline, falls, loss in continence and malnutrition, amongst others. Frailty

4329-647: Is legal in most of the South American countries where it is grown. The Cannabis plant is used as a herbal medicine , and as such is legal in some parts of the world. Since 2004, the sales of ephedra as a dietary supplement is prohibited in the United States by the FDA, and subject to Schedule III restrictions in the United Kingdom. Herbalism has been criticized as a potential " minefield " of unreliable product quality, safety hazards, and

4446-439: Is marked by a decline in physiological reserve, increased vulnerability to physiological and emotional stressors, and loss of function. This may present as progressive and unintentional weight loss, fatigue, muscular weakness and decreased mobility. It is associated with increased injuries, hospitalization and adverse clinical outcomes. Functional disability can arise from a decline in physical function and/or cognitive function. It

4563-522: Is not appropriate to indicate human effects, anecdotal evidence is an effective means of proving a substance works and herbs were created by God to cure disease. Tyler suggests that none of these beliefs have any basis in fact. Up to 80% of the population in Africa uses traditional medicine as primary health care. Native Americans used about 2,500 of the approximately 20,000 plant species that are native to North America. In Andean healing practices,

4680-437: Is not mandated in the United States, but even products made to the same specification may differ as a result of biochemical variations within a species of plant. Plants have chemical defense mechanisms against predators that can have adverse or lethal effects on humans. Examples of highly toxic herbs include poison hemlock and nightshade. They are not marketed to the public as herbs, because the risks are well known, partly due to

4797-462: Is often a legally restricted herb), Ayurvedic remedies , broom , chaparral , Chinese herb mixtures, comfrey , herbs containing certain flavonoids, germander , guar gum , liquorice root , and pennyroyal . Examples of herbs that may have long-term adverse effects include ginseng , the endangered herb goldenseal , milk thistle , senna , aloe vera juice , buckthorn bark and berry , cascara sagrada bark , saw palmetto , valerian , kava (which

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4914-402: Is often a predictive factor (Cannon et al., 2006). Research done on home/community health care found that "nearly 1 of 3 medical regimens contain a potential medication error" (Choi et al., 2006). Elderly persons sometimes cannot make decisions for themselves. They may have previously prepared a power of attorney and advance directives to provide guidance if they are unable to understand what

5031-512: Is often preferred over "decrepitude, because death means deliverance". "The problem of the ambiguity of old age has ... been with us since the stage of primitive society ; it was both the source of wisdom and of infirmity, experience and decrepitude, of prestige and suffering." In the Classical period of Greek and Roman cultures, old age was denigrated as a time of "decline and decrepitude". "Beauty and strength" were esteemed and old age

5148-413: Is one largely based on shared-decision making and is driven by patient goals and preferences, which can vary from preserving function, improving quality of life, or prolonging years of life. A guiding mnemonic commonly used by geriatricians in the United States and Canada is the 5 M's of Geriatrics which describes mind, mobility, multicomplexity, medications and matters most to elicit patient values. It

5265-420: Is safer and potentially more effective, for which there is no evidence either condition applies. Phytochemical researcher Varro Eugene Tyler described paraherbalism as "faulty or inferior herbalism based on pseudoscience", using scientific terminology but lacking scientific evidence for safety and efficacy. Tyler listed ten fallacies that distinguished herbalism from paraherbalism, including claims that there

5382-402: Is seldom the subject of public discourse. Simone de Beauvoir wrote that "there is one form of experience that belongs only to those that are old – that of old age itself". Nevertheless, simulations of old age attempt to help younger people gain some understanding. Texas A&M University offers a plan for an "Aging Simulation" workshop. The workshop is adapted from Sensitizing People to

5499-429: Is the pseudoscientific use of extracts of plant or animal origin as supposed medicines or health-promoting agents. Phytotherapy differs from plant-derived medicines in standard pharmacology because it does not isolate and standardize the compounds from a given plant believed to be biologically active. It relies on the false belief that preserving the complexity of substances from a given plant with less processing

