Abstract
Dear Editor:
The manifold studies on the usage of complementary and alternative medicine (CAM) indicate that its utilization differs with respect to the sociocultural background, gender, age, underlying diseases, and availability in the respective countries. 1 –9 Less is known about its usage in older adults, particularly reasons to choose among the various modalities. We intended to analyze this in a population of older German health insurance beneficiaries.
To avoid a biased recruitment of patients from specialized hospitals or wards with a strong focus on CAM, we analyzed data of an anonymous questionnaire survey among German health insurants. 10 Standardized questionnaires were provided to 20,000 randomly selected customers; 5830 sufficient data sets were returned (29%). Although most German customers are in a compulsory health insurance, we nevertheless chose a private insurance company because they cover CAM also. We asked for utilization of CAM treatments applied by medical doctors (MDs) or nonmedical practitioners (NMPs) within the last 5 years, and distinct CAM views with three response categories (applies; does not apply; don't know).
The respondents' mean age was 64.7 ± 11.2 years; 70% were men; most were living with a partner (82%) and had a high school education (53%); 9% had acute diseases, 9% cancer, 14% other chronic diseases, and 68% were healthy. Although women were younger than men (62.5 ± 13.0 versus 65.7 ± 14.4 years; p < 0.001, analysis of variance), they had significantly lower physical and mental health-related quality of life than men (Short Form 12 Health Survey Questionnaire [SF-12]: 46.0 ± 10.7 versus 48.0 ± 8.9, and 50.7 ± 9.6 versus 54.1 ± 7.2; p < 0.001). All relied on the expertise of MDs (>96%); within the last 5 years, 20% were also attending NMPs.
Among 13 different CAM treatments, acupuncture/Traditional Chinese Medicine was used by 21%, homeopathy by 21%, movement therapies/physical exercises (MTPE) by 19%, osteopathy by 12%, herbs/phytotherapy by 7%, specific diets/food recommendations by 6%, foot reflexology by 5%, and several other <5%. The five main relevant interventions applied by MDs were significantly more often used by women than men (p < 0.0001, Pearson's χ2 test); the ratio of women/men was 3.4 for herbs/phytotherapy, 2.6 for homeopathy, 2.4 for osteopathy, while MTPE (1.5) and acupuncture (2.0) were of higher interest also in men. MTPE was used predominantly during acute and chronic diseases (including cancer), while acupuncture, homeopathy, and osteopathy were more often used to treat chronic diseases (Table 1). In contrast, herbs/phytotherapy was used more often by patients with cancer.
All results refer to 100% of the respective group. Results are significant at ** p < 0.001, * p < 0.05 (Pearson's χ2 test).
Although praying should not be regarded as a CAM intervention, it was nevertheless assessed as an internal strategy (behavior).
MTPE, movement therapies/physical exercises; TCM, Traditional Chinese Medicine.
Facing unclear health problems, most patients would rely on both conventional medicine and CAM (Table 2). In most cases, it is not a disappointment with conventional medicine that results in a CAM utilization. Rather, it is true that they prefer CAM because they fear the side-effects of conventional medicine, and because of the conviction that CAM practitioners have more time for them or use “more profound” methods to treat the underlying causes of disease. Significantly more men than women would trust only treatments with a scientific rationale; in fact, 71% of men preferred conventional medicine because of this scientific rationale, as compared to 58% of women (Table 2).
All results refer to 100% of the respective treatment group (%); indecisive answers (“don't know”) were not presented (they can be calculated by adding the % of positive and negative statements). Results are significant at * p < 0.001 (Pearson's χ2 test).
Our data indicate that older adults were quite pragmatic and may use both CAM and conventional medication rather than making an ideological choice. It was striking that the usage of acupuncture was similar to that of homeopathy; both are alternative whole medical systems. Their usage might depend also on particular psychosocial profiles and convictions. In contrast to homeopathy users, acupuncture users were much more pragmatic and referred more often to an expected scientific background of chosen treatment. 10 Stepwise regression analyses revealed that the best predictors of acupuncture and homeopathy usage were the conviction that CAM is more profound and expends more time, fear of the side-effects of conventional medicine, and high scores in the measure of search for information and alternative help; negative predictors were physical health, male gender, age, and trust in a scientific rationale for treatments. 10 In fact, men would prefer treatments with a putative “scientific rationale” and thus were more likely to choose conventional medicine rather than CAM, but if they do choose CAM, they seem to prefer more “physical oriented” treatments such as MTPE (physical training) and acupuncture (needle insertion) instead of orally applied herbs and homeopathy.
Thus, the reasons to choose among the various CAM modalities are influenced by various factors, including gender-specific convictions. These should be considered in future studies. Moreover, one should be very clear which approaches were used in which population, and for which purpose. Although this study is just a first step, similar approaches from different sociocultural backgrounds are encouraged to complete the complex picture of CAM usage.
Footnotes
Acknowledgments
We are grateful to Die Continentale Versicherung (Dortmund) for their support. The authors thank Dr. David Lam, TATRC Brussels, for constructive comments!
Disclosure Statement
All authors are faculty staff of the University of Witten/Herdecke and disclose any commercial association that might create a conflict of interest in connection with the submitted manuscript. The health insurance company provided logistic and financial support to run the study and analyze the data. The authors were free to interpret the data according to a strict scientific rationale without any explicit demands of any company.