Synonyms

Holistic medicine; Natural medicine; Nonconventional medicine; Unorthodox medicine

Definition

Complementary and alternative medicine (CAM) is an umbrella term used to describe a group of diverse medical and healthcare systems, practices, and products that are not generally considered part of conventional medicine, that have not been part of the public healthcare system or administered by conventional medical practitioners (Adams et al. 2009). There has been a noted increase in CAM use across all populations during the past 20 years (Andrews 2002), including older adults (aged over 65). Depending on how CAM is measured, studies suggest 40–65% of older adults use either some form of CAM therapy and/or over-the-counter CAM products (Cohen et al. 2002). Older adults have been identified as being significant consumers of CAM, and the factors that influence this use are varied and have unique implications compared to other cohorts.

Population Ageing, Chronic Illness, and Health System Responsiveness

Complementary and alternative medicine (CAM) is broadly consumed by older adults and its use is on the rise. CAM, and indeed health care in general, is being influenced by the demographic shift of the ageing population (Adams et al. 2009). It is predicted that there will be 1.5 billion individuals over the age of 65 by 2050, driven by decreasing fertility rates and improved life expectancy (World Health Organization 2011). This comes at the cost of increased economic and social pressures on a range of systems and infrastructure globally. How health services are consumed and provided is changing across both traditional and nontraditional services.

The ageing population will place particular strain on the health system with disease patterns moving from acute short-term, infectious or parasitic diseases to chronic long-term, noncommunicable diseases (Hale et al. 2007). As longevity increases, frailty and chronic illness rise as physical and cognitive capacities decline at the later stages of life (World Health Organization 2011). In particular, the demand for chronic care, rehabilitation services, and palliative care all increase with the ageing of populations (Hale et al. 2007).

Criticisms have been made of the existing medical system and the difficulty it will face catering to the increased demand on services due to changing disease patterns (Holman 2004). The current health system is typically focused towards treating acute illnesses that are episodic where the health practitioner typically has the majority of control in determining treatment and management approaches, and the patient is largely a passive recipient. It has been argued the traditional medical model of health care (that focuses on biological aspects of disease and illness) is less conducive to treating chronic illnesses where treatment is ongoing and long-term management of symptoms is often the goal, rather than seeking a cure. Due to the ongoing and often personalized experience of chronic illness, it is argued that the roles in treatment need to shift from the health practitioner having full control to provide the patient with more authority over their treatment plan, allowing them more responsibility and autonomy in management of their conditions (Holman 2004). The current model of healthcare delivery offers limited flexibility.

Chronic Illness and CAM Use

The ageing population is at increased risk of chronic health complaints illness (Cherniack et al. 2001). Older consumers are cognizant of the need to treat these health complaints, and it has been found that as health conditions deteriorate, CAM use increases (Cherniack et al. 2001). Indeed, CAM use is five times higher in the chronically ill population compared to a healthy population. In general, research completed with chronic illness populations have noted that CAM use rates are elevated and typically centered around management of health conditions (Cherniack et al. 2001).

Within the chronically ill population, the use of CAM has been linked to a belief that CAM is a “safer” option than conventional medicine with fewer side effects to conventional medicine (Vincent and Furnham 1996). Furthermore, CAM users have reported strong beliefs in the efficacy of the CAM product/service being consumed (Vincent and Furnham 1996). Practitioners who provide CAM services often have longer consultations and reportedly provide more personalized services than offered by conventional medical systems (Gammack and Morley 2004). This in itself has a therapeutic benefit that can be particularly useful in the treatment of non-life-threatening chronic illnesses.

The Active Consumer

Researchers have noted that the flexibility in services offered through CAM allows the individual to play an active role in the management of their long-term chronic disease (Bishop et al. 2007). CAM offers a different approach to the traditional biomedical model, and studies have shown it can provide a prevention-focused, flexible healthcare model for chronic and degenerative diseases (Bishop et al. 2007). While the need for conventional medicine is still undisputed, the argument that CAM offers a more versatile form of care when dealing with non-life-threatening and chronic ailments has merit and may assist in addressing the need created by the ageing population. This shift appears to be occurring as traditional health systems are not currently structured to cater for the increase in long-term chronic diseases that is occurring across the globe associated with population ageing (World Health Organization 2011).

