Older Adults Use of Medical and Alternative
Care
Beverly Wellman, Merrijoy Kelner and Blossom T. Wigdor
University of Toronto
Introduction
Interest in and use of complementary and alternative medicine
has been increasing dramatically in recent years. A significant proportion
of the population in Western society are now using unconventional forms
of health care (Astin, 1998; Eisenberg et al., 1993, 1998; Ernst, 1995;
McGregor & and Peay, 1996). In Canada, where alternative medical
care is not covered by the otherwise inclusive health care system, reports
estimate that at least 3.3 million people sought treatment outside of
the medical establishment in 1995 and have spent at least one million
dollars that were not reimbursed from provincial health plans (Statistics
Canada, 1995). While these are current estimates, much less is known
about older adults. This article provides a descriptive analysis of
older adults who are patients almost exclusively of conventional health
care and compares them with patients found at the offices of practitioners
of alternative health care (chiropractors, acupuncturists/traditional
Chinese medicine doctors naturopaths and Reiki healers).[1]
Research questions
In this study we ask: 1) Do older adults seek care for
their health problems from alternative practitioners, and if so, do
the alternative care patients differ in their social and health characteristics
from those who do not? 2) What are the pathways older adults follow
when they seek care from alternative practitioners and do these differ
from the pathways pursued by older adults who consult their family physicians?
Conventional medical care
Research has shown that a small segment of older people
accounts for a disproportionately large amount of the use of medical
services, particularly at the end of life (Kane & Kane, 1978; Roos,
Shapiro & Roos, 1984; Wolinsky, Mosely & Coe, 1986). While older
adults consult their physicians for acute as well as chronic problems,
many older persons underutilise physician services for chronic conditions
and preventive health care (Haug, Belgrave & Gratton, 1984; Levkoff,
Cleary, Wetle & Besdine, 1988). This may be because chronic conditions
are difficult to treat and many physicians do not offer preventive care
to the elderly. Older people often decide just to live with the
problem rather than continue to pursue medical care. Nevertheless,
Haug, Wykle and Namazi (1989) found that the faith of older adults in
physicians tends to be high, even though nearly half the people in their
sample claimed to have been in a situation where a physician made a
mistake in their care.
Alternative health care
Since older adults tend to have more chronic illnesses
than younger people (Kart, 1997; Marshall, McMullin, Ballantyne, Daciuk
& Wigdor, 1995; Verbrugge 1986), and the most common problems brought
to alternative practitioners are chronic in nature, ( Kelner & Wellman,
1997; Vincent & Furnham, 1996), we began this research with the
assumption that a high proportion of people who seek out alternative
therapies would be older adults. This is in spite of the understanding
that patients from earlier generations were devoted adherents to conventional
medicine. Previous research indicates that in general users of alternative
care are younger, predominantly female, well educated, relatively affluent
and less likely to be affiliated with formal religions (Kelner &
Wellman, 1997).[2]
Pathway Studies
Pathway studies make it possible to specify linkages between
different practitioners as patients negotiate their way to health care
(e.g., Strain, 1990). Instead of addressing the question of who uses
health care services, the emphasis here is on why and how an individual
seeks health care (Sharma, 1992; Zola, 1973). In order to shed light
on how people decide what kind of care they will seek, we examine the
influence of family, friends, lay others and health care providers (McKinlay,
1973; Pescosolido, 1986; Pilisuk & Park, 1986; Salloway & Dillon,
1973). Who people know and speak with about their health have been shown
t be important sources of information and connections to others who
may be of use (Valente, 1995).
Methods
The study population
In order to focus on the use of conventional and alternative
health care by older adults, we selected a subsample from a larger study
of 300 patients from 20 to 90 years of age conducted in 1994-95 (Kelner
& Wellman, 1997). The 77 older adults analyzed here were members
of the larger sample who were 55 years of age and over [14 in their
late 50's, 36 in their 60's, 20 in their 70's and 7 between the ages
of 80 and 90].
The original research project from which these older
adults were identified was designed to investigate the health care practices
of patients in Toronto, Canada who were consulting either family physicians
or one of four kinds of alternative practitioners (chiropractors, acupuncture/traditional
Chinese medicine doctors, naturopaths, and Reiki healers). These five
modes of treatment were chosen because they represent a spectrum of
the many types of services currently available in the Toronto area.
