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NCCIH Clinical Digest

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Complementary and Integrative Health for Older Adults

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April 2015
An elderly man and woman sit at a table next to a window talking, with mugs on the table before them.

© Yuri Arcurs

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

Osteoarthritis

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.

Read more about the evidence-base of mind and body approaches for osteoarthritis

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.

Read more about the evidence-base of natural products for osteoarthritis

Cognitive Decline and Alzheimer’s Disease

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.

Read more about the evidence-base of natural products for cognitive decline and Alzheimer’s disease

Sleep Disorders

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.

Read more about the evidence-base of mind and body approaches for sleep disorders

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.

Read more about the evidence-base of natural products for sleep disorders

Menopausal Symptoms

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.

Read more about the evidence-base of mind and body approaches for 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.

Read more about the evidence-base of natural products for menopausal symptoms

Benign Prostatic Hyperplasia (BPH)

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.

Read more about the evidence-base of natural products for benign prostatic hyperplasia

Age-Related Macular Degeneration

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.

Read more about the evidence-base of natural products for age-related macular degeneration

Herpes Zoster (Shingles)

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.

Read more about the evidence-base of mind and body approaches for shingles

Clinical Guidelines

Scientific Literature

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH's Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH Web site at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

Copyright

Content is in the public domain and may be reprinted, except if marked as copyrighted (©). Please credit the National Center for Complementary and Integrative Health as the source. All copyrighted material is the property of its respective owners and may not be reprinted without their permission.

This page last modified May 02, 2017