5616-452: Is usually associated with an age at which pensions or medical benefits for the elderly become available. In commercial contexts, where it may serve as a marketing device to attract customers, the age is often significantly lower. In commerce, some businesses offer customers of a certain age a " senior discount ". The age at which these discounts are available varies from 55, 60, 62 or 65 upwards, and other criteria may also apply. Sometimes

5733-709: Is young-old (65 to 74), old (74 to 84), and old-old (85+). Describing sub-groups in the 65+ population enables a more accurate portrayal of significant life changes. Two British scholars, Paul Higgs and Chris Gilleard, have added a "fourth age" sub-group. In British English, the "third age" is "the period in life of active retirement, following middle age". Higgs and Gilleard describe the fourth age as "an arena of inactive, unhealthy, unproductive, and ultimately unsuccessful ageing". Key Concepts in Social Gerontology lists four dimensions: chronological, biological, psychological, and social. Wattis and Curran add

5850-467: The Byzantine Empire studied geriatrics, with doctors like Aëtius of Amida evidently specializing in the field. Alexander of Tralles viewed the process of aging as a natural and inevitable form of marasmus , caused by the loss of moisture in body tissue. The works of Aëtius describe the mental and physical symptoms of aging. Theophilus Protospatharius and Joannes Actuarius also discussed

5967-477: The Canon discussed the diet suitable for old people , and dedicated several sections to elderly patients who become constipated . The Arab physician Algizar ( c.  898 –980) wrote a book on the medicine and health of the elderly. He also wrote a book on sleep disorders and another one on forgetfulness and how to strengthen memory , and a treatise on causes of mortality . Another Arab physician in

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6084-548: The Committee on Herbal Medicinal Products . In the United States, herbal remedies are regulated dietary supplements by the Food and Drug Administration (FDA) under current good manufacturing practice (cGMP) policy for dietary supplements. Manufacturers of products falling into this category are not required to prove the safety or efficacy of their product so long as they do not make 'medical' claims or imply uses other than as

6201-610: The Ebers papyrus dates from about 1550 BCE, and covers more than 700 compounds, mainly of plant origin. The earliest known Greek herbals came from Theophrastus of Eresos who, in the 4th century BCE, wrote in Greek Historia Plantarum , from Diocles of Carystus who wrote during the 3rd century BCE, and from Krateuas who wrote in the 1st century BCE. Only a few fragments of these works have survived intact, but from what remains, scholars have noted overlap with

6318-774: The Therapeutic Goods Administration , despite this being a condition for their sale. They also found that nearly 60 percent of products surveyed had ingredients that did not match what was on the label. Out of 121 products, only 15 had ingredients that matched their TGA listing and packaging. In 2015, the New York Attorney General issued cease and desist letters to four major U.S. retailers ( GNC , Target , Walgreens , and Walmart ) who were accused of selling herbal supplements that were mislabeled and potentially dangerous. Twenty-four products were tested by DNA barcoding as part of

6435-556: The United Nations proposed a human-rights convention to protect old people. Definitions of old age include official definitions, sub-group definitions, and four dimensions as follows. Most developed Western countries set the retirement age around the age of 65; this is also generally considered to mark the transition from middle to old age. Reaching this age is commonly a requirement to become eligible for senior social programs. Old age cannot be universally defined because it

6552-1036: The Wallace Line . Jamu practices may vary from region to region, and are often not recorded, especially in remote areas of the country. Although primarily herbal, some Jamu materials are acquired from animals, such as honey , royal jelly , milk, and Ayam Kampung eggs . Herbalists tend to use extracts from parts of plants, such as the roots or leaves, believing that plants are subject to environmental pressures and therefore develop resistance to threats such as radiation, reactive oxygen species and microbial attack to survive, providing defensive phytochemicals of use in herbalism. Indigenous healers often claim to have learned by observing that sick animals change their food preferences to nibble at bitter herbs they would normally reject. Field biologists have provided corroborating evidence based on observation of diverse species, such as chickens, sheep, butterflies , and chimpanzees . The habit of changing diet has been shown to be

