Alternative medicine use in older Americans

A bibliometric study on trends in chiropractic research from 1920 to 2023

OBJECTIVE

An increasing body of evidence suggests a positive role of chiropractic in the treatment of neuro-musculoskeletal disorders. This study aims to explore current research hotspots and trends, providing insights into the broad prospects of this field.

METHODS

A bibliometric review was conducted on all chiropractic articles included in the Web of Science Core Collection before December 31, 2023.

RESULTS

Over the past century, the volume of research in the field of chiropractic has been fluctuating annually, with four peaks observed in total. The United States, Canada, Australia, and the United Kingdom are leading countries. Chu, Eric Chun-Pu is the author with the most publications, while Bronfort, Gert has the highest total citation count. The University of Southern Denmark has produced the most publications, while Queens University - Canada is the most central institution. The Journal of Manipulative and Physiological Therapeutics is the journal with the most publications and citations, while the Journal of the American Medical Association is the most central journal. The two most-cited articles were both authored by Eisenberg DM. Emerging keywords include "chronic pain" and "skills". The theoretical mechanisms and scientific basis of chiropractic, its clinical practice and safety, education and training, integration with other disciplines, and patient experiences and satisfaction are the frontiers and hotspots of research.

CONCLUSION

This study integrates bibliometric analysis to summarize the current state of research and global network centers in the field of chiropractic, further highlighting the hotspots and trends in this field. However, Individual and national rankings should be interpreted with caution due to our focus on Web of Science rather than PubMed.

Monitoring and risk assessment of pesticide residues in selected herbal medicinal products in Ghana

The high patronage of herbal medicinal products in Ghana for the treatment of diverse disease conditions raises concerns about patient safety, given that much of the raw materials for production are obtained from the wild or farmlands potentially exposed to varied agrochemical residues. Therefore, the work sought to investigate the contamination of herbal medicinal products with pesticide residues and assess the potential risk posed to patients. As a result, validated gas chromatography with mass spectrometry as a detector was used to determine forty-two pesticides in thirty herbal medicinal products. The performance parameters of the method such as linearity, accuracy, and precision were found as acceptable. Pesticide residues such as chlorpyrifos and/or bifenthrin were found in 4/30 herbal medicinal products. Specifically, 3/30 herbal medicinal products contained only one pesticide, while 1/30 was contaminated with both pesticide residues. The levels of pesticide residue contamination ranged between 2.5 and 5.0 µg/kg. The acute hazard quotient and chronic hazard quotient for the two pesticide residues were evaluated and ranged between 0.21 and 0.92% and between 8.21 × 10^-4 and 5.88 × 10^-3%. The detected pesticide residue levels are below the maximum residue limit values, which may not cause acute and chronic health risks due to intake of the selected herbal medicinal product. Nevertheless, patient safety and potential public health risk can be reduced by regular monitoring, and regulation of pesticide residue levels in herbal medicinal products.

Prevalence and correlates of complementary and alternative medicine use among diabetic patients in a resource-limited setting

BACKGROUND

The use of Complementary and Alternative Medicine (CAM) among diabetic patients is rising to manage diabetes mellitus (DM) and its complications. The burden of DM in developing countries coupled with a high prevalence of CAM use and its associated risks among diabetic patients. Therefore, this study aimed to assess the prevalence and predictors of CAM use among DM patients.

METHODS

Diabetic patients visiting the diabetic clinics of Debre Tabor governmental hospital were invited to participate in a cross-sectional study. Interview guided self-administered questionnaire was used for data collection. Descriptive statistics like, frequency, percentage, mean, standard deviation, and median were conducted for each of the questions entered in order to detect outliers and validate data entry. Independent sample 't' test and ANOVA were used to test continuous variables and Chi-square test was used to compare categorical variables. Univariate and multivariate logistic regression were computed to identify associated factors (sex, age, religion, marital status, residence, employment status, educational level, monthly income, duration of DM, presence of DM complication, and family history of DM) of CAM use.

RESULTS

Out of 422 diabetic patients invited to participate in this study, a total of 395 completed the survey questionnaire with a response rate of 93.6%. The use of CAM was reported by 73.7% of diabetic patients. Patients' average age was 48.7 ± 12.6 years, with 53.2% females and 52.4% married. The odds of CAM use among older diabetic patients were higher compared to younger diabetic patients (AOR: 1.92; CI: 1.75-3.17). Compared to not married, married diabetic patients had higher odds of using CAM (AOR: 2.01; CI: 1.36-4.25). The odds of CAM use among respondents who develop diabetic complications were higher than patients without diabetic complications (AOR: 1.94; CI: 1.50-4.36). The odds of CAM use among respondents with a family history of DM were higher than participants without a family history of DM (AOR: 2.53; CI: 1.27-2.75). Among CAM users, 54.3% used CAM as a complementary treatment along with conventional medicine. Traditional healers (38.8%) were the most frequently reported source of recommendation about CAM use. The majority of CAM users 172 (59.1%) didn't disclose CAM use for their health care professionals.

CONCLUSION

The prevalence of herbal medicine use among diabetic patients was high. Age, marital status, residence, family history of DM, presence of diabetic complications, and duration of DM were found to be strong predictors of CAM use among diabetic patients. A rigorous struggle by the government, healthcare professionals, and educational institutions is required to increase the safe use of CAM by diabetic patients and to integrate modern diabetic treatment modalities with CAM therapies.

