Understanding how older adults include different health care practices in their health self-management regimens is important for improving their health care resources, expectations, awareness, and priorities (Clark et al., 2008
). We have previously indicated that it is important to differentiate factors related to the use of specific complementary therapies, as distinct modalities likely have different behavioral, sociocultural, and cognitive antecedents (Arcury et al., 2007
). It is equally important to understand how older adults combine different types of complementary therapies within a health self-management regimen, as a specific complementary therapy is seldom used in isolation from other complementary therapies or other components of health self-management.
We delineate five patterned sets of complementary therapy use for health self-management among rural older adults. The determination of these five sets of complementary therapy use is based on the intersection of three dimensions in the use of complementary therapies: types of therapies used, mindfulness in therapy use, and sharing information about therapy use with conventional health care providers.
The older adults who participated in this study included care from conventional health care providers in their health self-management regimens. These older adults were not involved in alternative medical systems—such as Traditional Chinese Medicine or Ayurvedic medicine—that replace the use of conventional allopathic medicine. Although participants gave examples of limited substitution of complementary therapies for conventional medical care, for example, substituting vinegar for hypertension prescription medicine for 1 month, they seldom totally substitute complementary therapies for the use of conventional medical care. They also included over-the-counter medicine used as indicated on the label in their health self-management regimens.
Most of these older adults included home remedies in their health self-management regimens, many included contemporary supplements, and a few included complementary practices. We find in the discussions of these older adults three dimensions that differentiate how complementary therapies are integrated into self-management. The types of complementary therapies older adults use are an important, but not the sole, dimension that differentiates their set of complementary therapy use. The mindfulness that older adults have in their use of complementary therapies is important to health self-management. Those who are mindful are active in searching for information about their health and applying this information to their health self-management. Not surprisingly, women dominate this group. Some analysts have posited that the use of complementary therapies reflects a holistic health worldview (e.g., Astin, 1998
). These results provide some support for this position. The mindful complementary therapy users are looking for greater control of their health beyond conventional medicine, and most are using the resources available to them, including the Internet, to learn more about their health. Several of the participants, even those with low incomes, had computer and Internet connections that could be observed in their homes. Public libraries in each of the counties provide access to computers with Internet connections at no charge to users. These computers are intensively used.
In contrast, the nonmindful still include complementary therapies in their health self-management, and the level of complementary therapy use that they include can be extensive. Participant CAM015, an African American man whom we quote extensively, is an example of a nonmindful user of complementary therapies whose use was wide ranging in the number of therapies used and the number of years in which he used them. However, these individuals are not investing in learning about health or how specific therapies might affect their health. They are using remedies by rote that their parents used or by suggestion that their neighbors use. This nonmindful and often random use of complementary therapies makes helping older adults improve their health self-management challenging.
Survey data generally indicate that those who use complementary therapies also use conventional health care, often at higher levels than those who do not use complementary therapies (Eisenberg et al., 1993; Grzywacz et al., 2008
). At the same time, such data generally indicate that those who use complementary therapies do not tell their conventional care providers (Eisenberg et al., 1993
). The lack of discussion with conventional health care providers affects health self-management. We are not as much concerned here about the interactions of complementary therapies with prescription medicines as we are with health disparities of those who do not feel they can and should discuss their health self-management with their conventional health care providers. For example, Clark and colleagues (2008) find that the most socioeconomically vulnerable older adults are the least likely to discuss health self-management with their conventional health care providers. The most socioeconomically vulnerable older adults in this study are the least likely to discuss their use of complementary therapies with their conventional health care providers; they are nonmigrant African American women with less than a high school education. Those older adults who use complementary practices are the most likely to discuss complementary therapy with their conventional health care providers; these individuals are generally White, have a high school education or greater, and are return migrants or in-migrants.
This analysis focused on the use of complementary therapies among older adults who live in rural communities. This focus is based on historical differences in access to conventional health services in rural communities, and contemporary differences in the health care system of most rural communities compared with urban and suburban communities. At the same time, we find that only about half of these older adults are lifelong residents of rural communities. More than one third are return migrants, and about 15% are in-migrants who have been exposed to health care systems in metropolitan regions. Older adults in rural communities still have limited access to specialty conventional care (Bell et al., 2005
; Onega et al., 2008
). The interviews also indicate that these rural older adults have limited access to contemporary supplements and practices that they wish to use. Further, the characteristics of those involved in each set of complementary therapy use differ. The most prevalent sets of complementary therapy use among the “most rural” of the participants, those who had not migrated from the region, are mindful use of home remedies and nonmindful use of home remedies and contemporary supplements. Return migrants and in-migrants dominate in the mindful use of home remedies and contemporary supplements, and the mindful use of home remedies, contemporary supplements, and contemporary practices. This rural–urban difference in access to complementary therapies deserves further investigation.
This analysis reflects the limitations of qualitative analyses. Participants, although representative, were not selected randomly. Not being a random sample, statistics are not applied to test for differences, even when data, as in , allow for counts. However, with 62 participants, the sample is relatively large for a qualitative analysis. Procedures included recruiting participants from diverse sites in the counties to constitute a diverse, representative sample. Finally, the systematic approach to text analysis improves the validity and reliability of the results.
The complementary therapies that rural older adults include in their health self-management regimens are not independent events. The use of complementary therapies is patterned. These patterned sets of complementary therapy use give greater insight than a focus on individual remedies to the decisions older adults make in managing their health and their incorporation of different behaviors into their health self-management regimens.