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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #11, #12, #13, #25, #66, #73

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LEARNING OBJECTIVES

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Learning Objectives

  • Recognize current trends in the use of CAM therapies among older patients.

  • Understand reasons for their use and guide patients appropriately.

  • Develop an awareness of the commonly used modalities and their associated risks/benefits.

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Key Clinical Points

  1. A large proportion of the US population is using CAM therapy, and the prevalence among adults may be as high as 44%.

  2. Only a small proportion of adults using these modalities disclose this information to their clinicians.

  3. Nonvitamin, nonmineral natural product use constitutes the most common CAM therapy.

  4. Medical providers need to have a better understanding of CAM therapies to guide their patients appropriately.

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“Because the newer methods of treatment are good, it does not follow that the old ones were bad: for if our honorable and worshipful ancestors had not recovered from their ailments, you and I would not be here today.”

—Confucius (551–478 BC)

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BACKGROUND

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Complementary and alternative medicine (CAM) and traditional medicine (TM) have existed for thousands of years in the East and seem to be a growing social phenomenon in the West. The general public has expressed an increased desire to embrace ancient philosophies and approaches to medical care. At the present time there is easy access to health care information from multiple sources along with changing individual expectations of health and the nature of health care systems. Worldwide, the population has continued to age with an associated accumulation of chronic diseases. In the face of increasing demands, conventional medicine has continued to advance in its capabilities, along with a continued evolution of technology. Despite all this, people continue to seek alternative approaches to maintain or improve their health. In the presence of multiple health care options, there have been a growing number of patients seeking CAM therapies with very few patients sharing this information with their physician for fear of criticism and humiliation. At the present time there is a paucity of evidence-based research in the field of CAM therapies, even though, during the last 15 years, there has been an increase in published literature. It is therefore important for medical providers to recognize the changing trend, the evidence that does exist, and the benefits and risks based on good research trials to guide their patients appropriately.

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BRIEF HISTORY, DEFINITIONS, AND CLASSIFICATION OF CAM

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In 1995, a panel of experts convened at the National Institutes of Health (NIH) to develop a definition of CAM. This was subsequently modified in 1997 by the Institute of Medicine Committee on the Use of Complementary and Alternative Medicine by the American Public: “CAM is a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health ...

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