Anticancer efficacies of Krameria lappacea extracts against human breast cancer cell line (MCF-7): Role of oxidative stress and ROS generation

Breast cancer is a growing health issue globally and accounts as a second most cause of mortality. Natural products have been a fundamental of health care for long. Plants derived natural products have gained considerable attention over synthetic medicines, since they are safe and non-toxic. Krameria lappacea (Dombey) Burdet and B.B. Simpson plant belonging to Krameriaceae family, has been known for its beneficial effects against diseases. Herein, firstly, cytotoxic potential of petroleum ether (KLH), chloroform (KLC), ethyl acetate (KLEA), and ethanolic (KLET) extracts of K. lappacea was screened against MCF-7 cells exposed to 10–1000 μg/mL for 24 h. Secondly, the most cytotoxic extract (KLH) was used to explore the mechanisms of cytotoxicity in MCF-7 cells. MCF-7 cells were treated with KLH at 250–1000 μg/mL to measure the oxidative stress markers (glutathione (GSH) and lipid peroxidation (LPO)) and reactive oxygen species (ROS) generation. Further, loss of mitochondrial membrane potential (MMP) and caspase-3 and -9 enzyme activities were studied. The viability of MCF-7 cells were decreased from 44% to 90% for KLH, from 7% to 71% for KLEA, from 39% to 80% for KLC, and from 3% to 81% for KLET, respectively at 250–1000 μg/mL as observed by MTT assay. An increase of 91% in LPO and 2.2-fold in ROS generation and a decrease of 59% in GSH and 68% in MMP levels at 1000 μg/mL showed that KLH induced MCF-7 cell death via oxidative stress and elevated level of ROS generation which further leads to mitochondrial membrane dysfunction and activation of caspase enzymes. The findings of this study provide a mechanistic insight on anticancer efficacies of K. lappacea extracts against MCF-7 cells and support the use of it for the treatment of breast cancer diseases.

The Utilization of Complementary and Alternative Medicine among Saudi Older Adults: A Population-Based Study

BACKGROUND

Complementary and alternative medicine (CAM) is an integral part of patients' therapeutic experience worldwide. Among Saudi older adults, less is known about CAM utilization.

OBJECTIVES

To determine the prevalence, patterns, and factors associated with CAM utilization among SOA.

METHODS

In the Saudi National Survey for Elderly Health (SNSEH), subjects were asked about CAM use during the last twelve months before the interview. CAM use was defined as any use of herbal products, acupuncture, bloodletting, cauterization, medical massage, bones manual manipulation, honey, or religious rituals. Demographic characteristics included gender, age, marital status, region, educational level, and residence area. In addition, multiple comorbidities were included as possible factors that may be associated with CAM use. Multivariable logistic regression was used to explore factors associated with CAM utilization. All statistical analyses were done using STATA v.14.

RESULTS

Out of 2946 respondents, 50.4% were males, the mean age was 70.3 ± 8.3 years, and 70% were illiterate. CAM use was prevalent (62.5%). The most common CAM types were herbal products (25.4%), acupuncture (21.2%), bloodletting (12%), honey (9.5%), cauterization (7.4%), medical massage and bones manual manipulation (4%), and traditional bone setting (2.1%). In the multivariable regression, age, gender, and marital status did not have an impact on the odds of using CAM. Subjects from rural areas were 2.92 times more likely to use CAM compared with subjects in urban areas (OR = 2.92; 95%CI: 2.28-3.75). Subjects with metabolic disorders (OR = 0.50; 95% CI: 0.42-0.60) or kidney disease were less likely to use CAM (OR = 0.30; 95%CI: 0.14-0.64). About pain, CAM is used more in neck pain (OR = 1.69; 95%CI: 1.30-2.21) and also used in back pain (OR =  1.22; 95%CI: 1.03-1.46).

CONCLUSIONS

CAM use was very prevalent among SOA. Clinicians and pharmacists must ask about CAM use among older adults as many of CAM may interact with patients medications.

Complementary and alternative medicine use among patients with type 2 diabetes living in the United Arab Emirates

BACKGROUND

The use of Complementary and Alternative Medicine (CAM) among Type 2 Diabetes Mellitus (T2DM) patients is increasing to manage the complexities of their condition, enhance their health, and ease complications. The burden of T2DM in the United Arab Emirates (UAE) coupled with the high prevalence of CAM use and its associated risks among patients with T2DM necessitated the investigation of the use of CAM by this patients' population. The aim of this study is to examine the prevalence, types, and correlates of CAM use among T2DM patients in the UAE.

METHODS

Patients with T2DM attending the outpatient clinics in the two governmental hospitals in Dubai and Sharjah, UAE were invited to participate in a cross-sectional survey. Face-to-face interviews were conducted with participants to complete a multi-component questionnaire. The questionnaire comprised of three main sections: demographic data, diabetes-related information, and CAM use details. Data analysis employed descriptive statistics, univariate and multivariate logistic regression to assess the prevalence and correlates of CAM use.

RESULTS

Two hundred forty-four T2DM patients completed the questionnaire (response rate: 80%). A total of 39.3% of participants were CAM users since diagnosis. After adjustment; the logistic regression results showed that CAM use was significantly associated with age, sex, education, employment, and having health insurance. The most commonly used type of CAM by participants were folk foods and herbs followed by spiritual and natural healing and vitamins and minerals supplements. The majority of CAM users were referred or encouraged to use CAM by family (42.7%), friends (25%) or social media (17.7%). Only 13.5% of participants used CAM because it was suggested by health care practitioners. Only 1 in four of CAM users disclosed CAM use to their treating physician.

CONCLUSION

CAM use among T2DM patients in the UAE is considerably high. Health policy and decision-makers are encouraged to dedicate particular attention to facilitating proper regulation and integration of CAM within conventional medicine to protect the health and wellbeing of patients. A concerted effort by medical schools and public health authorities should be committed to educating health care providers and patients on the safe and effective use of CAM therapies.

Middle Eastern Plant Extracts: An Alternative to Modern Medicine Problems

Middle Eastern countries are primarily known for their dry sand deserts; however, they have a wider physiographic range which includes upland plateau and mountain ranges. The Middle East is home to various types of plants, such as Phoenix dactylifera (date palm tree), Scrophularia striata (herbaceous plants), and Opuntia ficus-indica (cactus). These plants have been found to have various types of bioactivities, such as antimicrobial activities against both bacteria and fungi, in addition to exhibiting anti-inflammatory effects and anti-cancer characteristics which can be utilized in the clinical setting for treatment. Due to limited reviews focusing on plant extracts from the Middle East, we aim to provide a discourse on plants from this region which have various bioactivities and to provide information on the compounds that can be identified from these plants. This is to enhance our understanding to improve modern medicine problems such as antimicrobial resistance and to find an alternative cure for cancer. It is hoped that the collation of information from this review will enable an assessment of the direct role of Middle Eastern plants in providing therapeutic options to address the predicaments in the medical field.

