1. Introduction and General use Wadie Najm, MD, MEd

2.  Aging  Orientation to Complementary and Alternative Medicine (CAM)  Use of CAM by the older adults  Use of CAM in different cultures/communities  Physician awareness of patient use UC Irvine- Reynolds Grant2

3.  US Census Bureau projections: Elderly population will more than double between now and 2050, to 80 million.  Much of this growth is attributed to the "baby boom" generation which is entering their elderly years between 2010 and 2030.  Older adults are becoming more racially and ethnically diverse. US Census Bureau 3 UC Irvine- Reynolds Grant

4. US Census Bureau 199 0 202 5 205 0 Age % Male % Female 4 UC Irvine- Reynolds Grant

5. U.S. Administration on Aging 5 UC Irvine- Reynolds Grant

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9.  7 /10 deaths each year are from chronic diseases.  In 2005, 133 million Americans (almost 1/2 adults) had at least one chronic illness.  Obesity has become a major health concern  About ¼ people with chronic conditions have 1+ daily activity limitations.  Arthritis is the most common cause of disability (nearly 19 million Americans).  Diabetes is the leading cause of kidney failure, non-traumatic lower-extremity amputations, & blindness among adults. CDC.gov UC Irvine- Reynolds Grant9

10. 10 CDC, National Center for Health Statistics, National Health Interview Survey, 2006.

11. UC Irvine- Reynolds Grant 11 www.ahrq.govwww.ahrq.gov 2006

12. UC Irvine- Reynolds Grant 12 www.ahrq.govwww.ahrq.gov 2006

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18.  Recommended by a friend or a relative. 55 (47%)  Prescribed, or referred by a health professional 35 (30%)  Media (TV, radio, newspapers, Internet) 27 (23%)  Literature10 (9%)  Practice it/involved with it 10 (9%) 18 Artus et al. BMC Family Practice 2007 8:26 doi:10.1186/1471-2296-8-26 UC Irvine- Reynolds Grant

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30. The number of supplements taken by U.S. adult supplement users, NHANES, 2003–2006, n = 9132. Bailey R L et al. J. Nutr. 2011;141:261-266 30 UC Irvine- Reynolds Grant

31. The prevalence of use of dietary supplements among U.S. adults ≥ 20 y by weight status, educational attainment, and race/ethnic group, NHANES 2003–2006. Bailey R L et al. J. Nutr. 2011;141:261-266 31 UC Irvine- Reynolds Grant

32.  525 community-residing elderly completed a 7-page questionnaire during a personal interview  Questionnaires were done in the person’s primary language of preference  Respondents ranged in age from 65 to 95 years old, with an average age of 73.7 (± 6 years). Fifty- five percent were women.  Two hundred and fifty-one (47.8%) reported using CAM during the previous year. UC Irvine- Reynolds Grant32 Altern Ther Health Med.Altern Ther Health Med. 2003 May-Jun;9(3):50-7.

33. UC Irvine- Reynolds Grant33 Altern Ther Health Med.Altern Ther Health Med. 2003 May-Jun;9(3):50-7.

34. UC Irvine- Reynolds Grant34 Altern Ther Health Med.Altern Ther Health Med. 2003 May-Jun;9(3):50-7.

35.  anonymous questionnaire survey among German health insurants  5830 respondents  mean age was 64.711.2 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. J ALTERN COMPLEM MED 2011, 17(6):487–489 35 UC Irvine- Reynolds Grant

36.  Use ◦ acupuncture/Traditional Chinese Medicine 21%, ◦ Homeopathy 21%, ◦ Movement therapies/physical exercises (MTPE)19%, ◦ Osteopathy 12%, ◦ Herbs/phytotherapy 7%, ◦ Specific diets/food recommendations 6%,  More women than men used herbs/phytotherapy (3.4X), 2.6 for homeopathy (2.6X), osteopathy (2.4X),  MTPE (1.5) and acupuncture (2.0) were of higher interest also in men. UC Irvine- Reynolds Grant36

37. UC Irvine- Reynolds Grant J ALTERN COMPLEM MED 2011, 17(6):487–489

38. UC Irvine- Reynolds Grant J ALTERN COMPLEM MED 2011, 17(6):487–489

39.  The GEM Study is a double-blind, placebo- controlled, randomized clinical trial evaluating the effectiveness of Ginkgo biloba (240 mg/d) in reducing the incidence of dementia -particularly Alzheimer’s disease- in older adults (75+; Age range was 75 -79)  At baseline, participants self-identified race: ◦ 95% White, ◦ 3% B lack, ◦ 1% Asian, ◦ 1% O ther; ◦ 1.2% Hispanics UC Irvine- Reynolds Grant39

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42.  Data from the 2002 National Health Interview Survey (NHIS)  27.7% of older adults use CAM, with the highest level of use among: ◦ Asians (48.6%), ◦ Hispanics (31.6%), ◦ Whites (27.7%), ◦ Blacks (20.5%). UC Irvine- Reynolds Grant 42 Ethn Dis 2006;16:723-731