The choice of alternative services was designed to reflect the range
from the most widely accepted and legitimate (chiropractic) to one of
the least well known and least institutionalized (Reiki).
Sample
To identify the larger sample of patients, we used a multistage
strategy. In the first stage, we randomly selected four practitioners
from each of the five treatment modalities (5x4=20) to assist us in
enlisting patients to study. The selections were made from professional
listings obtained from each of four practitioner associations. In the
case of the fifth group, Reiki, which does not have a formal association,
we sampled randomly from local listings in alternative directories.
In cases where practitioners felt they were too busy or had insufficient
numbers of patients, further random sampling was used to contact additional
practitioners.[3]
Once the practitioner agreed to take part, we requested
that they enlist the first 15 patients from their appointment book for
a given day, or a series of days, until the required number was reached
(Because we had no direct involvement in the recruitment of patients,
we cannot be certain about the rate of refusal). Inclusion criteria
for the sample were that they: (1) be willing to be interviewed, (2)
be eighteen years of age and over, (3) speak English fluently enough
to sustain a long interview, and (4) be in sufficiently good health
to participate.
When a patient agreed to be interviewed by us, the practitioner
gave us the name and phone number and we contacted them to set up an
appointment in another venue. In this paper, we report only on the data
from the 77 patients in the study who were 55 years and over.
Data Gathering
Semi-structured interviews were recorded by hand and by
tape, and lasted an average of one hour. Interviews were conducted at
the patients' homes, their places of work, at our offices, or in coffee
shops -- but never on the practitioners' premises.
We asked patients to provide us with a personal health
history dealing with the primary health problem that brought them to
seek care from the practitioner in whose office we had located them.
To minimize selective recall of events and information, we focused in
detail on the most recent health problem that had brought them to treatment.
We also probed the process of decision-making that led to choice of
therapy and practitioner. In addition, we collected information on social-demographic
characteristics, as well as their health narratives concerning who referred
them for care, who they spoke with about their health, and the various
types of health care practitioners they had been consulting for their
problem.
To test the extent of skepticism about medical doctors
among the patients in our sample, we created a scale using five of the
eight questions from the World Health Organizations questions
on medical scepticism (Kohn & White, 1976). We eliminated those
questions closely correlated to each other and modified the remaining
questions to clarify the meaning. For example, people were asked on
a five point Likert scale from strongly agree to strongly disagree,
whether drugs that physicians prescribe are better than other remedies.
Data Analysis
Much of the data were derived from closed-ended questions
and were analysed using quantitative methods. The responses to the interview
schedule were entered into SPSS/pc. Because we were dealing mainly with
categorical measures of the social and health characteristics of the
patients, we used chi-square to identify (at the 0.05 level) significant
differences between the patients of family physicians and the patients
of alternative practitioners. Because of the small numbers who used
each type of alternative therapy, we compared the patients of family
physicians with the patients of all four alternative practitioners (grouped
together).
The open-ended questions in the interview schedule were
analysed using qualitative methods including content analysis and constant
comparison (Glaser & Strauss, 1967; Strauss & Corbin, 1990).
The exact words used by the patients provided the original codes for
organizing the responses. The codes were then refined and condensed
to provide the key themes conveyed by the patients. The health narratives
provided the data for the construction of the pathways.
Results
Distribution of Patients
The 77 older adults were distributed in a strikingly
unequal manner (Table 1). Very few, only 42 of the 240 alternative patients
in the total sample were older adults. In comparison, more than half
(35 ) of the 60 patients of family physicians were 55 years or more.
While the number of older adults seeing family practitioners and those
seeing alternative practitioners seem on the surface to be relatively
similar, it is important to realize that the relative percentages of
the two groups are widely divergent (18% versus 58%). The fact that
only a small percentage of older adults currently use alternatives has
also been identified in a recent newsletter of the National Advisory
Council on Aging (1997). The pattern changes, however, when we consider
the younger people in the sample. Many more people under the age of
55 (82%) were consulting alternative practitioners.