Differences in Function and Comorbidities Between Older Adult Users and Nonusers of Chiropractic and Osteopathic Manipulation: A Cross-sectional Analysis of the 2012 National Health Interview Survey

OBJECTIVE

The purpose of this cross-sectional study was to compare functional limitations and comorbidity prevalence between older adult users and nonusers of chiropractic and osteopathic (DC/DO) manipulation to inform provider training.

METHODS

We conducted a secondary analysis of the 2012 National Health Interview Survey data. Adults age 65 or older who responded to the survey were included. Descriptive statistics are reported for adults who used DC/DO manipulation (vs nonusers) regarding function, comorbidities, musculoskeletal complaints, and medical services. Weighted percentages were derived using SAS and compared with χ² tests.

RESULTS

The DC/DO users were more often female, overweight or obese, and of white race than nonusers. More DC/DO users reported arthritis (55.3% vs 47.0%, <0.01) or asthma (15.0% vs 10.0%, P < .01) than nonusers; hypertension (61.9% vs 55.5%, P = .02) and diabetes (20.3% vs 15.7%, P = .02) were more prevalent in nonusers; and other comorbidities were comparable. The DC/DO users reported more joint pain/stiffness (55.7% vs 44.8%), chronic pain (19.8% vs 14.2%), low back pain (27.8% vs 18.4%), low back with leg pain (18.8% vs 10.6%), and neck pain (24.2% vs 13.1%) than nonusers (all P < .01). Functional limitations affected two-thirds overall, but DC/DO users reported more difficulties stooping and bending; other limitations were comparable. One in 9 reported activities of daily living or instrumental activities of daily living limitations; nonusers were more affected. Surgery was more common among DC/DO users (26.1% vs 19.3%, <0.01); emergency room visits were comparable.

CONCLUSION

Differences existed between older adult manipulation users and nonusers, especially surgical utilization, musculoskeletal complaints, and comorbidities; functional differences were modest. Our findings highlight areas for provider training and awareness regarding comorbidity burden and management needs in older patients who may simultaneously use manipulation and medical care for musculoskeletal complaints.

Prevalence of and factors associated with utilization of herbal medicines among outpatients in primary health centers in Cambodia

BACKGROUND

Traditional, complementary and alternative medicine (TCAM) is seen as a way to provide healthcare in both developed and developing countries across the world. In Cambodia, there is a long tradition of using TCAM. However, scant studies have been conducted on the extent of Cambodian TCAM use and how it interacts with allopathic health care to date. In this study, we examined the prevalence of and factors associated with utilization of herbal medicines among patients with chronic diseases in primary health care settings in Cambodia.

METHODS

A cross-sectional survey was conducted in 2015 with outpatients receiving treatment and care for chronic diseases in two urban and two rural primary health centers purposively selected from Phnom Penh, Kampong Cham and Siem Reap. Every eligible patient was randomly selected at the health centers using a systematic sampling procedure. I-CAM-Q was used to measure TCAM use. A multivariate logistic regression model was constructed to identify factors associated with herbal medicine use.

RESULTS

In total, 1602 patients were included in this study, of whom 77.7% were female, and 51.2% were recruited from urban primary health centers with a mean age of 46.5 years (SD = 15.2). Of total, 27.0% reported at least one consultation with a TCAM provider in the past 12 months. The most common modality of TCAM used was herbal medicine (89%). Herbs were obtained at drug or folk stores (36.9%), from herbalists directly (28.5%) or from their own gardens (18.6%). Of herb users, 55.2% reported that herbs were somewhat helpful. After adjustment, herb users were significantly more likely to be female (AOR = 1.42, 95% CI = 1.12-2.67), have completed less schooling (AOR = 0.66, 95% CI = 0.45-0.96), were unemployed or homemakers (AOR = 0.23, 95% CI = 0.13-0.52) and have a gastrointestinal illness (AOR = 0.49, 95% CI = 0.39-0.62).

CONCLUSIONS

Herbal medicines are broadly used among chronic disease patients in Cambodia. Understanding TCAM use in the general population will support health care practitioners and policy makers to make informed decisions about the use of TCAM. Integration of TCAM into the primary health system should be further explored.

The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided

Background

Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided.

Methods

Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition.

Results

The literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%).

Conclusions

This comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged.

Rural Older Adults’ Beliefs and Behavior Related to Complementary and Alternative Medicine Use

Little research has considered older adults’ health beliefs related to the use of complementary and alternative medicine (CAM). Based on a conceptual model of health selfmanagement, this analysis delineates health beliefs and behaviors related to CAM use among community-dwelling rural elders. In-depth interviews were conducted with 145 female and male African Americans, Native Americans, and Whites aged 70 and older residing in two rural, central North Carolina counties. CAM therapies are widely used but are largely limited to folk and home remedies and vitamin and mineral supplements. These rural elders integrate CAM use with conventional health care, and they are concerned that remedies they use not interfere with prescribed conventional treatment. They justify CAM use in terms of advice from their physician or nurse or from published sources. Most rural elders state that their knowledge of CAM therapies is limited.

Complementary and Alternative Medicine Use Among Rural Older Adults

Little research has investigated Complementary and Alternative Medicine (CAM) use prevalence and its determinants among older adults. We examined ethnic and gender variation in CAM use among rural older adults who reside in two North Carolina counties. Home and folk remedies, and vitamin and mineral supplements, were used by most participants. Men and women did not differ. African and Native American elders used home and folk remedies more than European Americans; European and Native Americans used vitamin and mineral supplements more than African Americans. Health care providers should be aware that their patients use CAM and may need counseling to minimize CAM-drug interactions.

