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).
Table 57–1.Classifications of complementary and alternative (CAM) treatments. ||Download (.pdf) Table 57–1. Classifications of complementary and alternative (CAM) treatments.
|CAM Domain ||Definition ||Examples |
|Alternative medical systems ||Complete systems of theory and practice that are completely independent of a biomedical approach ||Traditional oriental medicine, homeopathy, naturopathic medicine, and Ayurvedic medicine |
|Mind–body interventions ||Target the potential for the mind to affect the body’s basic function and reaction to disease ||Meditation, prayer and mental healing, hypnosis |
|Biologic therapies ||The use of herbs, dietary manipulation, supplements, or mixtures prepared from biologic sources to enhance health or treat disease ||Herbal remedies, such as ginseng and ginkgo, supplements, such as glucosamine and vitamin E, and mixtures, such as shark cartilage |
|Manipulative and body-based systems ||Therapies use a relationship between form and function to treat disease ||Massage, chiropractic manipulation, or osteopathic manipulation |
|Energy therapies ||Modify internal sources or flow of energy or alternately apply external sources of energy to modify body function or health ||Use of magnets or electromagnetic fields, which involve external sources of energy, or the practice of Qi Gong or therapeutic touch, which involve manipulating the internal balance or flow of energy |
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.
B Complementary and alternative medicine: what’s it all about? WMJ