6669-662: The "real old age" with the "rosy pictures" painted by middle-age writers. Writing at the age of 87, Mary C. Morrison describes the "heroism" required by old age: to live through the disintegration of one's own body or that of someone you love. Morrison concludes, "old age is not for the fainthearted". In the book Life Beyond 85 Years , the 150 interviewees had to cope with physical and mental debilitation and with losses of loved ones. One interviewee described living in old age as "pure hell". Research has shown that in high-income countries, on average, one in four people over 60 and one in three over 75 feels lonely. Johnson and Barer did

6786-524: The 9th century, Ishaq ibn Hunayn (died 910), the son of Nestorian Christian scholar Hunayn Ibn Ishaq , wrote a Treatise on Drugs for Forgetfulness . George Day published the Diseases of Advanced Life in 1849, one of the first publications on the subject of geriatric medicine. The first modern geriatric hospital was founded in Belgrade, Serbia, in 1881 by doctor Laza Lazarević . The term geriatrics

6903-611: The Act [21 U.S.C. § 321(g)(1)], because they are intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease and/or intended to affect the structure or any function of the body" when no such evidence existed. During the COVID-19 pandemic , the FDA and U.S. Federal Trade Commission issued warnings to several hundred American companies for promoting false claims that herbal products could prevent or treat COVID-19 disease . The World Health Organization (WHO),

7020-649: The American Herbalist Guild, "there is currently no licensing or certification for herbalists in any state that precludes the rights of anyone to use, dispense, or recommend herbs." However, there are U.S. federal restrictions for marketing herbs as cures for medical conditions, or essentially practicing as an unlicensed physician. Over the years 2017–2021, the U.S. Food and Drug Administration (FDA) issued warning letters to numerous herbalism companies for illegally marketing products under "conditions that cause them to be drugs under section 201(g)(1) of

7137-825: The Department of Geriatric Medicine, with rotations in Internal medicine, medical subspecialties etc. but in certain institutions, are limited to 2-year training in Internal medicine and subspecialities followed by one year of exclusive training in Geriatric Medicine. In July 2007, the Association of American Medical Colleges (AAMC) and the John A. Hartford Foundation hosted a National Consensus Conference on Competencies in Geriatric Education where

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7254-602: The Egyptian herbals. Seeds likely used for herbalism were found in archaeological sites of Bronze Age China dating from the Shang dynasty ( c.  1600  – c.  1046 BCE ). Over a hundred of the 224 compounds mentioned in the Huangdi Neijing , an early Chinese medical text, are herbs. Herbs were also commonly used in the traditional medicine of ancient India, where the principal treatment for diseases

7371-543: The Processes of Aging . Some of the simulations include: Herbal medication Herbal medicine (also called herbalism , phytomedicine or phytotherapy ) is the study of pharmacognosy and the use of medicinal plants , which are a basis of traditional medicine . With worldwide research into pharmacology , some herbal medicines have been translated into modern remedies, such as the anti-malarial group of drugs called artemisinin isolated from Artemisia annua ,

7488-686: The UK has been advanced by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention. In the United States , geriatricians are primary-care physicians ( D.O . or M.D. ) who are board-certified in either family medicine or internal medicine and who have also acquired the additional training necessary to obtain the Certificate of Added Qualifications (CAQ) in geriatric medicine. Geriatricians have developed an expanded expertise in

7605-540: The UK is also one with a rich multidisciplinary history. It values all the professions, not just medicine, for their contributions in optimizing the well-being and independence of older people. Another innovator of British geriatrics is Bernard Isaacs, who described the "giants" of geriatrics mentioned above: immobility and instability, incontinence , and impaired intellect . Isaacs asserted that, if examined closely enough, all common problems with older people relate to one or more of these giants. The care of older people in

7722-414: The United Kingdom, most geriatricians are hospital physicians, whereas others focus on community geriatrics in particular. Although originally a distinct clinical specialty, it has been integrated as a specialization of general medicine since the late 1970s. Most geriatricians are, therefore, accredited for both. Unlike in the United States, geriatric medicine is a major specialty in the United Kingdom and are