43. UC Irvine- Reynolds Grant 43 Ethn Dis 2006;16:723-731

44. UC Irvine- Reynolds Grant 44 Ethn Dis 2006;16:723-731

45.  Socio-demographics,  Acculturation factors, and  Medical conditions.  Independent predictors of higher CAM use were: ◦ Female gender, ◦ Being on Medicaid, ◦ Frequent church attendance and ◦ Higher number of medical conditions.  In contrast, subjects who were born in US and spoke either Spanish or English at interview had lower CAM use compared with subjects who were born in Mexico. 45 UC Irvine-Reynolds Grant Loera J et al. 2007;13:224-231

46.  153 Chinese-American (NY)  Self-administered questionnaires and chart review.  Mean Age: 44.8±16.2 years; Females: 66%  93% were foreign born  94% used CAM: ◦ Megavitamin therapy (70, or 46%), ◦ Chinese herbal medicine (66, or 43%), ◦ Massage therapy (40, or 26%), ◦ Acupuncture (38, or 25%), and ◦ Spiritual healing (36, or 24%).  Predictors: women; employed, poor function & Less acculturated. 46 Psychiatric Services 58:402–404, 2007 UC Irvine- Reynolds Grant

47.  Rural Health and Nutrition (RUN) project, a 3 year ethnographic study conducted in 2 rural, central North Carolina counties  145 persons, aged 70 + included: ◦ African American (33%), ◦ European American (37%), and ◦ Native American (30%).  The sample was 39% male and 61% female.  About 1/3 had more than a high school education, ◦ 43% had less than a high school education, and ◦ 23% had the equivalent of a high school education.  Almost 44% stated that their health was poor or fair.  About 48% took < than three prescription medicines. UC Irvine- Reynolds Grant 47

48.  Rural older adults regularly used home and folk remedies.  Rural older adults regularly used vitamin and mineral supplements at levels higher than recommended for normal intakes.  Men and women did not differ in CAM use.  There were significant ethnic differences in CAM use. UC Irvine- Reynolds Grant 48 UC Irvine-Reynolds Grant

49.  HIV Ontario Observational Database [HOOD]  In person interviews  Seventy subjects, 40 males and 30 females  In patients using CAM, the physician was aware of only 37% of CAM agents used.  In the 55% of cases where the physician was unaware of CAM use, 96% of the time the physician had not inquired about use. UC Irvine- Reynolds Grant 49 Furler M, Abstract presented at CAHR

50. UC Irvine- Reynolds Grant 50 Saxe GA Integr Cancer Ther. 2008Integr Cancer Ther. 2008

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52. UC Irvine- Reynolds Grant 52 Int Med 1998; 1(4)

53. UC Irvine- Reynolds Grant 53 Int Med 1998; 1(4)

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55.  A high number of older adults are using CAM  People with chronic health conditions and functional limitations might be higher users of CAM  Use of CAM is prevalent among all ethnic groups and ages.  Physicians need to educate themselves about CAM modalities and the science  Physicians need to ask patients about CAM use and help guide them in their choices. UC Irvine- Reynolds Grant 55

56.  National Center for Complementary and Alternative Medicine: http://nccam.nih.gov/ http://nccam.nih.gov/  Dietary Supplements - Adverse Event Reporting http://www.fda.gov/Food/DietarySupplements/Alerts/ucm111110.htm http://www.fda.gov/Food/DietarySupplements/Alerts/ucm111110.htm  National Cancer Institiute- CAM http://www.cancer.gov/cancertopics/cam http://www.cancer.gov/cancertopics/cam  Office of Dietary Supplement http://ods.od.nih.gov/http://ods.od.nih.gov/  The Cochrane Database of Systematic Reviews http://www.cochrane.org/ http://www.cochrane.org/  Computer Access to Research on Dietary Supplements (CARDS) Database http://ods.od.nih.gov/Research/CARDS_Database.aspx http://ods.od.nih.gov/Research/CARDS_Database.aspx UC Irvine- Reynolds Grant 56

57.  Natural Standard http://naturalstandard.com/http://naturalstandard.com/  Natural Medicine Comprehensive database http://naturaldatabase.therapeuticresearch.com/home.aspx http://naturaldatabase.therapeuticresearch.com/home.aspx  American Botanical Council (ABC) http://abc.herbalgram.org/site/http://abc.herbalgram.org/site/  American Holistic Medical Association (AHMA) http://www.holisticmedicine.org/http://www.holisticmedicine.org/  Bravewell Collaborative for Integrative Medicine http://www.bravewell.org/http://www.bravewell.org/  Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) http://www.imconsortium.org/ http://www.imconsortium.org/ UC Irvine- Reynolds Grant 57