Use of nontraditional therapies—implications for older adults

AORN Journal,  May, 2003  by Linda C. Haynes,  Jan Hoot Martin,  Dianne Endres

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* limited knowledge of the pharmacokinetic properties (eg, half-life, protein binding, biotransformation, excretion) of botanical, herbal, and nutritional supplements--interaction between highly protein-bound supplements increases the risk for toxicity;

* limited knowledge of the interaction between botanical, herbal, and nutritional supplements and perioperative medications--as new pharmaceuticals are developed for use during the perioperative period, supplements previously considered safe may prove unsafe when used in combination with these medications; and

* lack of standardization of botanical, herbal, and nutritional supplements--the amount of active ingredient found in many supplements varies from none to more than is listed on the packaging, and there may be unknown contaminants in unregulated supplements that could interact adversely with perioperative medications.

Uses and effects. Botanical, herbal, and nutritional supplements are used to treat physical ailments. Some of the more common ailments and the supplements used to attempt to alleviate these ailments are included in Table 1. Potential complications of these substances important to perioperative nurses also are presented. Although not all-inclusive, the table contains the more common preparations used by older adult health care consumers.

Supplements that have the potential to cause major complications in perioperative patients are those that prolong bleeding and those that increase sedative effects of anesthetics and analgesics. (16) Some commonly used supplements that inhibit clotting because they decrease platelet aggregation include

* bilberry,

* bromelain,

* dong quoi,

* feverfew,

* fish oil,

* flax seed oil,

* garlic,

* ginger,

* gingko biloba, and

* grape seed extract.

Supplements that inhibit clotting because they contain coumarin include

* chamomile,

* dandelion root,

* dong quoi, and

* horse chestnut.

Another supplement that may prolong bleeding is phosphatidylserine, which synergistically stimulates the effects of heparin. Supplements that prolong the effects of anesthesia because they potentiate central nervous system depressants include,

* hops,

* kava,

* passion flower, and

* valerian.

Botanical, herbal, and nutritional supplements should be discontinued two to three weeks before surgery to prevent potential complications or medication interactions. (17)

Vitamins and minerals. Many older adult patients, concerned with overall health, turn to popular dietary supplements (ie, vitamins and minerals) for added health benefits. Although many people report that it makes them feel better, there is no evidence-based support for daily multivitamin use. Additionally, use of minerals, which often is recommended by traditional health care practitioners, is not without consequences. Common dietary supplements and their clinical implications are listed in Table 2.

CASE STUDY

Mr E, a 91-year-old retired electrical engineer, and his 87-year-old wife of 66 years remain active by walking three to six miles daily and continue to live independently in their suburban home. Mr E's health has been good throughout his life. Other than mild arthritis, he reports no history of chronic illness or surgery. He has few vices, although he admitted to using tobacco for three years after World War II. Mr E reports that he has taken vitamins since retirement. Influenced by his then 50-year-old daughter, Mr E began using herbal and nutritional supplements approximately 10 years ago.