7839-763: The United States, being healthy, physically, and socially active are signs of a good old age. On the other hand, Africans focus more on food and material security and a helpful family when describing old age well-being. Additionally, Koreans are more anxious about aging and more scared of old people than Americans are. Research on age-related attitudes consistently finds that negative attitudes exceed positive attitudes toward old people because of their looks and behavior. In his study Aging and Old Age , Posner discovers "resentment and disdain of older people" in American society. Harvard University's implicit-association test measures implicit "attitudes and beliefs" about "Young vis

7956-448: The absorption, the effectiveness and the side effect profile of many drugs. These changes may occur in oral protective reflexes (dryness of the mouth caused by diminished salivary glands), in the gastrointestinal system (such as with delayed emptying of solids and liquids possibly restricting speed of absorption), and in the distribution of drugs with changes in body fat and muscle and drug elimination. Psychological considerations include

8073-461: The age of 65. When defined in a legal context, senior citizen is often used for legal or policy-related reasons in determining who is eligible for certain benefits available to the age group. It is used in general usage instead of traditional terms such as "old person", "old-age pensioner", or "elderly" as a courtesy and to signify continuing relevance of and respect for this population group as " citizens " of society, of senior "rank". The term

8190-678: The age of eligibility to 67, starting in the years 2023–2029, although the Liberal government of Justin Trudeau is considering leaving it at 65), and the Canada Pension Plan (CPP) as early as age 60. The distinguishing characteristics of old age are both physical and mental. The marks of old age are so unlike the marks of middle age that legal scholar Richard Posner suggests that, as an individual transitions into old age, that person can be thought of as different people "time-sharing"

8307-410: The aged have coexisted in complex relationships throughout history. "Old people were respected or despised, honoured or put to death according to circumstance." In ancient times, those who were frail were seen as a burden and ignored or, in extreme cases, killed. People were defined as "old" because of their inability to perform useful tasks rather than their years. Although he was skeptical of

8424-527: The aging process, the impact of aging on illness patterns, drug therapy in seniors, health maintenance, and rehabilitation . They serve in a variety of roles including hospital care, long-term care, home care, and terminal care. They are frequently involved in ethics consultations to represent the unique health and diseases patterns seen in seniors. The model of care practiced by geriatricians is heavily focused on working closely with other disciplines such as nurses, pharmacists , therapists, and social workers. In

8541-899: The belief that preserving various substances from a given source with less processing is safer or more effective than manufactured products, a concept for which there is no evidence. Archaeological evidence indicates that the use of medicinal plants dates back to the Paleolithic age, approximately 60,000 years ago. Written evidence of herbal remedies dates back over 5,000 years to the Sumerians , who compiled lists of plants. Some ancient cultures wrote about plants and their medical uses in books called herbals . In ancient Egypt, herbs were mentioned in Egyptian medical papyri , depicted in tomb illustrations, or on rare occasions found in medical jars containing trace amounts of herbs. In ancient Egypt,

8658-603: The benchmark for senior citizenship in numerous countries. This convention originated from Chancellor Otto von Bismarck's introduction of the pension system in Germany during the late 19th century. Bismarck's legislation set the retirement age at 70, with 65 as the age at which individuals could start receiving a pension. This age standard gradually gained acceptance in other nations and has since become deeply entrenched in public consciousness. The age which qualifies for senior citizen status varies widely. In governmental contexts, it

8775-557: The care of a geriatrician , or geriatric physician , a physician who specializes in the care of older people. Rather, this decision is guided by individual patient need and the caregiving structures available to them. This care may benefit those who are managing multiple chronic conditions or experiencing significant age-related complications that threaten quality of daily life. Geriatric care may be indicated if caregiving responsibilities become increasingly stressful or medically complex for family and caregivers to manage independently. There

