Complementary and alternative medicine (CAM) use by older adults: a comparison of self-report and physician chart documentation

BACKGROUND: Older adults are increasingly using complementary and alternative medicine (CAM) dietary supplements and herbal remedies, but may not discuss this with their physicians. When patients do report using CAM, their physicians may not record this information in patient charts. METHODS: This cross-sectional analysis compared results of a convenience sample survey with medical charts. Participants were older than 65 and from an urban academic hospital's ambulatory geriatrics practice. We measured (i) prevalence of CAM use; (ii) proportion of CAM supplements and herbs (CAMsh) reported by patients and documented in patients' charts; (iii) percentage of patients reporting taking CAMsh with anticoagulant activity (ginger, ginkgo, garlic, and vitamin E) while concomitantly taking prescribed anticoagulant medications, as per chart; and (iv) percentages of those patients for whom the CAM anticoagulant was or was not documented in the chart. RESULTS: We surveyed 212 patients; of those, 182 had available charts. Prevalence of CAM use was 64%. Only 35% of all self-reported supplements were documented in the charts. Of 182 patients, 84 (46%) reported taking CAM with anticoagulant properties: of these, 52% took a prescribed anticoagulant (per chart), while 48% took CAM but not prescribed anticoagulants. CONCLUSION: CAM use is highly prevalent among older adults. Physicians do not consistently record the use of CAMsh on patients' charts. This may lead to unrecognized, potentially harmful drug-herb/drug-supplement interactions. Physicians should elicit and document information on CAM use from older adult patients, both to provide sound medical care and to advance knowledge about drug-herb/drug-supplement interactions.     

The use of complementary and alternative treatment in patients with asthma

Complementary and alternative medicine (CAM) therapies such as herbal therapy, acupuncture, yoga, chiropractic, relaxation techniques, nutrition and dietary supplements, continue to gain popularity as modalities for treatment of asthma. A number of study in this area has shown frequently used CAM therapies by patients with asthma. It has found that parents who have children with asthma preferred commonly CAM therapies such as massage, relaxation techniques, diet and vitamin and that adult patients with asthma used commonly nutrition and diet supplements, herbal therapies and homeopathy. Because of many studies had weak methodology and small sample; it hasn't exposed entirely effectiveness of CAM therapies in asthma treatment. In this respect, it is required qualitative researchs with strong methodology. Furthermore; it is suggested that health professionals have to much knowledge about CAM therapies in asthma and they have to an active role in development guidelines related to CAM interventions.     

Complementary and alternative medicine use as health self-management: rural older adults with diabetes

OBJECTIVE: . This study describes complementary and alternative medicine (CAM) use among rural older adults with diabetes, delineates the relationship of health self-management predictors to CAM therapy use, and furthers conceptual development of CAM use within a health self-management framework. Methods. Survey interview data were collected from a random sample of 701 community dwelling African American, Native American, and White elders residing in two rural North Carolina counties. We summarize CAM use for general use and for diabetes care and use multiple logistic modeling to estimate the effects of health self-management predictors on use of CAM therapies. RESULT: . The majority of respondents used some form of CAM for general purpose, whereas far fewer used CAM for diabetes care. The most widely used CAM categories were food home remedies, other home remedies, and vitamins. The following health self-management predictors were related to the use of different categories of CAM therapies: personal characteristics (ethnicity), health status (number of health conditions), personal resources (education), and financial resources (economic status). Discussion. CAM is a widely used component of health self-management among rural among older adults with diabetes. Research on CAM use will benefit from theory that considers the specific behavior and cognitive characteristics of CAM therapies.     

Herbal remedy use as health self-management among older adults

OBJECTIVES: Guided by the self-regulatory model, we describe the proportions of older adults who include herbal remedies in their health self-management, determining differences in herb use in terms of personal and health characteristics, indicators of culture, and personal resources. METHODS: Data were from the 2002 National Health Interview Survey, which included a supplement on the use of herbal remedies. We limited the present analysis to adults aged 65 and older who were Black, Hispanic, Asian, or White. RESULTS: Herbs were an important component of the health self-management of older adults. Whereas about one quarter of Asian and Hispanic elders used herbal remedies, about 10% of Black and White elders used them. Older adults differed by ethnicity in the herbs they used and their reasons for using herbs. Predictors of herb use included gender, age, and health status. Ethnicity and region of the country, indicators of culture, and education, a personal resource, were significant predictors of herb use when personal and health characteristics were controlled. DISCUSSION: A complex set of factors is associated with the inclusion of herbs in the health self-management of older adults, with cultural and personal resources being extremely important.     