Use of Complementary and Alternative Medicine by Older Adults: An Exploratory Study

Determinants of complementary and alternative medicine (CAM) use and characteristics of users are examined using a sample of 848 adults aged 50 and older from the 2000 Health and Retirement Survey. Logistic regression is used to identify the factors associated with the likelihood of using CAM. Nearly 70% of the respondents use at least one CAM modality, with 44% reporting use of curative CAM and 58% reporting use of preventive/curative CAM. Whites, relative to Blacks, were more likely to use curative and less likely to use preventive/curative CAM. Widowed older adults were more likely to use preventive/curative CAM. Number of limitations in activities of daily living was positively associated with use of both types of CAM. Recommendations are made for improving research on alternative health care utilization, for educating CAM users, and for qualitative studies to gain further insight into factors affecting the use of specific CAM modalities.

Older adults' use of care strategies in response to general and upper respiratory symptoms

This study examined the use of complementary and medical treatments, both individually and in combination, to address common general and upper respiratory symptoms. Data for the analysis were collected from a series of 18 daily diary questionnaires administered to community-living older African American and white adults living in rural counties in North Carolina. Participants reported symptoms experienced on each diary day and the treatment strategies they used each day in response to the particular symptom(s). Older adults used diverse categories of strategies to treat symptoms; treatment strategies were used inconsistently across symptoms. Use of only complementary strategies, only medical conventional strategies, or both complementary and medical strategies to treat any one symptom rarely corresponded to the use of the same strategy to address other symptoms. Future research would benefit from analyzing how older adults use health care strategies across symptom categories.

Short term treatment versus long term management of neck and back disability in older adults utilizing spinal manipulative therapy and supervised exercise: a parallel-group randomized clinical trial evaluating relative effectiveness and harms

Background

Back and neck disability are frequent in older adults resulting in loss of function and independence. Exercise therapy and manual therapy, like spinal manipulative therapy (SMT), have evidence of short and intermediate term effectiveness for spinal disability in the general population and growing evidence in older adults. For older populations experiencing chronic spinal conditions, long term management may be more appropriate to maintain improvement and minimize the impact of future exacerbations. Research is limited comparing short courses of treatment to long term management of spinal disability.

The primary aim is to compare the relative effectiveness of 12 weeks versus 36 weeks of SMT and supervised rehabilitative exercise (SRE) in older adults with back and neck disability.

Methods/Design

Randomized, mixed-methods, comparative effectiveness trial conducted at a university-affiliated research clinic in the Minneapolis/St. Paul, Minnesota metropolitan area.

Participants

Independently ambulatory community dwelling adults ≥ 65 years of age with back and neck disability of minimum 12 weeks duration (n = 200).

Interventions

12 weeks SMT + SRE or 36 weeks SMT + SRE.

Randomization

Blocked 1:1 allocation; computer generated scheme, concealed in sequentially numbered, opaque, sealed envelopes.

Blinding

Functional outcome examiners are blinded to treatment allocation; physical nature of the treatments prevents blinding of participants and providers to treatment assignment.

Primary endpoint

36 weeks post-randomization.

Data collection

Self-report questionnaires administered at 2 baseline visits and 4, 12, 24, 36, 52, and 78 weeks post-randomization. Primary outcomes include back and neck disability, measured by the Oswestry Disability Index and Neck Disability Index. Secondary outcomes include pain, general health status, improvement, self-efficacy, kinesiophobia, satisfaction, and medication use. Functional outcome assessment occurs at baseline and week 37 for hand grip strength, short physical performance battery, and accelerometry. Individual qualitative interviews are conducted when treatment ends. Data on expectations, falls, side effects, and adverse events are systematically collected.

Primary analysis

Linear mixed-model method for repeated measures to test for between-group differences with baseline values as covariates.

Discussion

Treatments that address the management of spinal disability in older adults may have far reaching implications for patient outcomes, clinical guidelines, and healthcare policy.

Trial registry

www.ClinicalTrials.gov; Identifier: NCT01057706.

Relationship between nonprescribed therapy use for illness prevention and health promotion and health-related quality of life

OBJECTIVES

This study describes the nonprescribed therapy use (prayer, over-the-counter medications [OTC's], home remedies, vitamins, herbs and supplements, and exercise) for health promotion among rural elders. It also delineates the association of such therapy use with physical and mental health-related quality of life (HRQoL).

METHOD

The sample (N = 200) consisted of African American and White elders from south-central North Carolina. Participants completed baseline interviews and repeated measures of nonprescribed therapy use over a 6-month follow-up.

RESULTS

Prayer had the highest percentage (80.7%) of use for health promotion followed by OTC (54.3%); vitamins only (49.3%); herbs and supplements (40.5%); exercise (31.9%); and home remedies (5.2%). Exercise was significantly associated with better physical HRQoL (p < .05). However, elders who used nonprescribed therapies had poorer mental HRQoL than nonusers, adjusting for potential confounders.

CONCLUSION

This analysis suggests that use of some nonprescribed therapies for health promotion is associated with poorer mental HRQoL.

The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety

The use of herbal medicinal products and supplements has increased tremendously over the past three decades with not less than 80% of people worldwide relying on them for some part of primary healthcare. Although therapies involving these agents have shown promising potential with the efficacy of a good number of herbal products clearly established, many of them remain untested and their use are either poorly monitored or not even monitored at all. The consequence of this is an inadequate knowledge of their mode of action, potential adverse reactions, contraindications, and interactions with existing orthodox pharmaceuticals and functional foods to promote both safe and rational use of these agents. Since safety continues to be a major issue with the use of herbal remedies, it becomes imperative, therefore, that relevant regulatory authorities put in place appropriate measures to protect public health by ensuring that all herbal medicines are safe and of suitable quality. This review discusses toxicity-related issues and major safety concerns arising from the use of herbal medicinal products and also highlights some important challenges associated with effective monitoring of their safety.