8892-444: The context, but the state of being elderly was often thought as being 60 years of age or older in many respects. Gerontologists have recognized that people experience very different conditions as they approach old age. In developed countries, many people in their later 60s and 70s (frequently called "early old age") are still fit, active, and able to care for themselves. However, after 80, they generally become increasingly frail ,

9009-460: The developed world, where chronological age determines retirement, societies in developing countries determine old age according to a person's ability to make active contributions to society. This number is also significantly affected by lower life expectancy throughout the developing world. Dating back to the Middle Ages and prior, what certain scholars thought of as old age varied depending on

9126-455: The elderly are a happier age group than their younger counterparts. Physical marks of old age include the following: Mental marks of old age include the following: Many books written by authors in middle adulthood depict a few common perceptions on old age. One writer notices the change in his parents: They move slowly, they have less strength, they repeat stories, their minds wander, and they fret. Another writer sees her aged parents and

9243-529: The elderly develop some kinds of diseases and have more complications from mild problems (such as dehydration from a mild gastroenteritis ). Multiple problems may compound: A mild fever in elderly persons may cause confusion , which may lead to a fall and to a fracture of the neck of the femur ("broken hip"). The presentation of disease in elderly persons may be vague and non-specific, or it may include delirium or falls. ( Pneumonia , for example, may present with low-grade fever and confusion , rather than

9360-415: The fact that elderly persons (in particular, those experiencing substantial memory loss or other types of cognitive impairment) are unlikely to be able to adequately monitor and adhere to their own scheduled pharmacological administration. One study (Hutchinson et al., 2006) found that 25% of participants studied admitted to skipping doses or cutting them in half. Self-reported noncompliance with adherence to

9477-527: The fields of medicine, nursing, pharmacy, social work, physical and occupational therapy. Elderly patients can receive care related to medication management, pain management, psychiatric and memory care, rehabilitation, long-term nursing care, nutrition and different forms of therapy including physical, occupational and speech. Non-medical considerations include social services, transitional care, advanced directives, power of attorney and other legal considerations. The decline in physiological reserve in organs makes

9594-451: The gods, Aristotle concurred in the dislike of old people. In his Ethics , he wrote that "old people are miserly; they do not acknowledge disinterested friendship; only seeking for what can satisfy their selfish needs". The Medieval and Renaissance periods depicted old age as "cruel or weak". The 16th-century Utopians Thomas More and Antonio de Guevara allowed no decrepit old people in their fictional lands. For Thomas More, on

9711-405: The high fever and cough seen in younger people.) Some elderly people may find it hard to describe their symptoms in words, especially if the disease is causing confusion, or if they have cognitive impairment . Delirium in the elderly may be caused by a minor problem such as constipation or by something as serious and life-threatening as a heart attack . Many of these problems are treatable, if

9828-565: The hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. Frail elderly patients (score of 4 or 5) who were living at home before the surgery have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people. Some diseases commonly seen in elderly are rare in adults, e.g., dementia, delirium, falls. As societies aged, many specialized geriatric- and geriatrics-related services emerged including: A number of physicians in

9945-414: The interviewees faced new situations they changed their "cognitive and emotional processes" and reconstituted their "self–representation". Based on his survey of old age in history, Georges Minois concludes that "it is clear that always and everywhere youth has been preferred to old age". In Western thought, "old age is an evil, an infirmity and a dreary time of preparation for death". Furthermore, death

10062-537: The investigation, with all but five containing DNA that did not match the product labels. In some countries, formalized training and minimum education standards exist for herbalists, although these are not necessarily uniform within or between countries. In Australia, for example, the self-regulated status of the profession (as of 2009) resulted in variable standards of training, and numerous loosely formed associations setting different educational standards. One 2009 review concluded that regulation of herbalists in Australia

10179-492: The island of Utopia , when people are so old as to have "out-lived themselves" and are terminally ill, in pain, and a burden to everyone, the priests exhort them about choosing to die. The priests assure them that "they shall be happy after death". If they choose to die, they end their lives by starvation or by taking opium. Antonio de Guevara 's utopian nation "had a custom, not to live longer than sixty five years". At that age, they practiced self-immolation. Rather than condemn