![](col_older_adults_use_of1.jpg)
Social Characteristics of the Sample
The 42 older adults who were consulting alternative practitioners
were distinctive in a number of ways (Table 2). They were more likely
to be female, have graduated from university, to be in managerial or
professional occupations and to have higher household incomes. They
were somewhat more likely to have been born outside of Canada and to
describe their ethnic origins as non-Canadian. They were also less likely
to have a formal religious affiliation, although a number of them mentioned
the importance of spirituality per se as a guiding force in their lives.
It is noteworthy that close to half (46%) of the older
adults are retired so that the impact of their illness on work is not
an issue for them. Furthermore, the difference in the ages of the family
physician group (mean = 69) and the alternative group (mean = 65) means
that many of the family physician patients have been retired for several
years while the alternative patents have just approached retirement
age.
Primary Health Problems
The patients of alternative practitioners were also
quite different in the nature of their primary health problems. Alternative
patients cited problems such as musculoskeletal (50%), and emotional
(10%) conditions as their primary reasons for seeking care. Although
there is some evidence that people use alternative therapies when they
have life-threatening illnesses such as cancer and AIDS( Pawluch, Cain
& Gilbert, 1994), few such illnesses showed up in this sample. The
family physician patients were seeking care mainly for cardiovascular
conditions such as heart problems, high blood pressure and high cholesterol
(43%) and digestive complaints (20%). By contrast, none of the alternative
patients reported cardiovascular conditions as their primary reason
for seeking care.
![](col_older_adults_use_of2.jpg)
Perceptions about Health
When it came to how they felt about the meaning of good
health, the older adults who were seeing alternative practitioners were
no different than the others. Two facets of good health were important
for them all. The most frequently mentioned (43%) was the ability to
function at a high level on a daily basis. This ability was also described
as "freedom to do what I want", " having energy and vitality",
and "thinking positively". The absence of symptoms such as
pain and discomfort was second in importance (29%). The primary concern
was ability to carry on daily activities.
The alternative patients were less likely to worry about
their health than were the patients of family physicians (24% of the
alternative patients said they had no worries versus 17% of the others).
Fewer of the alternative patients expressed the concern that their current
health problems would continue and possibly exacerbate over time (14%
of the alternative patients versus 25% of the rest).
Functional Disability and the Need for Care
The decision to adopt some kind of health care has been
linked to interference of an illness with daily life ( Mechanic, 1982;
Zola, 1973). There is a significant difference between the alternative
care patients and the family physician patients in their perceptions
of the degree to which their health problems were placing limitations
on their lives. While 90 per cent of the patients of alternative practitioners
reported that their disability was impinging on their ability to function
normally, only 60 per cent of the patients of family physicians said
their health problem was interfering with their lives on a daily basis.
In both cases, fatigue and physical limitations were the primary complaints.
One aspect of interference is an inability to carry out
work obligations. About one quarter (26%) of both groups found that
their problems made work harder, and another 10 per cent of the alternative
group said that they were actually compelled to miss work.
Functional disability also affects people's lives in terms
of the way they interact with their family and friends. Slightly more
of the alternative care patients (39% as compared to 31% of the family
physician patients) said that their disability made them less responsive
to their family and less able to carry out their family responsibilities.
Alternative patients also reported more limitations on their social
activities (49% compared to 37% of the family physician patients).
Consulting Medical and Alternative Practitioners
for Health Problems
The older adults in this study had all made the decision
to seek some kind of professional care, since it was through their practitioners
that we identified them. When their problems had first interfered with
their daily living, most indicated that they had tried some self-care
measures and had consulted with their informal health networks. Sooner
or later, they decided to seek care from a professional. The health
narratives of those who were consulting alternative practitioners reveal
that a majority (67%) had first consulted a physician, and that many
were subsequently sent to a number of medical specialists. When medical
care no longer seemed sufficient to help them with their condition,
alternative therapies provided an option. Most of these alternative
patients said that by the time they consulted an alternative practitioner,
their situation had deteriorated. In contrast, most family physician
patients said they went to their doctor soon after they became aware
of their symptoms. There was usually only a delay of a few days.
There was also a sizeable group (33%) of older adults
who went directly to alternative practitioners for their primary health
problem. This was especially true for chiropractic patients. Some of
these did so because they had previously had a successful experience
with alternative care. Others subscribed to what has been called the
"alternative ideology" (Pawluch, Cain & Gilbert, 1994);
that is, they had a different philosophy about the nature of health
and healing from that advocated by conventional medicine and were uneasy
about the use of drugs and surgery. Others had relatives, friends and
colleagues who strongly recommended not only a therapy but a practitioner.