Chronic pain management by ethnically and racially diverse older adults: pharmacological and nonpharmacological pain therapies

SUMMARY Aims: Exploration of racial and ethnic group differences in noncancer chronic pain management in older adults. Participants & methods: Qualitative data, which were collected in semistructured face-to-face interviews with 44 racially and ethnically diverse community-dwelling older adults (ten African–Americans, ten Hispanics, 12 Afro–Caribbeans and 12 non-Hispanic whites), were analyzed using constant comparative analysis. Results: The three racial and ethnic minority groups were more likely to use culturally based treatments (e.g., herbal tea and avocado leaves), home remedies and folk medicine, and/or psychological therapies (e.g., distraction and relaxation) than non-Hispanic whites to manage chronic pain. African–Americans relied on religious coping methods. Non-Hispanic whites were more likely to use physical interventions such as massage and chiropractic treatment. Conclusion: Study findings suggest differences by ethnicity in preferred pain interventions for an older adult population.

Longitudinal use of complementary and alternative medicine among older adults with radiographic knee osteoarthritis

BACKGROUND

Osteoarthritis (OA), a chronic and often painful disease for which there is no cure, accounts for more mobility issues in older adults than any other disease. Cross-sectional studies have found that arthritis is the most common reason for older adults to use complementary and alternative medicine (CAM). Although previous research has profiled the sociodemographic and clinical characteristics of CAM users, few studies have provided information on variation in CAM use over time and most only considered use of any CAM, which was often a mixture of heterogeneous therapies.

OBJECTIVES

This study sought to describe the longitudinal patterns of CAM use among older adults with knee OA and to identify correlates and predictors of different commonly used CAM therapies.

METHODS

The Osteoarthritis Initiative included 1121 adults aged ≥65 years with radiographic tibiofemoral OA in one or both knees at baseline. Annual surveys captured current use of conventional therapies and 25 CAM modalities (grouped into 6 categories) for joint pain or arthritis at baseline and during the 4-year follow-up. We assessed longitudinal use of CAM modalities by summing the number of visits with participants reporting use of each modality. Correlates of CAM use under consideration included sociodemographic indicators, body mass index, overall measures of mental and physical well-being, and clinical indices of knee OA. Generalized estimation equations provided adjusted odds ratio estimates and 95% CIs.

RESULTS

Nearly one-third of older adults reported using ≥1 CAM modality for treating OA at all assessments. With the exception of glucosamine and chondroitin (18%), few were persistent users of other CAM modalities. One in 5 of those using nonsteroidal anti-inflammatory drugs or glucosamine and/or chondroitin were using them concurrently. Adjusted models revealed the following: (1) adults aged ≥75 years were less likely to use dietary supplements than those between ages 65 and 75 years; (2) persons with more severe knee pain or stiffness reported more CAM use; (3) better knee-related physical function was correlated with more use of chiropractic care or massage; and (4) older adults with more comorbidities were less likely to report use of dietary supplements.

CONCLUSION

Patterns of CAM use are, to some extent, inconsistent with current guidelines for OA treatment. Evaluating the potential risks and benefits in older adults from commonly used CAM modalities, with or without combination use of conventional analgesics, is warranted.

Perspectives of older adults on co-management of low back pain by doctors of chiropractic and family medicine physicians: a focus group study

Background

While older adults may seek care for low back pain (LBP) from both medical doctors (MDs) and doctors of chiropractic (DCs), co-management between these providers is uncommon. The purposes of this study were to describe the preferences of older adults for LBP co-management by MDs and DCs and to identify their concerns for receiving care under such a treatment model.

Methods

We conducted 10 focus groups with 48 older adults who received LBP care in the past year. Interviews explored participants’ care seeking experiences, co-management preferences, and perceived challenges to successful implementation of a MD-DC co-management model. We analyzed the qualitative data using thematic content analysis.

Results

Older adults considered LBP co-management by MDs and DCs a positive approach as the professions have complementary strengths. Participants wanted providers who worked in a co-management model to talk openly and honestly about LBP, offer clear and consistent recommendations about treatment, and provide individualized care. Facilitators of MD-DC co-management included collegial relationships between providers, arrangements between doctors to support interdisciplinary referral, computer systems that allowed exchange of health information between clinics, and practice settings where providers worked in one location. Perceived barriers to the co-management of LBP included the financial costs associated with receiving care from multiple providers concurrently, duplication of tests or imaging, scheduling and transportation problems, and potential side effects of medication and chiropractic care. A few participants expressed concern that some providers would not support a patient-preferred co-managed care model.

Conclusions

Older adults are interested in receiving LBP treatment co-managed by MDs and DCs. Older adults considered patient-centered communication, collegial interdisciplinary interactions between these providers, and administrative supports such as scheduling systems and health record sharing as key components for successful LBP co-management.

Use of complementary therapies by individuals with or at risk for cardiovascular disease: results of the 2007 National Health Interview Survey

BACKGROUND

Complementary and alternative medicine (CAM) therapies are often used as adjuvants to conventional treatment by individuals with cardiovascular disease (CVD) or CVD risk factors, such as hypertension and high cholesterol. Patterns of use of CAM practices and products represent important data for health care providers in delivering adequate patient care.

OBJECTIVE

This study compared CAM use among the US CVD and general population, as well as individuals with CVD risk factors (hypertension and/or high cholesterol), through secondary analyses of the 2007 National Health Interview Survey data.

METHODS

The analysis compared use of CAM by individuals with CVD (those individuals self-reporting a diagnosis of coronary heart disease; n = 1055), individuals with CVD risk factors (those individuals self-reporting a diagnosis of hypertension [n = 6849] or high cholesterol [n = 5808]), and individuals who self-report as not having CVD or CVD risk factors (n = 22 290).

RESULTS

Use of complementary practices and products by patients with CVD and CVD risk factors is common and significantly greater than individuals without CVD in the general population. The most common categories of complementary modalities used by individuals with a self-reported diagnosis of CVD or CVD risk factors were natural products and mind-body practices.

CONCLUSIONS

The diagnosis of CVD or CVD risk factors may be associated with the use of complementary practices and products.

The relationship between cognitive function and non-prescribed therapy use in older adults

OBJECTIVES

To examine the association of cognitive function with use of non-prescribed therapies for managing acute and chronic conditions, and to determine whether use of non-prescribed therapies changes over time in relation to baseline cognitive function.

