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Abstract & Commentary
Synopsis: Alternative medicine is used by 30% of English-speaking Americans older than age 65. Those who made the most visits to medical physicians were more likely to use alternative medicines, and 57% did not tell their doctors about it.
Source: Foster DF, et al. J Am Geriatr Soc. 2000;48:
A national survey from the center for alternative Medicine and Research at Beth Israel Deaconess Medical Center in Boston, Mass, was conducted in 1997-98 to assess the prevalence and patterns of alternate therapies in the United States. They found 42% of all Americans reporting use in the previous year.1 This current study further analyzes that data for persons aged 65 and older.
In the telephone survey, which was limited to English speakers, random-digit dialing was used to identify households and financial incentives were used to ensure adequate participation. The data were then weighted to adjust for geographic variation in cooperation. Out of 2049 total respondents, 311 were aged 65 or older. Demographically this group corresponded to US Census Bureau descriptors for older Americans compared to younger ones, such as lower incomes, less well educated, less racial diversity, and more women.
The survey first asked about the respondent’s medical conditions, and then about their use of 20 alternate medicine therapies, which were defined as interventions not taught in medical schools and not widely available in US hospitals. Herbal and vitamin use was clearly defined to exclude daily vitamin use or vitamins prescribed by a medical doctor (MD or DO). All users of alternate therapies who acknowledged seeing a medical doctor in the past year were also asked if they had discussed their use with their medical doctor.
Compared to respondents younger than 65, the older persons used alternative medicine less often (30% compared to 46% for < 65 years). The most popular choices were chiropractic (11%) and herbal remedies (8%) for the older group, compared to relaxation/massage and herbal choices in younger persons. The other top choices for older persons were high-dose vitamins, relaxation techniques, and religious healing by others.
The use of alternative medicine declined with advancing age, starting at a high of 33% in ages 65-74, 28% in ages 75-84, and 17% for those age 85 and older. In contrast, the age group 36-55 reported 50% usage of alternative medicine.
Arthritis and back pain were the most common reported conditions for which alternative medicine was used. One in 9 of the older group reported using chiropractic in the past year. Alternative medicine use was correlated with visits to conventional physicians, with users ranging from 22% of those making 1-2 annual visits to 44% of those who had 7 or more visits. Only 7% of older persons who made no visits to medical physicians used alternative therapies.
COMMENT BY MARY ELINA FERRIS, MD
This is the first study showing that older Americans are following national trends of increasing alternative medicine use, although their choice of therapies may be somewhat different from younger persons. A previous survey from Great Britain suggested that 15% of older persons used alternatives there, but this number may be greater today.2
The fact that users of alternative medicine also subscribed to conventional medicine (indicated by the correlation between medical visits and alternative visits) suggests that users are not necessarily rejecting or abandoning traditional care, a view that is supported by other research.3 It may be that they are overusers, but a more likely explanation is that they are combining all available therapies when faced with illness and discomfort. Surveys have shown most alternative users are very satisfied with the care they receive, even if they did not find improvement in their presenting complaint.4
Safety issues and drug interactions are a concern if our patients are not telling us about the alternate treatments they are receiving. Many published reviews have reminded us that not all herbal remedies are harmless, and older persons with joint deformities may not tolerate vigorous physical manipulations.
Although this study had a small sample size and was probably culturally limited, it gives us useful information to guide our history taking. No longer should we assume that older persons are immune from the rush to alternative medicines, nor that they would tell us if they were seeking alternate treatments. Only by directly asking can we hope to obtain a complete picture of the various treatments our older patients are using.
1. Eisenberg DM, et al. JAMA. 1998;280:1569-1575.
2. Thomas KJ. BMJ. 1991;302:207-210.
3. Astin JA. JAMA. 1998;279:1548-1553.
4. Zollman C, et al. BMJ. 1999;319:1486-1489.