The length and frequency of practitioner visits differed
for the two groups. Patients of alternative practitioners had been consulting
their practitioners for a relatively short time (mean = 3 years), compared
to family physician patients who had been seeing their doctors for a
much longer time (mean = 10 years). Family physician patients see their
doctors less frequently than the patients in the alternative group:
28 per cent of the family physician patients go more than once a month,
whereas over half (53%) of the patients of alternative practitioners
go more than once a month. This pattern is associated with the fact
that alternative treatments typically require numerous visits, at least
during the initial stages.
Our data show that the older adults consulted other kinds
of health practitioners for their health problems. In the case of family
physician patients, it was mainly other types of medical practitioners
and services to date. Only a very few had ventured to consult alternative
practitioners (mainly chiropractors) at any time. It is possible, however,
that some of these older adults will eventually decide to seek care
from an alternative practitioner if their health problems are not satisfactorily
resolved. However, there may be a group of older adults who will always
be too sceptical or too fearful of alternative care to ever consider
this option. By comparison, the alternative care patients had used a
wider range of types of alternative practitioners. The most frequently
consulted were: chiropractors, 93%; acupuncture/traditional Chinese
medicine doctors, 62%; naturopaths, 57%; homeopaths, 55%; physiotherapists,
52%; and herbalists, 50%.
The pattern of multiple use of health care providers also
extended to visits with family physicians. The great majority of alternative
care patients (86%) reported that they had a family physician and saw
him/her at least once a year. Half of these physician visits were for
annual checkups and monitoring of chronic conditions and medications.
Other health problems that prompted the alternative care patients to
consult family physicians were musculoskeletal conditions (10%), cardiovascular
problems (8%) and colds or "flu" (8%). Nonetheless, when examining
the health care pathways of the various patient groups, several patterns
of use became obvious.
Typical alternative pathways demonstrate a combination
of medical and alternative use. Moreover, those who use alternatives,
in addition to chiropractics, use several kinds of therapies and often
many therapists until they find the one that satisfies their needs.
For example, upon examining the pathway of a naturopathic patient who
is a 60 year old woman with a longstanding illness common to older people
(arthritis), it is notable that family physicians refer to specialists
and relatives and friends refer to alternatives (Figure 1). The typical
pathway illustrated by the case of this woman, transpired over ten years
and included a family physician, a specialist doctor, self care, lay
consultation and the use of a naturopath and a second naturopath. The
patient began with prescribed medications and cortisone shots. While
this tended to be effective at first, it became less so over time. When
these proved to be ineffective (about three years prior to the interview),
her sons friend recommended his naturopath. She changed her diet,
her pain disappeared and she began with a second naturopath only because
the first one moved out of the country.
A second example is also female (Figure 2). She is 62,
a patient who consulted an acupuncturist for care due to a stroke. Her
pathway included her family physician, a specialist doctor, a physiotherapist,
self care and lastly, an acupuncturist. Similar to figure 1, the family
physician referred her to a medical specialist, while a friend advised
acupuncture. In both cases, use of an alternative therapist did not
preclude the use of medical care for the same problem.
When we examined a third pathway of a Reiki patient
with cancer who is female and 60 years of age, we noted the use of many
medical doctors and two kinds of alternative therapists (Figure 3).
It is noteworthy that alternative therapists are the last ports of call
for help and not the first. This woman went from a specialist to another
specialist to a surgeon and used self-care before turning to a homeopath
and lastly a Reiki practitioner.
![](col_older_adults_use_of3.jpg)
By comparison, a typical physician patient pathway, although
it includes self-care and discussions with friends, is characterized
mainly by different types of medical care. The case of a family physician
patient demonstrates the concise pathway for a typical heart condition
problem (Figure 4). This man (77 years old) went to his family physician
on the advice of his wife, and then a second family physician after
the first one retired. He was then referred to a cardiologist who referred
him to a cardiac surgeon. The question is why do some patients stay
within the medical sphere, while some others seek help from alternative
practitioners?