METHODS

200 community-dwelling adults aged 65 and older were recruited from three counties in south central North Carolina. Repeated measures of daily symptoms and treatment were collected on three consecutive days at intervals of at least one month. The Mini-Mental State Examination, the primary cognitive measure, was collected as part of the baseline survey. Data were collected on the daily use of common non-prescribed therapies (use of prayer, ignore symptoms, over-the-counter remedies, food and beverage therapies, home remedies, and vitamin, herb, or supplements) on each of the three days of the follow-up interviews for up to six consecutive months.

RESULTS

Older adults with poorer cognitive function were more likely to pray and ignore symptoms on days that they experienced acute symptoms. Poorer cognitive function was associated with increased use of home remedies for treating symptoms related to existing chronic conditions.

CONCLUSIONS

Cognitive function may play a role in why older patients use some non-prescribed therapies in response to acute and chronic conditions.

Use of complementary and alternative medicine in a large sample of anxiety patients

OBJECTIVE

To examine a large sample of patients with anxiety and the association between types of complementary and alternative treatments that were used, demographic variables, diagnostic categories, and treatment outcomes.

METHOD

Cross-sectional and longitudinal survey during the Coordinated Anxiety Learning and Management (CALM) study that assessed this intervention against the Usual Care in a sample of patients with anxiety recruited from primary care. Interviewer-administered questionnaires via a centralized telephone survey by blinded assessment raters. The interviews were done at baseline, 6, 12, and 18 months of the study. A total of 1004 adults ages 18-75 who met DSM-IV criteria for Generalized Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, or Post-Traumatic Stress Disorder. We assessed medication/herbal use, the use of any alternative therapies, and combined Complementary and Alternative Medicine (CAM) use.

RESULTS

We found an extensive (43%) use of a variety of CAM treatments that is consistent with previous study results in populations with anxiety. Only a few significant demographic or interventional characteristics of CAM users were found. Users most often had a diagnosis of GAD, were older, more educated, and had two or more chronic medical conditions. CAM users who had a 50% or more drop in anxiety scores over 18 months were less likely to report continued use of alternative therapies.

CONCLUSIONS

The study confirms the importance of awareness of CAM use in this population for possible interference with traditional first-line treatments of these disorders, but also for finding the best integrative use for patients who require multiple treatment modalities.

Geographic variations in availability and use of chiropractic under medicare

OBJECTIVE

The purpose of this study was to measure geographic variations in the availability and use of chiropractic under Medicare.

METHODS

A cross-sectional design was used to analyze a large nationally representative sample of Medicare data. Data from a 20% representative sample of all paid Medicare Part B fee-for-service claims for 2007 were merged with files containing beneficiary and provider data. The sample was restricted to adults aged 65 to 99 years. Measures of chiropractic availability and use were described and selectively mapped by state. Geographic variations were quantified. Spearman test was used to evaluate for correlation between chiropractic availability and use.

RESULTS

The average number of doctors of chiropractic (DC) by state was 1135; average DC per 1000 beneficiaries was 2.5 (SD, 1.1). The average number of chiropractic users by state was 34,502 (SD, 30,844); average chiropractic users per 1000 beneficiaries was 76 (SD, 41). Chiropractic availability by state varied 6-fold, and chiropractic use varied nearly 30-fold. Availability was strongly correlated with use (Spearman ρ, 0.86; P < .001). Expenditures per DC were highest in the upper Midwest and lowest in the far West; expenditures per user were highest in New England and New York, and lowest in the West.

CONCLUSION

Chiropractic availability and use by older adults under Medicare predominated in rural states in the North Central United States. Expenditures were higher in the East and Midwest and lower in the far West. Chiropractic availability and use by state were highly correlated. Future analyses should use small-area analysis and statistical modeling to identify factors predictive of chiropractic use.

Epidemiology: spinal manipulation utilization

The objectives of this article are to (1) describe spinal manipulation use by time, place, and person, and (2) identify predictors of the use of spinal manipulation. We conducted a systematic review of the English-language literature published from January 1, 1980 through June 30, 2011. Of 822 citations identified, 213 were deemed potentially relevant; 75 were included after further consideration. Twenty-one additional articles were identified from reference lists. The literature is heavily weighted toward North America, Europe, and Australia and thus largely precludes inferences about spinal manipulation use in other parts of the world. In the regions covered by the literature, chiropractors, osteopaths, and physical therapists are most likely to deliver spinal manipulation, often in conjunction with other conservative therapies. Back and neck pain are the most frequent indications for receiving spinal manipulation; non-musculoskeletal conditions comprise a very small percentage of indications. Although spinal manipulation is more commonly used in adults than children, evidence suggests that spinal manipulation may be more likely used for non-musculoskeletal ailments in children than in adults. Patient satisfaction with spinal manipulation is very high.

Biofield therapies in cardiovascular disease management: a brief review

Though there have been advances over the last 30 years in the therapeutic approaches to cardiovascular disease (CVD), heart disease and stroke remain the leading cause of mortality and morbidity worldwide. Many medical therapies for CVD are associated with a number of side effects, often leading patients to seek non-pharmacological treatments to complement standard care. Referred to as complementary and alternative medicine (CAM), these therapies consist of a heterogeneous group of modalities used in addition to conventional health care. Biofield therapies exist within this CAM domain and involve the direction of healing energy to facilitate general health and well-being by modifying the energy field. What follows is a brief overview of three biofield therapies developed or used within the field of nursing (Therapeutic Touch, Reiki, and Healing Touch), surveying the use of these interventions for individuals with CVD, and outcomes that may impact CVD risk factors and health-related quality of life.

A comparative study of complementary and alternative medicine use among heterosexually and lesbian identified women: data from the ESTHER Project (Pittsburgh, PA, 2003-2006)

OBJECTIVES

The prevalence of complementary and alternative medicine (CAM) use among women in the United States is high. Little is known about how CAM use may differ based on sexual orientation. Study aims were to measure the prevalence of CAM use in a community sample of women, explore differences in CAM use patterns by sexual orientation, and identify correlates of CAM use.