Use of complementary and alternative medicine by older patients with arthritis: a population-based study

OBJECTIVE: To determine the prevalence of complementary and alternative medicine (CAM) use and to identify factors associated with its use in older patients with arthritis. METHODS: A population-based telephone survey of 480 elderly patients with arthritis was conducted to determine demographics, comorbidities, health status, arthritis symptoms, and the use of CAM and traditional providers and treatments for arthritis. RESULTS: CAM provider use was reported by 28% of respondents, and 66% reported using one or more CAM treatments. Factors independently related to CAM provider use (P < 0.05) included podiatrist or orthotist use, physician visits for arthritis, and fair or poor self-reported health. For CAM treatments, independent associations were found with physical or occupational therapist use, physician visits for arthritis, chronic obstructive pulmonary disease, and alcohol abstinence. Rural residence, age, income, education, and health insurance type were unrelated to CAM use. CONCLUSION: Many older patients with arthritis reported seeing CAM providers, and most used CAM treatments. The use of CAM for arthritis was most common among those with poorer self-assessed health and higher use of traditional health care resources.     

Sex differences in the use of complementary and alternative medicine in older men and women

Aim: The aim of this study was to examine sex differences in complementary and alternative medicine (CAM) use among older adults. Methods: Cross‐sectional analysis of data from two cohort studies of community‐dwelling women (n = 5399) and men (n = 3188) aged 82–87 and 77–91 years, respectively. The main outcome measure was self‐report of consultations with an alternative health practitioner. Results: Men were 1.79 (95% confidence interval (CI): 1.46, 2.20) times more likely to use CAM than women. People born in a non‐English speaking country were 1.49 times (95% CI: 0.94, 2.35) more likely to use CAM. Self‐reported general health (P = 0.01) and bodily pain (P < 0.01) were significantly associated with CAM use. Conclusion: In contrast to previous research, CAM use is more prevalent among older men than older women in our sample. Both men and women are using CAM to maintain good health and for the treatment of ongoing conditions.     

Complementary and alternative medicine use among elderly persons: one-year analysis of a Blue Shield Medicare supplement

BACKGROUND: Large scale surveys in the United States and abroad suggest that 35-60% of adults have used some form of complementary/alternative medicine (CAM). However, no studies to date have focused on predictors and patterns of CAM use among elderly persons. METHODS: The population surveyed were Californians enrolled in a Medicare risk product that offers coverage for acupuncture and chiropractic care. Surveys were mailed to 1597 members in 1997 and responses received by 728 (51% response rate). Health risk assessment data were also obtained at baseline and 12-15 months following enrollment in the plan. Multiple logistic regression analyses were carried out to examine predictors of CAM use. RESULTS: Forty-one percent of seniors reported use of CAM. Herbs (24%), chiropractic (20%), massage (15%), and acupuncture (14%) were the most frequently cited therapies. CAM users tended to be younger, more educated, report either arthritis and/or depression/anxiety, not be hypertensive, engage in exercise, practice meditation, and make more frequent physician visits. Use of CAM was not associated with any observed changes in health status. Respondents also expressed considerable interest in receiving third-party coverage for CAM. Although 80% reported that they had received substantial benefit from their use of CAM, the majority (58%) did not discuss the use of these therapies with their medical doctor. CONCLUSIONS: Findings suggest that there is significant interest in and use of complementary/alternative medicine among elderly persons. These results suggest the importance of further research into the use and potential efficacy of these therapies within the senior population.     

Dietary and health supplement use among older Australians: results from a national survey

Objectives: To measure the extent of dietary and health supplement use among older Australians and to contrast older supplement users from older non‐supplement users. Method: Survey participants (n= 1,263) provided information related to demographic, health and lifestyle features. The target population were Australians aged 65 years and over, randomly chosen from the Australian Electoral Commission. Data was obtained using a 12‐page self‐administered, mail questionnaire. Results: Forty‐three percent (n=548) of the sample reported using at least one dietary and health supplement, 52% of females and 35% of males. Supplement use was significantly related to several demographic and lifestyle features including: gender, educational level, smoking status and number of visits to complementary health therapists. Conclusions: Clearly, supplements were chosen more for their perceived ability to attenuate or modify ailments, rather than their role in correcting nutritional deficiencies. Older Australians appear intent on taking health matters in their own hands. Approximately one third of them rarely inform their doctor about the supplements they use, which raises concerns about the safety and appropriateness of this action.     

Complementary and alternative medicines in ankylosing spondylitis: a cross-sectional study

Prevalence of dietary complementary and alternative medicine (CAM) and consultation with a CAM practitioner was examined in a cross-sectional study of 75 AS patients. Seventy one of 75 (94.7%) study participants reported previous or current CAM use. Among these AS patients, 44 (72.1%) reported dietary CAM use and 27 (36.0%) were seeing a CAM practitioner at the time of study. Of 89 dietary CAM, 50 (56.4%) were perceived to be of slight or no benefit, and only 10 (11.2%) were initiated by a CAM practitioner. Compared with non-users, current dietary CAM users were more likely to be female (OR 6.5; 95% CI, 1.8–23.9). Patients attending a CAM practitioner were more likely to have university education (OR 5.7; 95% CI, 1.5–21.9) and higher BASDAI (OR 1.3; 95%CI, 1.0–1.7). Despite low rates of perceived benefit, dietary CAM use and CAM practitioner attendance is common among AS patients.     

