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Complementary and Integrative Medicine in Older Adults
Katarina Friberg Felsted, Complementary and Integrative Medicine Special Interest Group member
Complementary and integrative medicine (CIM) is popular in the United States, especially-perhaps surprisingly-among older adults. Over a quarter of older adults (27%) utilize it in some form (Arcury, Suerken, Grzywacz, Bell, Lang, & Quandt, 2006). As life expectancy increases and older adults are faced with cumulative comorbidities and disabilities, their satisfaction with typical and customary medicine often wanes (Getz, 2011). Older adults often turn to alternative therapies to seek relief, either in conjunction with or instead of more traditional offerings (Cassileth, Gubili, & Yeung, 2009). CIM therapies tend to be less invasive than traditional medicine and have fewer side effects (Orzech, 2007).
As this trend in interest and use continues, more scientific research is being conducted. Structural support is building nationally: for example, the National Institutes of Health's National Center for Complementary and Integrative Health. Support is also building organizationally: for example, the Society of Behavioral Medicine's (SBM's) CIM Special Interest Group (SIG). Many academic and professional journals are also advancing the science of CIM. As this body of research grows, it intersects with another growing trend: team science. The scientific community is seeing an increase of interdisciplinary, multidisciplinary, and transdisciplinary collaboration. Within SBM, there are over 20 SIGs, and the increase in team science translates into cross-SIG opportunities.
CIM offers treatment and relief for issues and illnesses that are often the most common in an older adult population. Fatigue, cancer symptoms, chronic pain, mood disturbances, and the like are often addressed using effective complementary and alternative therapies. Studies along this vein encourage interaction between many of SBM's SIGs. Much attention is being paid to mind body therapies in older adults, such as yoga and mindfulness. These studies are encouraging in their findings, showing improvements in such varied arenas from decreased insulin levels to relief of bronchial asthmatic episodes (Kooperman & Ackerman, 2005). Additional chronic conditions and their symptoms are being treated with these modalities, including depression, anxiety, chronic fatigue syndrome, and symptoms of cardiovascular disease, type 2 diabetes, and rheumatoid arthritis (Merkes, 2010). Pertinent cross-SIG collaborations could appropriately be developed between the CIM SIG and the Cancer, Health Decision Making, and Multi-Morbidities SIGs. Often, researchers are finding that conditions that were assumed to be purely physiological in nature may also have some psychological etiology, and application of mind-body therapies is producing positive results. One such area is urinary incontinence. Previously believed to be a bladder problem, recent research is highlighting the likelihood that incontinence is caused, at least in part, by an abnormal psychological reaction referred to as catastrophizing (Baker, Costa, and Nygaard, 2012).
Catastrophizing is imagining the worst possible outcome and assuming that the negative outcome will actually be a catastrophe (Bailey, 2013). Irritable bowel syndrome has also been found to have substantial psychological components (Zernicke, Campbell, Blustein, Fung, Johnson, Bacon, & Carlson, 2013).
Mindfulness-based stress reduction, pioneered by Jon Kabat-Zinn in the late 1970s, is showing relief of both symptoms and bother when used to treat urinary urge incontinence in middle aged women (Baker, Costa, & Nygaard, 2012). For example, a recent trial found that an eight week course of mindfulness-based stress reduction significantly reduced urinary urge incontinence episodes in younger and middle aged adults, and this was still the case at the one year follow-up (Baker, Costa, Guarino, & Nygaard, 2014). Older adults are often marginalized in scientific research, and CIM is yet another instance where studies involving them as the target population could advance science considerably if they would be included. A study of mindfulness-based stress reduction as a treatment for urinary urge incontinence could be moved into the older adult population to see if results hold. In the future, complementary and integrative modalities may prove to be increasingly important to a variety of health issues in older adults. This area of research further encourages cross-SIG opportunities between the CIM SIG and Aging, Spirituality and Health, and Women's Health SIGs.