Toning and Nurturing Health in Elders
A basic premise of this course is that phytotherapy can nurture health and not simply treat illness. This strength of this approach lies in the use of tonics and gentle effect or remedies, using the stronger effectors only where absolutely necessary. This is also the basis for herbal treatment for elders, thus everything covered in the course so far has relevance to the treatment of the individual concerned. Perhaps the most outstanding contribution that herbs can make to the health care of our elders is through system tonics. Tonics and gentle normalizer remedies not only avoid most side effect complications but offer possibilities for the maintenance of wellness and prevention of many problems associated with aging. Please review the material covering wellness and prevention discussed in the last lesson.

Prescribing Issues Unique to Elders
When considering herbal therapy it is important to acknowledge some of the age related pharmaco-kinetic and pharmaco-dynamic changes that occur. Safe drug or herb prescribing for older patients has to be based upon an understanding of the changes that occur to absorption, distribution and elimination mechanisms in the aging process. Taking such issues into consideration helps avoid many complications. Whilst such concerns are not as important for the phytotherapist, they still exist. A brief review of some of the factors involved for both plant extracts and chemical drugs might be helpful. Pharmacological research suggests that the most important issues to consider are :

• `Drug' absorption. For a chemical or plant extract to enter the blood stream when taken by mouth, the absorptive lining of the gastrointestinal tract must be healthy. Medicines must remain in contact with the lining for an adequate amount of time for absorption to occur. There must also be an adequate blood flow to and from the site of absorption. Normal age related changes impact all of these factors. There is a reduction in mucosal surface area, reduction in blood flow to the intestines and changes in secretions.
• Plasma binding. Plant constituents are transported via the blood once they have been absorbed from the intestines. The more complex molecules are in a form that is often bound with a blood chemical such as albumin. Such protein bound drugs can compete for binding sites, which in turn may have a profound effect upon availability of medications.
• Distribution around the body. With advancing age the proportion of body water and lean body mass decreases whilst body fat increases. This favors the distribution of fat soluble constituents over water soluble.
• Elimination. The effect of a medicine is ended by it being eliminated from the body or its being changed into some inactive form. This will involve liver metabolism, kidney function, and elimination at other sites around the body. All of these factors become less efficient with age.