Adverse Effects of Complementary and Alternative Medicine on Antihypertensive Medication Adherence: Findings from the Cohort Study of Medication Adherence Among Older Adults

OBJECTIVES: To determine the association between complementary and alternative medicine (CAM) use and antihypertensive medication adherence in older black and white adults.
DESIGN: Cross-sectional.
SETTING: Patients enrolled in a managed care organization.
PARTICIPANTS: Two thousand were hundred eighty black and white adults aged 65 and older and prescribed antihypertensive medication.
MEASUREMENTS: Information on CAM use (health food and herbal supplements, relaxation techniques) for blood pressure control and antihypertensive medication adherence were collected in a telephone survey between August 2006 and September 2007. Low medication adherence was defined as a score less than 6 using the eight-item Morisky Medication Adherence Scale.
RESULTS: The mean age of participants was 75.0±5.6, 30.7% were black, 26.5% used CAM, and 14.1% had low antihypertensive medication adherence. In managing blood pressure, 30.5% of black and 24.7% of white participants had used CAM in the last year ( P =.005), and 18.4% of black and 12.3% of white participants reported low adherence to antihypertensive medication (<.001). After multivariable adjustment for sociodemographic information, depressive symptoms, and reduction in antihypertensive medications because of cost, the prevalence ratios of low antihypertensive medication adherence associated with CAM use were 1.56 (95% confidence interval (CI)=1.14–2.15; P =.006) in blacks and 0.95 (95% CI=0.70–1.29; P =.73) in whites ( P value for interaction=.07).
CONCLUSION: In this cohort of older managed care patients, CAM use was associated with low adherence to antihypertensive medication in blacks but not whites.     

Complementary medicine use in rheumatology: A review

Complementary and alternative medicine (CAM) use is increasing worldwide; specifically it appears that these treatment modalities are popular among rheumatology patients. The most commonly reported CAM therapies are herbal medicines, homeopathy, chiropractic, acupuncture and reflexology. Despite high reported rates of CAM use, the number of patients disclosing use to their rheumatologists remains low. This review highlights rates of current CAM use in rheumatology in studies performed worldwide, and discusses potential reasons for nondisclosure of CAM use to clinicians.     

Complementary and alternative medicine in fibromyalgia and related syndromes

Complementary and alternative medicine (CAM) has gained increasing popularity, particularly among individuals with fibromyalgia syndrome (FMS) for which traditional medicine has generally been ineffective. A systematic review of randomized controlled trials (RCTs) and non-RCTs on CAM studies for FMS was conducted to evaluate the empirical evidence for their effectiveness. Few RCTs achieved high scores on the CONSORT, a standardized evaluation of the quality of methodology reporting. Acupuncture, some herbal and nutritional supplements (magnesium, SAMe) and massage therapy have the best evidence for effectiveness with FMS. Other CAM therapies have either been evaluated in only one RCT with positive results (Chlorella, biofeedback, relaxation), in multiple RCTs with mixed results (magnet therapies), or have positive results from studies with methodological flaws (homeopathy, botanical oils, balneotherapy, anthocyanidins, dietary modifications). Lastly, other CAM therapies have neither well-designed studies nor positive results and are not currently recommended for FMS treatment (chiropractic care).     

Recent trends in use of herbal and other natural products

BACKGROUND: The benefits of herbal and other natural products (dietary supplements) are increasingly cited in the media. Dramatic increases in use reported during the last decade have led to growing concerns about efficacy and safety. METHODS: To determine which dietary supplements American adults use, whether the prevalence has continued to increase in recent years, and whether popularity of individual supplements has changed, demographic information and details of use of all medicines and dietary supplements in the preceding week were obtained by telephone interview from February 1998 through December 2002 from households in 48 contiguous states and the District of Columbia. Participants included randomly selected residents of households with telephones; compared with 2000 US Census data, participants were representative of the US population. The main outcome measure was the weekly prevalence of dietary supplement use, alone or in a multicomponent product. RESULTS: There were 8470 subjects 18 years or older. The annual prevalence of dietary supplement use increased from 14.2% in 1998-1999 to 18.8% in 2002. Although use did not change among younger subjects, it doubled for men and women 65 years or older. Use of Ginkgo biloba and Panax ginseng declined during the study, while lutein use increased dramatically, because of its addition to multivitamin products. The overall 2002 prevalence excluding lutein use was 13.9%. CONCLUSIONS: The popularity of specific supplements has varied over time and differs according to age and sex. The sharp increase in supplement use in the 1990s appears to have slowed. However, the addition of supplements, such as lutein and lycopene, to mainstream multivitamins has become an important source of exposure.     