Explaining Older Patients' Choices
The reasons for deciding to consult a family physician
or an alternative practitioner are reflected in the language that patients
use when they recount their health histories. Alternative care patients
express their ongoing search for help in statements like:
I prefer natural remedies that have no side effects
rather than the physician prescribed medications that didnt help
and only made things worse;
I had to find a way to deal with my problem. This
was a last resort --I saw every specialist and still no answer";
I feel the acupuncturist gets to the root of
the evil.
![](col_older_adults_use_of4.jpg)
Family physician patients tend to explain their decisions
to seek care more in terms of trust and belief in their doctor's authority
and expert skills. For example:
Everyone should have a family physician because
he knows your background. I put my trust in his decisions. I think hes
very knowledgeable and hes caring Ive always
gone to see a family physician whenever something I thought needed treatment.
Its a normal reaction to see a doctor. I rely on my doctor to
know if the problem is little or big; this is something only a physician
can confirm
There are two kinds of decisions required when people
make choices about using health care services. First, they must decide
which kind of therapy and then which practitioner to consult. The responses
of our older adult patients suggest that the two decisions often become
blurred into one and the choice of therapy and practitioner are made
simultaneously. For example, people may hear of a practitioner who has
been successful in relieving problems like theirs, and decide to consult
him/her whatever the type of therapy practised. Nevertheless, for purposes
of clarity, we present these choices separately here.
![](col_older_adults_use_of5.jpg)
Choice of therapy: When asked why they
chose their current therapy, the responses of the two groups of older
adults showed significant differences. The vast majority (83%) of the
family physician patients expressed a strong belief in medical care.
On the other hand, the reasons cited by the alternative patients were
varied: some (31%) made their choice on the basis of their belief in
the superior benefits of alternative care; another 12 percent reported
that they were influenced by a prior positive experience with alternative
care; others mentioned referrals from friends, family or other members
of their social network (36%) and still others said they were motivated
by a sense of desperation because they had not been able to find relief
through self-care or medical care (19%). Only one patient made the choice
of an alternative therapy on the basis of a referral from a physician.
Choice of practitioner: When it came
to selecting a particular practitioner, referrals by family, friends,
coworkers and others were the most important influence on both groups
of patients (family physician patients, 40%; alternative patients, 55%).
Referrals by another physician also had an important effect on the choice
of family physician by their patients (14%), as did a strong belief
in medicine (20%). In the case of the alternative patients, one quarter
(26%) of them made their choice on the basis of the practitioners
reputation. The information about these practitioners came from sources
such as newspapers, television or public lectures, since there are no
central registries of approved practitioners. Referrals from other alternative
practitioners also influenced the choice of some alternative patients
(10%).
![](col_older_adults_use_of6.jpg)
Someone to talk with: The older patients
in this study did not lack people to talk with about their health, nor
did they lack people who could supply them with relevant health information
(health informants). Indeed, alternative patients had more people to
talk to than did patients of family physicians and these health informants
were mainly family and friends. In the case of patients of family physicians,
family members comprised slightly more than half (55%) of the people
who provided some type of health support, while friends comprised only
about one-fifth (21%). Similarly, family also played an important role
for alternative patients, but friends generally provided an even larger
amount of support and information; just over a third (36%). It is important
to recognize that some alternative patients had medical doctors as well
as alternative practitioners (11%) as their health informants, whereas
patients of family physicians had only medical doctors.
Scepticism about Medicine: It is not
surprising that the two groups of patients differed in their views regarding
the ability of medicine to help them with their health problems. The
results of the modified World Health Organizations scepticism
scale (Kohn & White, 1976) showed that patients of alternative practitioners
were more doubtful about the practice of medicine (mean = 3.8) than
the family physician patients (mean = 2.6). Alternative patients proved
to be much more sceptical than physician patients with regard to the
following statements:
"For most kinds of illness, it is the physician
who can help you most (24% alternative patients versus 83% physician
patients agree);
"Drugs physicians prescribe are better than
other remedies" (80% alternative patients versus 20% of physician
patients disagree);
"If you follow a physicians advice you
will have less illness in your lifetime (22% alternative patients
versus 68% physician patients agree);
Physicians can prevent most serious illnesses
(14% alternative patients versus 40% physician patients agree);
"I doubt some of the things physicians think
they can accomplish (65% alternative patients versus 49% physician
patients agree).
