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According to a study in the October American Journal of Geriatric Psychiatry, there is a high prevalence of herbal medicine use among elderly people. There are often two unfortunate side effects from use botanicals or herbal medicines in the senior population: 1) ignorance of what they are taking and 2) not letting their physician or pharmacist know that they are taking over the counter medicines when they are prescribed other medications.
The authors of the study point out that even though herbal products are marketed as dietary supplements, they need to be considered drugs. The review also highlights the potentially serious risk of herb - drug interactions and discusses communication issues and regulatory concerns associated with use of herbal medicines. They describe that 'plant substances contain hundreds, sometimes thousands, of bioactive compounds. Bioflavonoids, flavones, lactones, glycosides, polysaccharides, essential oils, and terpenes are but a few of the types of biologically-active substances found in herbs.' Some of the commonly used herbal remedies include chamomile, garcinia, ginseng, and valerian, kava kava, ma huang (ephedra) and St John's Wort.
Communication
The review emphasized the need to 'modernize' medical/psychiatric history taking. They point out that up to 70% of patients do not reveal their herbal use to their physicians and pharmacists. Questions need to be specific and asked in a non-judgmental fashion. Questionaires have proven ineffective in identifying herbal remedies in patients. A recent study indicates that few physicians feel comfortable discussing complementary and alternative medicine (CAM) with their patients, and most physicians want education about CAM to enhance communication with their patients.
The authors conclude that "health practitioners should remember to include herbal use history in their routine drug histories and remain informed of the beneficial and harmful effects of these treatments." Evidence of effectiveness of various herbs is incomplete, and risk-benefit assessment is not completely reliable. Hence, physicians should minimize the use of conventional medications and herbs for the same clinical condition because of the potential for herb-drug interactions that may compromise the beneficial effects of the prescribed medicine.
AJGP
8:23:06 PM 
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