DESIGN/SUBJECTS

Analyses were based on women (Total N = 879; n = 479 lesbians) enrolled in the Epidemiologic STudy of HEalth Risk in Women (ESTHER) Project, a cross-sectional heart-disease risk-factor study.

SETTINGS/LOCATION

Data were collected through convenience sampling of adult females in Pittsburgh, PA (2003-2006).

OUTCOME MEASURES

Main outcome measures included lifetime and past 12-month CAM use, and types of CAM modalities used in the past 12 months.

RESULTS

The prevalence of having ever used CAM was 49.8%, with 42% having reported CAM use within the past 12 months. Lesbians had greater odds of having ever used CAM (adjusted odds ratio [AOR] = 1.68 [95% confidence interval (CI): 1.23, 2.28]) and of having used CAM in the past 12 months (AOR = 1.44 [CI: 1.06, 1.97]) than heterosexuals. In multivariate analyses, correlates of lifetime and past 12-month CAM use included being lesbian, white, higher educated, and a large-city resident; experiencing perceived discrimination in a health care setting; and having a greater spirituality rating and a history of a diagnosed mental health disorder. Past 12-month CAM use was also associated with having a provider of usual health care. Among women who used CAM within the past 12 months, heterosexuals had significantly higher yoga participation rates than lesbians.

CONCLUSIONS

Sexual orientation is important in understanding lifetime and past 12-month CAM use. Because of the high prevalence of CAM use found in this study, medical practitioners should inquire about the CAM practices of female patients, particularly lesbians.

Age-related patterns in mental health-related complementary and alternative medicine utilization in Canada

BACKGROUND

The aim of this study was to examine whether age-related differences in rates of use of complementary and alternative medicine (CAM) specifically for mental health problems parallel well-known age-related differences in use of conventional mental health services and medications.

METHODS

A sample of middle-aged (45-64 years; n = 10,762), younger-old (65-74; n = 4,113) and older-old adults (75 years and older; n = 3,623) was drawn from the 2001-2002 Canadian Community Health Survey (CCHS), Cycle 1.2, Mental Health and Wellbeing. Age-related utilization rates of conventional and complementary mental health services and medications/products were calculated. Logistic regression analyses were used to examine the strength of association between age group and utilization of services and medications or products in the context of other important sociodemographic and clinical characteristics.

RESULTS

When considered in the context of other sociodemographic and clinical characteristics, older age was positively associated with mental health-related utilization of alternative health products. Older age was not significantly associated with mental health-related consultations with CAM providers.

CONCLUSIONS

Overall, age-related patterns in mental health-related use of CAM did not directly correspond to age-related patterns in conventional mental health care utilization, suggesting different sets of predictors involved in seeking each type of care.

Efficacy and safety assessment of T. Angelica herbal tonic, a phytomedicinal product popularly used in Nigeria

T. Angelica Herbal Tonic (TAHT) is a herbal product indicated for indigestion and constipation and highly patronized in Nigeria. In this study, the efficacy and safety of the herbal tonic in relation to the label claims were assessed. The effect on peristalsis in mice was evaluated by the charcoal meal model and in vitro using guinea pig ileum. The effects of TAHT on behavior, fertility, birth and organ weights were also determined. Teratogenic potential and reproductive toxicity were studied in pregnant rats. Acute toxicity studies showed that at doses above 5000 mg kg(-1), the herbal tonic did not cause lethality and produced no signs of intoxication in mice. The study did not show any gross behavioral changes in mice treated with 1000 mg kg(-1) of TAHT as compared with the negative control treatment. TAHT (400 mg kg(-1)) exhibited a dose-dependent enhancement in the gastrointestinal tract motility in mice when compared with the negative control. At concentrations up to 300 μg mL(-1), TAHT did not cause any significant effect on acetylcholine, histamine and nicotine-evoked contractions of guinea pig ileum preparation. It took an average of 31.25 ± 4.52 days for the TAHT-treated animals to litter, which is significantly (P < .05) different from the 55 ± 4.51 days recorded for the control treatment group. TAHT exhibited a modest fertility-promoting effect and showed lack of abortifacient and teratogenic properties in the study. Generally, the results of this study showed some favorable pharmacological effects of TAHT in animals which may authenticate some of the label claims.

Daily use of complementary and other therapies for symptoms among older adults: study design and illustrative results

OBJECTIVE

This article describes research designed to specify complementary therapies used among older adults by obtaining daily use data and the specific purposes for use.

DESIGN

Two hundred African American and White participants completed a baseline interview and up to six sets of three daily-diary interviews at monthly intervals.

RESULTS

Participants provided retrospective information on complementary therapy use and information on the use of therapies for specific symptoms experienced across 3,070 person days. Retrospective information indicated that most participants used complementary therapies (e.g., 85.0% used home remedies in the past year). The use of complementary or other therapies and the number of days the therapies were used varied for specific symptoms. For example, home remedies were used on 86 (9.1%) of the 944 person days for which joint pain was reported.

DISCUSSION

The daily-diary design provides detailed information for delineating how elders include complementary and other therapies in their health self-management.

Spirituality, religion, social support and health among older Australian adults

AIM

To examine the impact of perceived importance of spirituality or religion (ISR) and religious service attendance (RSA) on health and well-being in older Australians.

METHODS

A cross-sectional survey of 752 community-dwelling men and women aged 55-85 years from the Hunter Region, New South Wales.

RESULTS

Overall, 51% of participants felt spirituality or religion was important in their lives and 24% attended religious services at least 2-3 times a month. In univariate regression analyses, ISR and RSA were associated with increased levels of social support (P < 0.001). However, ISR was also associated with more comorbidities (incidence-rate ratio= 1.2, 95% confidence interval 1.08-1.33). There were no statistically significant associations between ISR or RSA and other measures such as mental and physical health.

CONCLUSION

Spirituality and religious involvement have a beneficial impact on older Australians' perceptions of social support, and may enable individuals to better cope with the presence of multiple comorbidities later in life.