Although the responses to the last two items show considerable
scepticism on the part of physician patients toward physicians' claims,
the alternative patients' scepticism is markedly stronger. These findings
support those of Furnham and Forey (1994) in Great Britain who similarly
found that patients of alternative practitioners were more critical
of the efficacy of medicine.
When asked who they thought could help them most with
their health problems, the alternative care patients replied that they
relied mainly on themselves. Over one third of them
said they believed that they alone would be the most helpful
and another fifth thought that they, in partnership with their practitioner
could help the most. The patients of family physicians, however, were
much more likely to subscribe to the belief that for most illnesses,
the physician would be the most helpful (83% vs. 24% of the alternative
care patients).
Discussion
Limitations of the study make it unwise to claim generalizability
for the findings. The sample of older adults is small and there is potential
bias in the choice of patients by practitioners since we were not in
a position to ensure that all practitioners enlisted their patients
exactly as we instructed them. We therefore make no claims that the
patterns revealed by the data are representative of the total population
of older adults. We believe, however, that the study yields important
insights and identifies some trends in the health care behavior of older
adults.
The findings suggest that there are only a few older people
currently turning to alternative therapies and practitioners for their
health care. This is in spite of the fact that older adults suffer predominantly
from chronic conditions which are the very kinds of problems that are
most often presented to alternative practitioners. Their reluctance
to try other options is undoubtedly related to the fact that this cohort
of older adults grew up believing heavily in the power of scientific
medicine and in the authority of experts like physicians. However, the
popularity of alternative care among younger people today may mean that
in the future, more people over 55 years of age will be using the services
of alternative practitioners. This study shows that those older people
who are prepared to venture into new territory and make use of non-insured
alternative health care services are distinctive in a number of ways.
There is a difference in the kinds of health problems
that older adults bring to alternative practitioners. They consult them
primarily for chronic problems such as arthritis or back pain which
they perceive as discomforting and intruding in their daily lives. The
patients of family physicians, on the other hand, turn to their doctors
for conditions which they feel are more worrisome and possibly life-threatening
(such as heart problems). These patterns suggest that people regard
more serious or life-threatening types of problems as the domain of
physicians who are perceive as authoritative experts, rather than consulting
alternative practitioners whose expertise is not so widely established.
The fact that alternative patients are less worried about their health
may also be related to the distinctive kinds of health problems for
which they seek non-medical care.
The two groups of patients also display different social
characteristics, with alternative care patients being better educated
and more affluent. The most obvious implication of these differences
is that alternative care patients have more disposable income to use
for uninsured health care. The older adults who chose to use alternative
therapies could more easily afford to pay the out of pocket expenses
required. These differences in social characteristics provide older
adults who use alternatives with more social capital; that is they are
better educated, have larger and broader social networks which provide
them with diverse kinds of health care information. All of these factors
combine to facilitate the use of alternatives by people with higher
social class status.
The pathways to care followed by the two groups of patients
were also different. At the beginning, the older adults in both groups
mainly consulted with their family physicians. In most cases, the family
physicians referred them to medical specialists. Most patients followed
the suggestions of their doctors but some felt that either they were
not being helped or they were not receiving the kind of support and
care they needed. These patients were encouraged to try alternative
care by family and friends and sometimes by other alternative practitioners
who had become friends in the process of caring for other health problems.
Here we see a pattern in which patients of family physicians get health
information primarily from family and physicians. Alternative patients,
however, have more sources to turn to for information; friends are more
important in the consultation process and so are other alternative practitioners.
The length of pathways was somewhat longer for alternative
patients who had tried more kinds of therapies and practitioners. Although
the pathways have been presented here in a linear fashion, it must be
remembered that patients were often using different therapies simultaneously
while at the same time giving consideration to using others and also
employing self-care measures. The findings of this study make it clear
that pathways to care are untidy and cannot be captured in an orderly,
organized picture.
Explaining why some of the older adults in this study
chose to consult alternative practitioners proved to be a complex process.
The findings show that there is no simple explanation for the appeal
of alternative therapies. For most, they offered hope for relief from
persistent chronic conditions, but the basis for this hope varied. Some
believed that alternative forms of care were more holistic and effective,
others had been helped with health problems before, still others heard
that friends or family members had been successfully treated, and some
chose alternative therapy out of a sense of desperation about alleviating
their discomfort. Moreover, the choice to use alternative services did
not mean that these older patients had decided to leave their physicians.
