Complementary & Alternative Medicine and Healthy Living

CAM in Older Adults

It is estimated that by 2015, 50% of people with HIV in the U.S. will be over 50. As more people are aging with HIV, they are encountering the chronic health conditions that become more common at older ages. As a result, they are experiencing more complicated medication regimens. With increasing numbers of medications, the potential for interactions among conventional and CAM treatments increases.

Recognizing this potential, the American Association of Retired Persons (AARP) and the NCCAM teamed up in 2010 to examine CAM use among adults over 50. They found that 53% of older adults had used CAM and 47% had used it in the past year. Use of herbal and dietary products, which are most concerning from the standpoint of adverse effects, was the most common type of CAM reported (37%). Among those who had ever used CAM, 78% were using at least one prescription medication at the time of the survey, while 37% were using four or more medications. Among all older adults, 33% had talked with any health care provider about CAM. Among CAM users, that rate almost doubled to 58%. People who discussed CAM with a health care provider were more likely to talk about it with their physician than with any other type of provider, and they were much more likely than the health care provider to bring up the topic.

Among those who talked about CAM with a health care provider, the conversation focused on:

• Interactions between CAM and other medications (44%)
• Whether to start CAM (41%)
• The effectiveness of CAM (41%)
• What to use (40%)
• The safety of CAM (38%)
• Where to get more information about CAM (28%)
• Referrals to CAM providers (21%)

Among individuals who did not talk with their health care provider about CAM, a variety of reasons were cited:

• Health care provider never asked (42%)
• Didn't know they should (30%)
• Not enough time during the doctor visit (17%)
• Didn't think the health care provider knew about CAM (16%)
• Thought the provider would be dismissive or tell them not to use CAM (12%)
• Didn't feel comfortable talking with the provider about CAM (11%)

Researchers from Syracuse University and ACRIA used data from ACRIA's Research on Older Adults with HIV (ROAH) study to examine CAM use among people with HIV who were over 50. ROAH found that 28.8% of the sample reported CAM use, including:

• 13.9% using body-based CAM (such as massage or Reiki)
• 16.0% using mind/body-based CAM (such as acupuncture, yoga, or prayer)
• 11.7% using biologically-based CAM (such as herbs, supplements, or vitamins)

Consistent with prior research, whites and people with higher education, higher incomes, higher levels of pain, and lower levels of depressive symptoms were more likely to use CAM.

Among those who used CAM:

• 55.3% used some body-based CAM
• 63.2% used mind/body-based CAM
• 45.6% used biologically-based CAM

Among CAM users, use of body-based CAM was higher among women, LGBT people, and those taking HIV medications. Use of mind/body-based CAM was higher among LGBT people, those who felt they were in worse health, and those who were not taking HIV medications. Finally, use of biologically-based CAM was higher among non-LGBT people, whites, Hispanics, employed persons, people on Medicare, and people not taking HIV medications. These complex patterns reflect the diverse social and cultural influences on CAM use, as well as the fact that some individuals use CAM to enhance existing health and well-being while others use CAM to manage pain, symptoms, and the side effects of treatment.

The Future of CAM in HIV Care

The high levels of CAM use among people with HIV are likely to continue, and many CAM health behaviors most likely pose no risks. They are practices that can reduce stress, build fitness, and promote well-being. It is not clear that they need to be considered "medicine." Stress reduction may affect immune function, but these practices are part of a healthy lifestyle and need not be medicalized.

High levels of CAM use among people with HIV are likely to continue, and many CAM health behaviors most likely pose no risks. They are practices that can reduce stress, build fitness, and promote well-being.

However, some forms of biologically-based CAM may pose risks of drug interactions that could undermine health. More research is needed to determine which of these are safe and effective and which are not. More efforts need to be made to make sure that state-of-the-science information about the safety and efficacy of CAM is available to people with HIV. Health care providers must start conversations about CAM and be able to answer questions about it.

The NCCAM defines integrative care as the combined use of conventional medical care and CAM for which there is evidence of safety and effectiveness. This is a worthy goal to pursue for the sake of holistic health and well-being.

Andrew S. London is Chair and Professor of Sociology, and Co-Director of LGBT Studies, at Syracuse University.