The subject of CAM is important for this elderly cohort because the use of CAM and traditional healers are often anecdotally mentioned in presentations but frequently not supported by empirical data. The data that is available includes samples of the elder population.
Prevalence of CAM
About 1 in 3 people in the U.S. are estimated to use some type complementary/alternative medicine for chronic illness, which includes use of herbal medications as well as alternative therapies such as chiropractic, acupuncture, and massage (Eisenberg, Kessler, & Foster, 1993). Herbal therapy is known to be one of the most frequently used a form of complementary medicine used in the U.S. (Bruno & Ellis, 2005). Two national studies revealed that 12.1% and 9.6% of the US population used a form of herbal therapy in the previous year (Eisenberg, Davis, Ettner, Appel, Wilkey, Van Rompay et al., 1998).
A more recent national study revealed that the use of herbal remedies were highest among women, Hispanics, and non-Hispanic ethnic minorities (Bruno & Ellis, 2005). In this same study findings revealed that elderly used specific herbal remedies for conditions such as liver dysfunction, urinary and prostate problems, irritable bowel, depression and thyroid conditions to name a few.
The elderly in this study believed that taking the herbal remedies along with their prescribed medicine would be helpful while others tried herbal remedies out of curiosity (Bruno & Ellis, 2005). Despite the reasons for taking the herbal supplements about half of the study participants did not discuss this use with their medical provider thus it is important for medical providers to ask their elderly patients whether they use herbal supplements or other alternative medicines.
In a study of CAM use among older Californians, 50% of the 40 Hispanic elders in the sample reported using some type of CAM, but the type was not reported (Astin, Pelletier, Marie, & Haskell, 2000). Hunt, Arar, & Akana (2000) report that when the use of herbal remedies, traditional healers, and the use of health-related religious beliefs, are studied, it is usually only the frequencies of the beliefs and practices that are reported rather than looking at the importance of these treatments or methods to individual health care and how the use affects the utilization of biomedical treatments.
Healing Systems and Techniques
As defined in Villa et al., (1993) within the various Hispanic/Latino groups, healing systems/techniques include:
Healers within these defined systems include:
- Curanderos (general practitioners of Mexican folk healing)
- Espiritistas (Puerto Rican faith healers)
- Santeros (Cuban faith healers)
- Yerbistas (herbalists)
- Sobadores (massage therapists)
Studies which have discussed the use of these healers and/or systems have not solely studied the aged population of Hispanic/Latinos, however the elderly population have been included in the study cohorts (Higginbotham, Trevino, and Ray, 1990). There continues to be mixed data regarding use of these alternative healers and systems (Villa, et., al., 1993).
Use of Folk Medicine Healers
HHANES Study: In 1990, the classic HHANES study on the utilization of curanderos by Mexican Americans found only 4.2% of this group reported using a curandero, yerbista, or other folk medicine healer, whereas another study conducted in the metropolitan area of Denver, Colorado found 18.5% used a curandero in a 5 year period (Padilla, Gomez, Biggerstaff, Mehler, 2001). Both of the above studies incorporated elderly within their samples.
Texas: In a qualitative (N=43) study on type 2 diabetes in San Antonio, and Laredo, Texas, 9% of respondents reported using herbs regularly for treatment of their diabetes (Hunt, et al., 2000). There were no respondents who reported using a curandero for their diabetes, however, three mentioned using a curandero for other illness (Hunt, et, al., 2000). The specific herbs mentioned in this study for use of treatment of diabetes included: nopal (cactus), aloe vera, nispero (loquat leaves), garlic, and diabetina. Respondents using these herbs reported never replacing their medical regimens with herbs.
Prayer was reported as helping to reduce stress and anxiety. Of the subjects interviewed, 77% reported that prayer helped their diabetes but did not replace the biomedical treatments they currently used (Hunt, 2000). Prayer and faith has been reported to be an important value, belief and coping mechanism used by this cohort of Hispanic/Latino elders (Talamantes, Lawler, Espino, 1995; Villa, 1991).
Arizona: In an ethnographic study of Mexican American elders in Arizona, Applewhite (1995) explored folk healing and knowledge or use of curanderos or other healers. Of the 25 respondents interviewed, 84% reported that they learned about folk medicine in early childhood, adolescence and early adulthood.
These elders indicated that they had either received treatments as children or used folk healers to treat their own children for conditions such as colico (colic), empacho (locked bowels), susto (fright), mal de ojo (pink eye), and caida de la mollera (fallen fontanel). About 12% indicated their involvement with spirtual cleansing (barridas or limpias). As they aged, they reported to have less faith in the folk healing methods and reported relying more on “conventional health providers, self-medications, home remedies, or God’s divine will,” (Applewhite, 1995).
Due to the high cost of medicine, many preferred home remedies or over the counter drugs. Many (64%) knew about herbalism and 76% believed that herbs were effective in the treatment of simple illnesses ranging from headaches to insomnia (Applewhite, 1995). Half of these respondents indicated that they would consider trying a curandero if their physician could no longer treat their illness. However, 43% held negative attitudes regarding folk healing and believed that their illnesses required conventional medicine. Overarching comments throughout the study indicated the elders’ faith in God, which has been described in other studies (Applewhite, 1995; Talamantes, Lawler, Espino, 1995; Villa, 1991).
Espiritismo (Spiritism) is rooted in the belief system that the spirit world can intervene in the human world and is widely practiced in Puerto Rico and among Puerto Ricans on the mainland (Nunez-Molina, 1996). In an analysis of Puerto Rican espiritismo, Nunez-Molina (1996) indicates that espiritismo can function as a religion, as a healing system, or as a philosophy or science for those who are academically oriented.