10296-672: The leading cause of emergency department admissions and hospitalizations in adults age 65 and older, many of which result in significant injury and permanent disability. As certain risk factors can be modifiable for the purpose of reducing falls, this highlights an opportunity for intervention and risk reduction. Modifiable factors include: Urinary incontinence or overactive bladder symptoms is defined as unintentionally urinating oneself. These symptoms can be caused by medications that increase urine output and frequency (e.g. anti-hypertensives and diuretics), urinary tract infections, pelvic organ prolapse, pelvic floor dysfunction, and diseases that damage

10413-514: The long-term boiled extracts, usually of harder substances like roots or bark. Maceration is the cold infusion of plants with high mucilage -content, such as sage or thyme . To make macerates, plants are chopped and added to cold water. They are then left to stand for 7 to 12 hours (depending on the herb used). For most macerates, 10 hours is used. Tinctures are alcoholic extracts of herbs, which are generally stronger than herbal teas. Tinctures are usually obtained by combining pure ethanol (or

10530-481: The nerves that regulate bladder emptying. Other musculoskeletal conditions affecting mobility should be considered, as these can make accessing bathrooms difficult. Malnutrition and poor nutritional status is an area of concern, affecting 12% to 50% of hospitalized elderly patients and 23% to 50% of institutionalized elderly patients living in long-term care facilities such as assisted living communities and skilled nursing facilities. As malnutrition can occur due to

10647-462: The other hand is a non-polar solvent and it will absorb non-polar compounds. Alcohol lies somewhere in between. Many herbs are applied topically to the skin in a variety of forms. Essential oil extracts can be applied to the skin, usually diluted in a carrier oil. Many essential oils can burn the skin or are simply too high dose used straight; diluting them in olive oil or another food grade oil such as almond oil can allow these to be used safely as

10764-578: The patient's face looks—can help older patients make fully informed choices about their options. Assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories. One frailty scale uses five items: unintentional weight loss, muscle weakness , exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in

10881-828: The person or the estate. Elder abuse occurs increasingly when caregivers of elderly relatives have a mental illness. These instances of abuse can be prevented by engaging these individuals with mental illness in mental health treatment. Additionally, interventions aimed at decreasing elder reliance on relatives may help decrease conflict and abuse. Family education and support programs conducted by mental health professionals may also be beneficial for elderly patients to learn how to set limits with relatives with psychiatric disorders without causing conflict that leads to abuse. Old age Old people often have limited regenerative abilities and are more susceptible to illness and injury than younger adults. They face social problems that relate to retirement , loneliness , and ageism . In 2011,

10998-750: The potential for misleading health advice. Globally, there are no standards across various herbal products to authenticate their contents, safety or efficacy, and there is generally an absence of high-quality scientific research on product composition or effectiveness for anti-disease activity. Presumed claims of therapeutic benefit from herbal products, without rigorous evidence of efficacy and safety, receive skeptical views by scientists. Unethical practices by some herbalists and manufacturers, which may include false advertising about health benefits on product labels or literature, and contamination or use of fillers during product preparation, may erode consumer confidence about services and products. Paraherbalism

11115-480: The practice, Bishop Guevara called it a "golden world" in which people "have overcome the natural appetite to desire to live". In the modern period, the cultural status of old people has declined in many cultures. Joan Erikson observed that "aged individuals are often ostracized, neglected, and overlooked; elders are seen no longer as bearers of wisdom but as embodiments of shame". Attitudes toward old age well-being vary somewhat between cultures. For example, in

11232-624: The practitioners of this medical system. The Indian book, Vedas, mentions treatment of diseases with plants. In Indonesia , especially among the Javanese , the jamu traditional herbal medicine may have originated in the Mataram Kingdom era, some 1300 years ago. The bas-reliefs on Borobudur depict the image of people grinding herbs with stone mortar and pestle , a drink seller, a herbalist, and masseuse treating people. The Madhawapura inscription from Majapahit period mentioned