Traditional medicine and CAM use are very much rooted in cultural contexts, and the legitimacy of both health treatment options is influenced by sociocultural perspectives (Root Wolpe 2002). The sociocultural context not only influences people’s perceptions of both traditional medicine and CAM but also the illnesses that trigger their use. In the literature surrounding health service provision, there is an expanding body of research attempting to describe a shift towards consumerism and the identity of health users (Milewa 2009). The typical health consumer now interacts with health services as an active participant, picking and choosing the products best tailored and personally suited to their needs rather than being a passive consumer. The ability to make personal decisions, select from a range of options, and make choices based on a sense of personal responsibility and shared decision making are valued by many patients. Patients who adopt this viewpoint are more likely to look for broader healthcare options beyond what is offered by traditional health service providers, including services offered by CAM.

With higher uptake of CAM use, there is increasing pressure for conventional medical practitioners to have knowledge about individual patients CAM usage. Historically, many doctors have not discussed CAM usage with their patients. Research has demonstrated that up to 77% of CAM users did not disclose their CAM use to their treating practitioner (Xue et al. 2007). CAM users who discussed their CAM use with their medical practitioner were more likely to describe themes of acceptance and control whereas CAM users who did not have these conversations were more likely to describe their treating physicians as narrow minded (Vincent and Furnham 1996). To add to this, general practitioners frequently underestimate the extent to which their patients use CAM (Nahin and Straus 2001). This is concerning as studies have additionally shown that patients often have a poor understanding of the effects of CAM. Harmful interactions have been found between some CAM products and conventional medicine approaches, e.g., herbal therapies and pharmaceutical therapies (Votova and Wister 2007).

The Third Age

Increasing longevity of life has contributed towards a period of time referred to as the Third Age, between postretirement but prior to age-imposed limitations such as illness (Weiss and Bass 2002). This growing generation in general has improved physical and mental health, greater wealth, and higher levels of education, with predicted longer life-spans than their predecessors. The Third Age provides a platform for older adults to explore personal growth, self-fulfillment, freedom, and personal engagement, with a noted increase in the desire to maintain health status and postpone the inevitable decline in health (Weiss and Bass 2002). Indeed, there is often an acute awareness of one’s mortality coupled with uncertainty about future health needs (Weiss and Bass 2002). The combination of increased resources and the time to use them has placed older adults in an optimal position to experiment with previously unexplored services and products, e.g., CAM. There is often a sense of responsibility for personal self-maintenance that promotes concepts such as awareness of medical conditions, proactive intervention, wellness techniques, self-care of diet and exercise, and new learning. With this combination of factors, an increase in CAM use among this population is understandable (Andrews 2002).

Antiageing Movements

Antiageing movements through media and marketing have additionally influenced the use of CAM through increased consumerism of antiageing products (Milewa 2009). There exists a marked increase of interest in products and services that are marketed as being able to slow down or even reverse the natural ageing process. Improvements in access and marketing that targets consumers through media such as the press, television, and Internet have contributed to this increased interest. While CAM services have increased broadly, there has been a particular boom in CAM technologies aimed towards antiageing with middle-aged and older adults being primary consumers (Weiss and Bass 2002). An increased focus on positive frameworks of growing older that include the denial of physical signs of ageing and the promotion of healthy active living has been witnessed. In particular, the chronological process of ageing has been reframed as a transition, emphasizing a distinction between chronological age and cognitive age of individuals.

Personal Motivators of CAM Use

Some researchers have categorized the motivators for individuals choosing to use or not use CAM as being in terms of push/pull influences. Pushes indicate factors that “push” an individual away from conventional medicine. Typically, these experiences are underpinned by dissatisfaction with conventional medicine, e.g., poor communication, adverse side effects, poor treatment options (Sirois and Gick 2002). Pulls in contrast indicate factors that draw the individual towards CAM, e.g., holistic approach, long appointment times, and perceived safety of the approach (Furnham 2005). Typically, there appears to be a mix of motivators that change over time and an interplay factors that influence whether an individual is a CAM user or nonuser. It is often the case that older adults use CAM in conjunction with conventional medicine, as a concurrent service to the management of their health care. Indeed, in some studies CAM users were found to consult with a specialist doctor more frequently than non-CAM users (Adams et al. 2003). The researchers hypothesized that this suggested a pragmatic approach to selecting treatments that “best fit” their health concerns.

