Health in older adults

DEFINITION: Complementary and alternative medicines and therapies that are focused on older adults.

Overview

The health and functionality of older individuals can be highly variable. As humans age, the prevalence of chronic conditions, such as high blood pressurehypertensioncataracts, arthritis, and diabetes, increases. Complementary and alternative medicine (CAM) gained popularity among older adults treating illnesses in the first two decades of the twenty-first century. Populations with a higher incidence of illness benefit from evidence-based medicine (EBM), with CAM as a secondary treatment method, not the primary. Most older persons who use CAM do so as a complement to standard medicine, not as a substitute.

Some studies show that CAM use in older adults is associated with poorer overall health, although people with life-threatening conditions are more likely to use CAM. Prescription medications and surgery, the main conventional treatments, are often lifesaving, but in individuals with multiple chronic conditions, special risks exist because medications and CAM treatments may interact poorly.

Although many adults over sixty-five are physically and mentally healthy, some individuals experience chronic diseases such as arthritis, heart disease, cancer, and diabetes in their retirement years. Some people develop these diseases earlier, are successfully treated, and live full and productive lives. Their illnesses are manageable or, in some instances, cured. Others experience only minor illnesses throughout their lives but develop chronic conditions as they age. Some get older without having any serious conditions. Still, others develop debilitating illnesses at relatively young ages, minimally respond to treatment, and enter their retirement years with limited mobility and independence. Nonetheless, many people who reach age sixty-five are frequently healthy.

Even for healthy adults, physical changes occur with age. The organs become less efficient—the kidneys take longer to filter waste from the blood, lung capacity decreases, and the immune system weakens. Variation in health among individuals, however, is large. A person’s chronological age does not necessarily indicate that person’s level of health or functionality. Still, older adults differ from younger people because they are more likely to have chronic conditions. Acute diseases, such as colds and influenza, decline with age.

Using CAM

Older adults and the very young children under the age of five use conventional medicine more than other age groups. It remains unclear which age group is most likely to use CAM. All age groups, however, are increasing their use of CAM, but older adults still appear somewhat less likely to use CAM than other age groups. Estimates of CAM use by elders vary from 30 to 66 percent across surveys, in part because studies consider different CAM therapies. It is difficult to estimate CAM use by seniors because some research studies do not report age differences, while others use a variety of age cut-offssuch as fifty-two-plus, sixty-five-plus, and seventy-seven-pluswhen studying older adults.

Seniors usually use CAM in addition to standard treatments. That is, they use complementary therapies to alleviate symptoms and pain, manage the side effects of conventional treatment, or find a cure. Most older adults do not use alternative therapy alone. Instead, they use alternative therapy as a complement to standard medicine. This is true for most people, regardless of age, in the United States and other developed countries.

Demographics

A study of mostly U.S.-focused research examined the demographics of CAM users. The study found CAM users are more educated than the general population but are not necessarily higher earners. This pattern also holds for older adults. One reason older adults use CAM less often may be that many are less educated than younger adults. Educated persons are often informed consumers who also tend to seek information about topics with which they are unfamiliar. For many in the United States, CAM is little known.

The importance of income in determining CAM use is less clear, and it appears to play a role independent of education level. It is also not certain if older women are more likely to use CAM therapies than older men, although CAM use is higher among younger women than younger men. CAM use based on one’s ethnicity also does not fall into a clear pattern.

CAM is often used by people with chronic conditions. Because older adults frequently experience chronic conditions, some will use CAM. CAM is also more likely to be used by people with multiple health problems. CAM use is associated with poorer overall health in all age groups, although people with life-threatening conditions do not appear more likely to use CAM. There is no strong evidence that, for example, people with cancer are more likely to use CAM. Older people who only use CAM tend to be younger and healthier than those using only standard medicine or a combination of standard medicine and CAM. Older CAM users tend to be more health conscious or more seriously ill than non-CAM users.

Attitudes and one’s philosophy of life play only small parts in determining CAM use by older people, although these factors were found to be more significant for younger adults. Older adults are more likely than younger adults to say they want their doctors to make health decisions. It appears that adults over sixty-five use CAM, which is often a pragmatic decision based on health status and the desire to alleviate symptoms rather than on philosophy and interest in cultural alternatives.