11349-443: The prevalence of herbal remedy use. There are many forms in which herbs can be administered, the most common of which is a liquid consumed as a herbal tea or a (possibly diluted) plant extract. Herbal teas , or tisanes, are the resultant liquid of extracting herbs into water, though they are made in a few different ways. Infusions are hot water extracts of herbs, such as chamomile or mint , through steeping . Decoctions are

11466-476: The process of aging and their role in the presence of older patients and residents. In India, Geriatrics is a relatively new speciality offering. A three-year post graduate residency (M.D) training can be joined for after completing the 5.5-year undergraduate training of MBBS (Bachelor of Medicine and Bachelor of Surgery). Unfortunately, only eight major institutes provide M.D in Geriatric Medicine and subsequent training. Training in some institutes are exclusive in

11583-709: The risk of drug interactions or adverse drug reactions . Pharmacokinetic and pharmacodynamic changes arise with older age, impairing their ability to metabolize and respond to drugs. Each of the four pharmacokinetic mechanisms (absorption, distribution, metabolism, excretion) are disrupted by age-related physiologic changes. For example, overall decreased hepatic function can interfere with clearance or metabolism of drugs and reductions in kidney function can affect renal elimination. Pharmacodynamic changes lead altered sensitivity to drugs in geriatric patients, such as increased pain relief with morphine use. Therefore, geriatric individuals require specialized pharmacological care that

11700-449: The risk-benefit ratio is different. For example, frail elderly women routinely stop screening mammograms , because breast cancer is typically a slowly growing disease that would cause them no pain, impairment, or loss of life before they would die of other causes. Frail people are also at significant risk of post-surgical complications and the need for extended care, and an accurate prediction—based on validated measures, rather than how old

11817-418: The root cause can be discovered. Elderly people require specific attention to medications . Elderly people particularly are subjected to polypharmacy (taking multiple medications) given their accumulation of multiple chronic diseases. Many of these individuals have also self-prescribed many herbal medications and over-the-counter drugs . This polypharmacy, in combination with geriatric status, may increase

11934-438: The safety and efficacy of each plant before medical use. Although many consumers believe that herbal medicines are safe because they are natural, herbal medicines and synthetic drugs may interact, causing toxicity to the consumer. Herbal remedies can also be dangerously contaminated, and herbal medicines without established efficacy, may unknowingly be used to replace prescription medicines. Standardization of purity and dosage

12051-620: The safety and efficacy of herbal products, the European Medicines Agency provided criteria in 2017 for evaluating and grading the quality of clinical research in preparing monographs about herbal products. In the United States, the National Center for Complementary and Integrative Health of the National Institutes of Health funds clinical trials on herbal compounds, provides fact sheets evaluating

12168-593: The safety, potential effectiveness and side effects of many plant sources, and maintains a registry of clinical research conducted on herbal products. According to Cancer Research UK as of 2015, "there is currently no strong evidence from studies in people that herbal remedies can treat, prevent or cure cancer". The use of herbal remedies is more prevalent in people with chronic diseases , such as cancer, diabetes , asthma , and end-stage kidney disease . Multiple factors such as gender, age, ethnicity, education and social class are also shown to have associations with

12285-534: The same identity. These marks do not occur at the same chronological age for everyone. Also, they occur at different rates and order for different people. Marks of old age can easily vary between people of the same chronological age. A basic mark of old age that affects both body and mind is "slowness of behavior". The term describes a correlation between advancing age and slowness of reaction and physical and mental task performance. However, studies from Buffalo University and Northwestern University have shown that

12402-401: The single most numerous internal medicine specialists. In Canada , there are two pathways that can be followed in order to work as a physician in a geriatric setting. Many universities across Canada also offer gerontology training programs for the general public, such that nurses and other health care professionals can pursue further education in the discipline in order to better understand

12519-556: The specialized agency of the United Nations (UN) that is concerned with international public health, published Quality control methods for medicinal plant materials in 1998 to support WHO Member States in establishing quality standards and specifications for herbal materials, within the overall context of quality assurance and control of herbal medicines. In the European Union (EU), herbal medicines are regulated under