They typically maintained close ties with
them, in spite of consulting alternative practitioners
as well. It is clear that the choice of an alternative therapy cannot
be accounted for without understanding the meaning such a therapy has
for the individual user.
Conclusion
As the number of people who consult alternative practitioners
continues to rise, we can expect that a greater proportion of older
adults will use alternative health care in the future, probably integrating
it with conventional medical care. The potential spread of alternative
services has several implications for policies that affect older adults.
It will be important that reliable information be available about the
efficacy and safety of these services, both for the older adults who
may wish to use them and for the physicians who may recommend them for
chronic conditions. At the present time, research funds to establish
the validity of alternative therapies are only minimally available.
Government funding to carry our high quality research in this area should
be a priority for the future.
There is also an important role for government to play
in ensuring that alternative practitioners are adequately educated,
accredited and regulated. Regulatory bodies need to be established to
ensure that professional standards are developed and adhered to. For
a diverse field like alternative care, this is an enormous undertaking
and one that will require time, patience and a degree of cohesiveness
and co-operation that is not yet evident among alternative practitioners.
If satisfactory standards of quality control are established,
governments that support national health insurance may consider including
alternative services in insurance schemes for older adults. In the United
States, HMOs have begun to incorporate alternative services into their
health plans and most of the major national health insurance plans are
investigating the inclusion of alternative therapies (Weeks & Layton,
1998).
A recent report indicates that 78% of the older adults
in Canada have at least one chronic problem (Tamblyn & Perreault,
1998). The report also expresses concern that there is evidence of overuse
of prescription drugs among the elderly. One possible remedy for this
problem may lie in the increased use of alternative services to relieve
chronic conditions. If these alternatives are helpful, older adults
will be able to take an active part in the society without experiencing
the adverse consequences of over medication.
Increased use of alternatives by older adults in the
future has the potential to enhance their comfort and well-being, but
policy initiatives need to be developed that will ensure the effectiveness,
safety and accessibility of these unconventional health services.
List of authors' and co-authors' names, addresses,
etc
Beverly Wellman (Tel) 416 - 978 - 1787 (Fax) 416 - 978 -4771
(Email) bevwell@chass.utoronto.ca
Merrijoy Kelner (Tel) 416 - 978 - 1787 (Fax) 416 - 978 -4771
(Email) merrijoy.kelner@utoronto.ca
Blossom Wigdor (Tel) 416 - 978 - 4706 (Fax) 416 - 978 -4771
(Email) b.wigdor@utoronto.ca
Institute for Human Development, Life Course and Aging
University of Toronto
222 College Street, Suite 106
Toronto, Ontario M5T 3J1
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ENDNOTE
[1]. Chiropractic is a system of manipulation
of the spine and the joints based on the view that maladjustments of
the vertebrae interfere with the healthy operation of the nervous system.
Acupuncture works on the theory that meridians, or energy channels,
link inner organs to external points of the body. Treatment involves
applications of needles at external points along these meridians. Naturopathy
is based on the theory that therapy should mobilize the bodys
inherent capacity to heal itself. Treatment focuses on the whole person
and may include a wide range of therapies. Reiki healing emphasizes
the mind, body, spirit connection. Therapy consists of hands on, non-invasive
techniques which use universal life-force energy to deal
with emotional and other problems.
[2]. As yet, there is no consensus on
how best to describe this diverse set of non-medical health care therapies;
sometimes called alternative, complementary, holistic, unorthodox or
marginal. The common thread is that they do not focus solely on biomedical
processes, nor do they fit under the rubric of scientific medicine (Berliner
& Salmon, 1980; Levin & Coreil, 1986). While the form and content
of each alternative may be quite different, most share underlying concepts
of the body's natural ability to heal itself (Gevitz, 1988; Weil, 1995).
Alternative therapies tend to emphasize the harmonious integration of
body, mind and spirit, and regard disease as having dimensions beyond
the "purely biological". In this study we adopt the term 'alternative'
health care, to describe the multitude of therapies provided by non-medical
practitioners.
[3]. It was only necessary to approach
more practitioners for three of the five groups. For family physicians
and Reiki, we were obliged to contact eight practitioners in order to
enlist four. It was not too dissimilar for naturopaths; we contacted
seven to arrive at four.