Evidence-Based Medicine

Evidence-based medicine (EBM) is a growing movement focused on the use of empirical scientific standards to evaluate treatments. EBM encourages health professionals to use treatments that have been shown by careful study to be effective. At its best, EBM promises high-quality research of CAM modalities and conventional medicine. Because older adults have more health problems, are often taking multiple medications, and are more likely than other age groups to develop conditions for which surgery is the most common treatment, evidence-based research is especially important for this age group.

For many CAM modalities, evidence of effectiveness is limited. There is also little evidence for the effectiveness of some conventional therapies. One example is chronic back pain, which affects more older adults than younger adults. Back pain is one of the most common conditions for which seniors use CAMother conditions are arthritis, heart disease, allergy, and diabetes. Research suggests that back surgery may be overused and that the more invasive types of back surgery become increasingly risky with age.

Research in the late 2010s through the mid-2020s indicated that the most commonly used CAM treatments for back pain include acupuncture, spinal manipulation including chiropractic, yoga, and herbal remedies. Yoga's benefits in older adults show promise for improving mood, relieving stress, and increasing mobility, balance, and strength, which all play a role in continued independence at an advanced age. However, yoga also offers a social benefit for older adults that is critical for health.

Another CAM modality that received initial, though inadequate, study is homeopathy. A 2009 study of persons with chronic low back pain who were followed for two years found that the subjects showed significant improvement and decreased use of prescription medications. Because older adults are more likely to have low back pain than younger persons, continued research on various treatment modalities for this health problem might have benefits for this age group.

EBM is still relatively new and sometimes meets resistance from both conventional and CAM practitioners. The latter sometimes argue that CAM therapies are not taken seriously by conventional doctors, even when evidence of their effectiveness exists. A 2005 article on chiropractic practices suggested that EBM was mostly used to justify the use of conventional medicine. The process of determining what treatment modalities are effective can be expected to continue slowly and contentiously.

Other research concerning CAM's benefits in individuals of retirement age indicates some supplements are beneficial to maintaining health, mainly if the individual is deficient in a particular vitamin or mineral. Vitamin E, Ginkgo biloba, omega-3s, and many more supplements have been proposed for individuals in this age group. Additionally, practices like meditation and aromatherapy may offer some health benefits for older adults.

Careful evaluation of the evidence for treatment is superior to giving treatment for which little or no evidence of effectiveness exists. The greater incidence of illness and treatment of older adults means they will especially benefit from the further development of EBM.

Treatment Types

The main conventional treatments for all persons are prescription medications and surgery. Both are often lifesaving, but each treatment modality has some special risks for individuals of a particular age. CAM could prove to be one way to address these risks.

Because rates of illness increase with age, older adults are more likely to take multiple medications. Interactions among these medications are often unknown, even if there have been effective studies of the individual drugs. Conventional drugs often are not tested on older adults, even though they take more of them than their younger counterparts. Thus, scientific evidence on prescription drugs that is specific to this group is sparse. The need for evidence-based CAM is critical in the case of older adults who take many medications because CAM can reduce the chances of drug interactions, such as when massage is used instead of medication for back pain. Some CAM treatments interact with conventional medications. One example is St. John’s wort, an herbal preparation often used to treat depression. This preparation can interact with antidepressants such as alprazolam (Xanax).

Older adults are also more likely than younger adults to have conditions that require surgical treatment. Surgical technologies and methods improved significantly in the late twentieth and early twenty-first centuries, increasing the chances of safe and successful surgeries for high-risk individuals. The age at which surgical treatment remains a viable, safe option continues to increase.

Surgery, however, is always risky, and individuals over the age of fifty are at greater risk than younger people. Chronic high blood pressure, multiple chronic conditions, and a weaker immune system can make surgery more dangerous and can lead to a longer recuperation time. Effective alternatives to surgery are particularly beneficial for older adults. Less healthy individuals over the age of sixty-five have an increased risk of complications and morbidity from surgery. The possibility of cognitive decline in seniors who are surgically treated also remains a concern. However, a 2021 study indicated that only ten percent of older adults experience long-term cognitive decline after surgery. This issue requires further study. The effect of CAM in aiding postsurgical healing also deserves increased research.

Evidence on all medical modalities, CAM and conventional, is particularly inadequate for older people. The aging American population and societies worldwide underscore the critical need for continued research.

Bibliography

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