The use of complementary and alternative medicine (CAM) in the USA is increasing rapidly, exceeding a prevalence of 60% in a nationally representative survey conducted by the National Center for Health Statistics in 2002 [1
]. CAM therapies are defined by the National Center for Complementary and Alternative Medicine as a group of diverse medical and health systems, practices, and products that are not currently considered to be part of conventional medicine [201
]. An alternative approach to mental healthcare is one that emphasizes the interrelationship between mind, body and spirit. A national US survey noted a 47% increase in total visits to CAM practitioners, from 427 million in 1990 to 629 million in 1997. These figures surpass the total number of visits to primary care physicians [3
]. Estimated expenditures for CAM professional services were conservatively estimated at US$21.2 billion in 1997, with at least US$12.2 billion of out-of-pocket expenditures, exceeding out-of-pocket expenditures for all US hospitalizations [201
]. In a more recent nationwide survey, 36% of US adults aged 18 years and over use some form of CAM, and aging baby-boomers are expected to accelerate the use of CAM in the coming years [5
Despite the increasing use of CAM by individuals, the scientific support for its efficacy is limited. The treatments with the best evidence of effectiveness are St John’s wort (SJW), exercise, cognitive behavior therapy and light therapy (for seasonal depression). There is only some degree of evidence to support the effectiveness of acupuncture, light therapy (for nonseasonal depression), massage therapy, negative air ionization (for winter depression), relaxation therapy, S
-adenosyl-L-methionine (SAMe), folate and yoga breathing exercises [6
]. The use of CAM therapies is typically associated with higher levels of education, poorer health status, environmentalism, feminism and interest in spirituality and personal growth psychology [7
]. CAM users tended to be female, younger, better educated and employed [8
]; however, older adults are also using CAM at increasingly higher rates. Barnes and colleagues noted that nearly 33% of older adults used CAM in the preceding year (2004) [5
]. In a survey, 42% of the patients in a managed care organization reported using at least one CAM therapy, most commonly relaxation techniques (18%), massage (12%), herbal medicine (10%) or megavitamin therapy (9%) [8
]. Perceived efficacy of CAM was very high, ranging from 98% (energy healing) to 76% (hypnosis). The most commonly used CAM approaches include prayer and megavitamin supplements.
Although some alternative approaches have a long history, many remain controversial owing to less than comprehensive research and poor integration of the Western and Eastern methods of diagnosis and treatment that are often mutually misunderstood and criticized. These practices encompass a diverse range of therapies and techniques but have in common a general lack of acceptance or use in traditional medical settings. However, with the increasing public use of CAM for preventive and therapeutic purposes, including a very active ‘antiaging’ movement, a significant effort is now devoted to the integration of alternative methods of treatment into mainstream healthcare practice and research. The principal uses in older adults include stress reduction, antiaging effects of CAM for prevention of diseases of aging, memory enhancement and treatment of various neuropsychiatric disorders, such as depression, anxiety, insomnia, pain and many other specific indications. Our review is devoted to the description of the existing CAM treatments applied to the care of older adults with neuropsychiatric illnesses that include late-life mood and cognitive disorders.
To identify articles related to this subject, we conducted a systematic search of the MEDLINE database and of Cochrane Database of Systematic Reviews for English articles published in the past 10 years using the following keywords: late life, depression, dementia, memory, cognition, sleep, complementary medicine, omega-3 fatty acids, hypericum, SAMe, acupuncture, ayurveda, massage, energy therapies, therapeutic massage, yoga and herbal remedies, diet, art (music and dance) therapy and spirituality/prayer.