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Introduction and General use Wadie Najm, MD, MEd

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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

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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

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

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

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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 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

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

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

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

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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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The number of supplements taken by U.S. adult supplement users, NHANES, 20032006, n = 9132. Bailey R L et al. J. Nutr. 2011;141:261-266 30 UC Irvine- Reynolds Grant

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The prevalence of use of dietary supplements among U.S. adults 20 y by weight status, educational attainment, and race/ethnic group, NHANES 20032006. Bailey R L et al. J. Nutr. 2011;141:261-266 31 UC Irvine- Reynolds Grant

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525 community-residing elderly completed a 7-page questionnaire during a personal interview Questionnaires were done in the persons 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.

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

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

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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):487489 35 UC Irvine- Reynolds Grant

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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

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UC Irvine- Reynolds Grant J ALTERN COMPLEM MED 2011, 17(6):487489

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UC Irvine- Reynolds Grant J ALTERN COMPLEM MED 2011, 17(6):487489

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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 Alzheimers 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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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

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

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

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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

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153 Chinese-American (NY) Self-administered questionnaires and chart review. Mean Age: 44.816.2 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 58:402404, 2007 UC Irvine- Reynolds Grant

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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

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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

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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

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

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

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

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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

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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

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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