Many older adults are turning to complementary and integrative health approaches, often as a reflection of a healthy self-empowered approach to well-being. Natural products often sold as dietary supplements are frequently used by many older people for various reasons despite safety concerns or a lack of evidence to support their use. Although there is a widespread public perception that the botanical and traditional agents included in dietary supplements can be viewed as safe, these products can contain pharmacologically active compounds and have the associated dangers.
Mind and body practices, including relaxation techniques and meditative exercise forms such as yoga, tai chi, and qi gong are being widely used by older Americans, both for fitness and relaxation, and because of perceived health benefits. A number of systematic reviews point to the potential benefit of mind and body approaches for symptom management, particularly for pain. However, research on these mind and body approaches is still hampered by methodological issues, including a lack of consensus on appropriate controls and lack of intervention standardization. While much of the clinical data is inconclusive, these approaches may help older adults maintain motivation to incorporate physical exercise into their regular activities.
This issue of the digest provides information on complementary and integrative health approaches for conditions clinically relevant to older adults.
Condition and Summary of Current Evidence
In 2012, the American College of Rheumatology issued recommendations for using pharmacologic and nonpharmacologic approaches for OA of the hand, hip, and knee. The guidelines conditionally recommend tai chi, along with other non-drug approaches such as manual therapy, walking aids, and self-management programs, for managing knee OA. Acupuncture is also conditionally recommended for those who have chronic moderate-to-severe knee pain and are candidates for total knee replacement but are unwilling or unable to undergo surgical repair.
The preponderance of evidence on glucosamine and chondroitin sulfate—taken separately or together—indicates little or no meaningful effect on pain or function. Independent clinical practice guidelines published in 2012 by the American College of Rheumatology (ACR), and in 2010 by the American Academy of Orthopaedic Surgeons (AAOS) recommend not using glucosamine or chondroitin for OA. Recommendations from Osteoarthritis Research Society International (OARSI) published in 2014 conclude that current evidence does not support use of glucosamine or chondroitin in knee OA for disease-modifying effects, but leave unsettled the question of whether either may provide symptomatic relief.
Although a few trials of natural products, such as ginkgo biloba and omega-3 fatty acid supplements, for the prevention of cognitive decline or dementia have shown some modest effects, direct evidence is lacking.
Evidence suggests that using relaxation techniques before bedtime can be helpful components of a successful strategy to improve sleep habits. A 2006 practice parameter report published by the American Academy of Sleep Medicine concluded that several psychological and behavioral interventions, including relaxation training, stimulus control therapy, and cognitive behavioral therapy are effective, and recommended inclusion of at least one in initial treatment strategies for chronic primary and comorbid (secondary) insomnia.
Current evidence suggests that melatonin may be useful in treating several sleep disorders, such as jet lag, delayed sleep phase disorder, and sleep problems related to shift work. However, melatonin can have additive effects with alcohol and other sedating medications, and older people should be cautioned about its use.
Overall, evidence suggests that some mind and body approaches, such as yoga, tai chi, and meditation-based programs may provide some benefit in reducing common menopausal symptoms.
Many natural products have been studied for their effects on menopausal symptoms, but there is little evidence for their efficacy. While some herbs and botanicals are often found in over-the-counter formulas and multi-supplement preparations, many of these combination products have not been studied. Further, because natural products used for menopausal symptoms can have side effects and can interact with other botanicals or supplements or with medications, research in this area is addressing safety as well as efficacy.
Although several small studies have suggested modest benefit of saw palmetto for treating symptoms of BPH, a large study evaluating high doses of saw palmetto and a Cochrane review found that saw palmetto was not more effective than placebo for treatment of urinary symptoms related to BPH.
There is some evidence that natural products such as antioxidant vitamins and minerals may delay the development of advanced age-related macular degeneration (AMD) in people who are at high risk for the disease. However, other studies of vitamin E and beta carotene supplementation did not show benefit in preventing the onset of AMD.
There have only been a few studies on the effects of tai chi on cell-mediated immunity to varicella zoster virus following vaccination, but the results of these studies have shown some benefit.