Use of complementary and alternative medicine by older patients with arthritis: a population‐based study

Objective

To determine the prevalence of complementary and alternative medicine (CAM) use and to identify factors associated with its use in older patients with arthritis.

Methods

A population‐based telephone survey of 480 elderly patients with arthritis was conducted to determine demographics, comorbidities, health status, arthritis symptoms, and the use of CAM and traditional providers and treatments for arthritis.

Results

CAM provider use was reported by 28% of respondents, and 66% reported using one or more CAM treatments. Factors independently related to CAM provider use (P < 0.05) included podiatrist or orthotist use, physician visits for arthritis, and fair or poor self‐reported health. For CAM treatments, independent associations were found with physical or occupational therapist use, physician visits for arthritis, chronic obstructive pulmonary disease, and alcohol abstinence. Rural residence, age, income, education, and health insurance type were unrelated to CAM use.

Conclusion

Many older patients with arthritis reported seeing CAM providers, and most used CAM treatments. The use of CAM for arthritis was most common among those with poorer self‐assessed health and higher use of traditional health care resources.

     

Complementary and alternative medicine use decreases adherence to HAART in HIV-positive women

The use of complementary and alternative medicine (CAM) to treat chronic illnesses, especially HIV, is becoming increasingly widespread. Given this popularity, it is critical to understand how HIV-positive individuals use CAM and, more specifically, whether CAM use impacts their adherence to prescribed antiretroviral regimens (HAART). The present study examined the relationship between CAM use and HAART adherence among HIV+ women. Data were analysed from 366 HIV-positive, mostly African-American women, aged 18-50 years in Alabama and Georgia who were enrolled in an intervention to reduce high-risk sexual behaviour. At enrollment data were collected describing use of CAM and HAART use. Women were classified as CAM users if they reported taking herbal/natural immunity boosters (Chinese herbs, mushrooms, garlic, ginseng or algae) or multivitamins, or reported using religious/psychic health or bodywork to treat HIV. Women were classified as non-adherent if they reported missing any doses of their HAART medication in the 30 days preceding baseline assessment. Logistic regressions models, adjusted for potential confounders, were used to investigate the relationship between CAM use and HAART adherence. Women using CAM (immunity boosters or vitamins), relative to non-CAM users, were 1.69 times more likely to report missing HAART doses in the last 30 days (CI: 1.02-2.80; P=.041) even after adjusting for age, education, race, religion and income. The findings provide preliminary evidence that patients using CAM may be doing so as an alternative to traditional medicine as opposed to complementing prescribed HARRT treatment regimens. The inconsistent use of HAART is problematic given its association with drug resistance. Therefore, health care providers and patients should have explicit dialogues about how to effectively integrate CAM practices into traditional treatment regimens so that the safety and health of HIV-positive patients is not compromised.     

Factors Related to Primary Health Care Provision: A Cross-Sectional Study in an Elderly Rural Population

We examined the relationship between social support, lifestyle habits, and disease-related factors in two primary health care settings: the health care center and the elders’ homes. Logistic regression analysis was performed to determine the effect of independent variables on the provision of health care services. Those who received home visits were significantly older, had lower family income, and had poorer social support systems. Furthermore, elderly people with nutritional risk status, heart failure, functional dependence, or cognitive impairment were among those most likely to request in-home care visits. Our study suggests that age, nutritional risk, and functional dependence are the most important factors to predict the use of home health care services compared with general practitioner visits.     

The Role of Spirituality in the Self-management of Chronic Illness among Older African and Whites

This study used data from in-depth interviews collected from 88 African American and White men and women aged 65 years and older who reside in Allegheny County, Pennsylvania. The purpose of this study was to understand the role of spirituality in the self-management of chronic illness among this population. Thematic content analysis addressed two specific questions: (1) how do older adults use spirituality to help manage their chronic illness, and (2) are there any racial differences in the use of spirituality. Several core themes emerged from the linkage of spirituality and self-management: God: the healer, God: the enabler through doctors, faith in God, prayer as a mediator, spirituality as a coping mechanism, combining conventional medicine and spiritual practices, and empowering respondents to practice healthy eating habits. These results display racial differences in the use of spirituality in the self-management of chronic illness. African American elders were more likely than White elders to endorse a belief in divine intervention. White elders were more likely than African America elders to merge their spirituality in various self-management practices. Despite these differences, spirituality can play an integral part in a person’s health and well-being of chronically ill elders.