12636-545: The temptation to manipulate the patient by withholding information, such as the dismal prognosis for a condition or the likelihood of recovering from surgery at home. Elder abuse is the physical, financial, emotional, sexual, or other type of abuse of an older dependent. Adequate training, services, and support can reduce the likelihood of elder abuse, and proper attention can often identify it. For elderly people who are unable to care for themselves, geriatricians may recommend legal guardianship or conservatorship to care for

12753-554: The topic in their medical works. Byzantine physicians typically drew on the works of Oribasius and recommended that elderly patients consume a diet rich in foods that provide "heat and moisture". They also recommended frequent bathing, massaging, rest, and low-intensity exercise regimens. In The Canon of Medicine , written by Avicenna in 1025, the author was concerned with how "old folk need plenty of sleep" and how their bodies should be anointed with oil , and recommended exercises such as walking or horse-riding . Thesis III of

12870-511: The use of entheogens , in particular the San Pedro cactus ( Echinopsis pachanoi ) is still a vital component, and has been around for millennia. Some researchers trained in both Western and traditional Chinese medicine have attempted to deconstruct ancient medical texts in the light of modern science. In 1972, Tu Youyou , a pharmaceutical chemist and Nobel Prize winner , extracted the anti-malarial drug artemisinin from sweet wormwood ,

12987-403: Was an Egyptian scribe who lived 4,500 years ago. The scribe addressed God with a prayer of lament: O Sovereign my Lord! Oldness has come; old age has descended. Feebleness has arrived; dotage is here anew. The heart sleeps wearily every day. The eyes are weak, the ears are deaf, the strength is disappearing because of weariness of the heart and the mouth is silent and cannot speak. The heart

13104-445: Was apparently coined in 1938 during a political campaign. Famed caricaturist Al Hirschfeld claimed on several occasions that his father Isaac Hirschfeld invented the term "senior citizen". It has come into widespread use in recent decades in legislation, commerce, and common speech. Especially in less formal contexts, it is often abbreviated as "senior(s)", which is also used as an adjective . The age of 65 has long been considered

13221-530: Was diet. De Materia Medica , originally written in Greek by Pedanius Dioscorides ( c.  40  – c.  90 CE ) of Anazarbus , Cilicia , a physician and botanist, is one example of herbal writing used over centuries until the 1600s. The World Health Organization (WHO) estimates that 80 percent of the population of some Asian and African countries presently uses herbal medicine for some aspect of primary health care. Some prescription drugs have

13338-437: Was essential to the care of older people. Using her experiences as a physician in a London Workhouse infirmary, she believed that merely keeping older people fed until they died was not enough; they needed diagnosis, treatment, care, and support. She found that patients, some of whom had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment. The practice of geriatrics in

13455-416: Was needed to reduce the risk of interaction of herbal medicines with prescription drugs , to implement clinical guidelines and prescription of herbal products, and to assure self-regulation for protection of public health and safety. In the United Kingdom, the training of herbalists is done by state-funded universities offering Bachelor of Science degrees in herbal medicine. In the United States, according to

13572-570: Was proposed in 1908 by Ilya Ilyich Mechnikov , Laurate of the Nobel Prize for Medicine and later by 1909 by Ignatz Leo Nascher , former Chief of Clinic in the Mount Sinai Hospital Outpatient Department (New York City) and a "father" of geriatrics in the United States. Modern geriatrics in the United Kingdom began with the "mother" of geriatrics, Marjory Warren . Warren emphasized that rehabilitation

13689-510: Was viewed as defiling and ugly. Old age was reckoned as one of the unanswerable "great mysteries" along with evil, pain, and suffering. "Decrepitude, which shrivels heroes, seemed worse than death." Historical periods reveal a mixed picture of the "position and status" of old people, but there has never been a "golden age of aging". Studies have challenged the popular belief that in the past old people were venerated by society and cared for by their families. Veneration for and antagonism toward

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