Research on push versus pull factors has been varied and there is little consensus in the literature on which variables are consistently associated with CAM use in the past or future. For example, one found that personal control over health and dissatisfaction with conventional medicine were inversely related to CAM use (Testerman et al. 2004). In previous research however, criticisms of the existing medical system have been proposed to influence CAM use (Willison and Andrews 2001). A more recent study that found dissatisfaction with conventional medicine was positively correlated with past but not future use (McFadden et al. 2010). An important variable that is not always addressed in research is dissatisfaction with conventional medicine treatment versus dissatisfaction with the treating physician. For some individuals, there were high rates of satisfaction with their physician; however, they felt that the use of CAM would assist in relieving symptoms in a way that conventional medicine was not able to provide (Testerman et al. 2004).

A number of attitudinal dimensions have been identified as being related to CAM use. Those who are more likely to seek CAM have been identified as having a heightened awareness and commitment to environmental issues (Astin 1998; Kranz and Rosenmund 1998). Other attitudes that have been linked to CAM use include a belief in personal responsibility towards health and holistic healthcare approaches (Astin 1998). Holistic beliefs include views of the mind–body relationship as being in balance and maintained by self-healing. Some studies have noted that as holistic beliefs and health complaints increased, so too did CAM use, indicating that both personal beliefs about health care and a desire to relieve illness symptoms influence CAM use (Vincent and Furnham 1996). It has been proposed that conventional medicine, through focusing on the physical elements of a disease, fails to account for the person as a whole (Kranz and Rosenmund 1998). For individuals holding this perspective, CAM provides an appealing alternative.

It has been suggested that CAM users perceive that they have increased control over the active management and choices concerning their health (Astin 1998). Previous researchers have hypothesized that a desire for control (Astin 1998) and a sense of personal responsibility towards health and holistic healthcare approaches (Furnham and Kirkcaldy 1996) are important factors that influence an individual’s choice to use CAM. The desire to seek holistic, natural, and preventative approaches is often motivators for commencing CAM use (Kranz and Rosenmund 1998). A systematic review explored 94 studies that included themes of control, illness, holism treatments, natural treatments, and life philosophies and how they related to CAM use (Bishop et al. 2007). The researchers reported that a desire for participation in treatment decisions, active coping styles, and holistic approaches to health were all significantly related to CAM use, however control was not. Many of these studies use a cross-sectional design so directionality cannot be easily established to determine if beliefs about CAM use, active coping styles, and holistic approaches to health were formed before or as a result of CAM use. Other research has found positive relationships between personal control and CAM use for healthy individuals (McFadden et al. 2010). Testerman et al. (2004) did not find such a link but his population was recruited from a medical clinic. These studies demonstrate that the specific relationships between predictor variables are often complicated.

Structural and Sociodemographic Influences on CAM Use

There are also a number of structural and personal sociodemographic influences that influence frequency and type of CAM use (Kelner and Wellman 1997). The physical availability and access to CAM products, personal income, insurance plans, private health care, and distance travelled to access services have all been linked to CAM use (Kelner and Wellman 1997). Studies have consistently shown that CAM use is higher in rural and remote regions compared to urban settings (Robinson and Chesters 2008), and lower in Metropolitan areas compared to nonurban locations (Adams et al. 2003). This is an issue of particular concern to older adults as there are often mobility and driving restrictions that further complicate their access compared to younger cohorts (McLaughlin and Adams 2012). Difficulty accessing conventional health services in rural regions compared to urban areas may be influential in the decision to use CAM (Robinson and Chesters 2008). Indeed, the relationship between geography and location to CAM use is not as strongly established in the literature as other elements including health status, gender, income, and level of education. Connected elements to geography may include population of available clinicians, proximity of specialist services and range of services, socioeconomic status of the region and policies, and politics of the region (Adams et al. 2011). A number of studies specifically exploring older adult CAM use in rural settings found that CAM is used far more broadly than the treatment of existing health complaints, but also for maintaining current health status and well-being (Adams et al. 2003; Robinson and Chesters 2008).

Conclusion

The ageing population, the antiageing movement, and shifts in consumerism and disease patterns have all contributed to changing the way in which older adults consume traditional health care and CAM. CAM use amongst older adults is an increasing phenomenon that is uniquely impacted on by a number of broader cultural shifts. The combination of the ageing population and the rise of chronic illness requires all health providers, independent of their qualifications or personal beliefs, to recognize and be informed about the processes and factors influencing CAM uptake in the older population. There is a need for future research to investigate directional relationships to explain the mechanisms which influence decisions to adopt and maintain CAM therapies. This information will potentially provide guidance for healthcare service providers who seek to understand how CAM usage interacts with conventional medicine, and will help ensure that the most effective health-related outcomes for those in later life.