57: Considering Complementary & Alternative Medicines for Older Adults

General Principles in Older Adults

Complementary and alternative therapies have been defined as therapies that either fall outside of the conventional thought and approach to a given disease or that are not taught in U.S. medical schools or widely provided by U.S. hospitals. The National Center for Complementary and Alternative Medicine divides these therapies into 5 major domains (Table 57–1).

Among older adults, the most commonly used complementary and alternative therapies are chiropractic therapy, herbal remedies, relaxation techniques, and high-dose or megavitamins.

Patients using complementary and alternative therapies often do not report their use to their physicians. Some therapies, such as herbs, may have side effects or may interact with conventional therapies. Physicians should ask specifically whether older patients are using them or seeing practitioners. Asking about interest in and use of complementary and alternative therapies may also strengthen the physician–patient relationship and facilitate exploration of a patient’s needs and expectations.

When an older patient elects to use complementary and alternative treatments, it is important to establish clear goals and endpoints, to apply the same evidence-based medicine principles to the literature, to be knowledgeable and open-minded, and to listen to and hear patient preferences. Practitioners should discuss evidence (or lack thereof) for safety and efficacy of both conventional and alternative options. Do not break the patient’s trust by quarreling over placebo effect if you note an improvement, the cost is manageable, there is low toxicity, and the patient is not rejecting other appropriate treatments. Finally, it is recommended that physicians get to know licensed complementary and alternative practitioners and develop a referral base.