[Analysis of international application of complementary and alternative medicine]

Traditional Chinese medicine (TCM) is an important part of complementary and alternative medicine (CAM) in the world medical market. The basis of globalization of TCM was to make sure the current situation of CAM and the role that TCM plays. It will improve the application and reputation of TCM by analyzing the global usage rate, sort of diseases, social-demographic characteristics of users and medical economics of CAM.

Who Are the Users of Vitamin–Mineral and Herbal Preparations among Community-Living Older Adults?

Information on the characteristics of seniors who use supplements is lacking. A convenience sample of community-living seniors (n= 128) was recruited from 10 sites to identify factors associated with supplement use (vitamin-mineral and/or herbal preparations). Data on nutritional variables, health history, and supplement use were collected with an interview-administered questionnaire. APropensity to Use Supplementsscale was developed and was associated with increased use of herbal supplements. At the bivariate level, few characteristics distinguished users and non-users. Multivariate modelling revealed the Propensity scale and a low Body Mass Index to be factors related to the total number of supplements used. When individual scale items were examined at the bivariate level, food supply concerns, health beliefs, and a proactive role in one's own health were associated with increased supplement use. Initial results suggest seniors' attitudes towards supplements may be an important factor contributing to their decision to use supplements. Further work is required in a more diverse, randomly selected, older Canadian population.

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.

Community pharmacists' identification of natural health product/drug interactions in older persons

Objective

To document the prevalence and significance of potential natural health products (NHPs)/prescribed drug interactions in a sample of older adults; to determine whether community pharmacists detected these drug interactions; and to characterise users and non-users of NHPs.

Setting

The project involved 15 community pharmacists providing pharmaceutical care to 213 non-institutionalised older adults.

Method

The study was a subanalysis of a prospective, non-randomised, before-and-after trial of the provision of pharmaceutical care. Pharmacists documented each time medication-specific information or advice was provided to subjects. The numbers and types of NHPs that clients reported taking and the number of potentially significant NHP/prescribed drug interactions were determined. Whether pharmacists identified such drug interactions and made the necessary interventions were also documented.

Results

Forty-two NHPs were reported 96 times by 49 (23%) clients, most commonly glucosamine (n = 10), garlic (n = 10), prune juice (n = 9), and Ginkgo biloba (n = 6). There was a total of 446 possible NHP/prescribed drug combinations in the 49 clients, of which 53 (12%) were considered to be of potential clinical significance. Of these 53 combinations, three pharmacists identified four (8%) potential interactions in three different patients. Although gender, mean age and number of reported medical conditions did not differ between users and non-users of NHPs, users reported taking fewer prescribed drugs compared with non-users (5.0 ± 3.2 vs 6.0 ± 2.9, respectively, P = 0.043) and more non-prescribed drugs (4.2 ± 2.5 vs 2.1 ± 2.0, respectively, P &lt; 0.0001).

Conclusion

The reported prevalence of NHP and the potential for NHP/prescribed drug interactions in our sample of older adults were high. Pharmacists providing pharmaceutical care did not commonly identify potentially significant NHP/prescribed drug interactions.

Self-medication with over-the-counter drugs and complementary medications in South Australia's elderly population

Background

A number of surveys have examined use of complementary and alternative medicines (CAM) in Australia. However, there are limited Australian data on use of CAM and over-the-counter (OTC) medicines in the elderly population. The main aims of this study were to examine self-medication practices with CAM and OTC medicines among older Australians and variables associated with their use.

Methods

The Australian Longitudinal Study of Ageing (ALSA) is an ongoing multidisciplinary prospective study of the older population which commenced in 1992 in South Australia. Data collected in 4 waves of ALSA between 1992 and 2004 were used in this study with a baseline sample of 2087 adults aged 65 years and over, living in the community or residential aged care. OTC medicines were classified according to the World Health Organization Anatomical Therapeutic Chemical (ATC) classification. CAM were classified according a modified version of the classification adopted by the Therapeutics Goods Administration (TGA) in Australia.

Results

The prevalence of CAM or OTC use ranged from 17.7% in 2000-2001 to 35.5% in 2003-2004. The top classes of CAM and OTC medicines used remained relatively constant over the study period. The most frequent classes of CAM used were vitamins and minerals, herbal medicines and nutritional supplements while the most commonly used OTC were analgesics, laxatives and low dose aspirin. Females and those of younger age were more likely to be CAM users but no variable was associated with OTC use.

Conclusion

Participants seemed to self-medicate in accordance with approved indications, suggesting they were informed consumers, actively looking after their own health. However, use of analgesics and aspirin are associated with an increased risk of adverse drug events in the elderly. Future work should examine how self-medication contributes to polypharmacy and increases the risk of adverse drug reactions.

Herbal Product Use in a Patient with Polypharmacy

A 70-year-old homebound patient was experiencing new onset porthostatic hypotension and lightheadedness. The pharmacist conducted a thorough medication review, which revealed the use of several herbal products, including St. John's wort, in addition to several prescription medications. The pharmacist counseled the patient on the potential hazards of using herbal products with prescription medications. This prompted the patient to discontinue all herbal supplements with the subsequent resolution of his lightheadedness and orthostasis. He also experienced improvement in his pain control. Pharmacists need to be vigilant in establishing a dialogue with their patients about the pros and cons of herbal product use, particularly with prescription medications.

A longitudinal analysis of older Australian women's consultations with complementary and alternative medicine (CAM) practitioners, 1996-2005

OBJECTIVE

to determine the factors associated with complementary and alternative medicine (CAM) use among older Australian women over time.

METHODS

a longitudinal analysis of postal questionnaires completed in 1996, 1999, 2002 and 2005 as part of the Australian Longitudinal Study on Women's Health.

RESULTS

the percentage of women who consulted a CAM practitioner in the years 1996, 1999, 2002 and 2005 were 14.6%, 12.1%, 10.9% and 9.9%, respectively. Use of CAM increased as the number of reported symptoms increased and physical health deteriorated, for non-urban residents compared to urban residents.

CONCLUSION

use of CAM amongst older women appears to be strongly influenced by poor physical health. There is also a suggestion that lack of access to conventional health care providers increases CAM use. There is also an overall decline in the use of CAM among older women as they age.