Abstract
Chinese people have practiced traditional Chinese medicine (TCM) for thousands of years, but there is a paucity of research regarding TCM use in Chinese older adult immigrants in the United States. This study aims to provide an overall estimate of TCM use for Chinese older adults in the United States and to examine associations between sociodemographic characteristics, health measures, and TCM use. Data were collected through the Population Study of Chinese Elderly in Chicago, a community-based participant research study that surveyed 3,158 Chinese older adults aged 60 and older. TCM use was measured using an eight-item scale that examined eight kinds of TCM. Seventy-six percent of participants reported any use of TCM within the past year. After adjusting for potential confounding factors, health status was associated with greater use of acupuncture (odds ratio (OR) = 1.33, 95% confidence interval (CI) = 1.06–1.68) and massage therapy (OR = 1.53, 95% CI = 1.21–1.93), and quality of life was associated with less use of prescribed herbal products (OR 0.69, 95% CI = 0.55–0.87), tai chi (OR = 0.62, 95% CI = 0.50–0.78), and other traditional medicine (OR = 0.47, 95% CI = 0.40–0.56). These findings call for further investigation of TCM use by Chinese older adults, especially those with poor health and those with better quality of life. In the clinical setting, physicians should have awareness of TCM when treating Chinese older adults and look toward possible integration with Western medicine for more culturally appropriate, patient-centered care.
Keywords: Chinese, older adults, traditional Chinese medicine, United States
For longer than 2,000 years, traditional Chinese medicine (TCM) has been developed and practiced in China as a way to improve and sustain health.1 TCM holds strong cultural relevance for people of Chinese descent all over the world.2 It encompasses a variety of techniques, including herbal medicine, acupuncture, massage therapy, mind and body exercise, and dietary recommendations. Although TCM predates scientific medical theory, TCM diagnoses may correspond to Western medical diagnoses.1 As a result, TCM is commonly used in conjunction with biomedical treatment plans. In a study of Western-trained doctors in China, 76% also treated patients with TCM.3
In the United States, TCM is often referred to under the umbrella term “complementary and alternative medicine” (CAM). The National Institutes of Health (NIH) defines CAM as healthcare approaches developed “outside of mainstream Western, or conventional, medicine” and reported that nearly 40% of Americans use CAM.4 In a study of non-Chinese community-dwelling older adults in Minnesota, 62.9% of respondents reported use of CAM, and CAM use became increasingly common in older adults with health problems.5 There are no estimates for TCM use in the general U.S. population, but according to the 2007 National Health Interview Survey, 3.1 million Americans used acupuncture and 2.3 million Americans had practiced tai chi in the past year.6
There is growing evidence of the usefulness of TCM for physical and mental health, although the existing body of literature is not conclusive. Multiple studies have indicated that Chinese herbs may be beneficial in cancer treatment.7 Many Western-trained medical practitioners in China report a belief that TCM is useful for treating patients,3 although there have also been indications that TCM, especially in herbal form, may interact poorly with other medicine.6
There is inadequate knowledge about TCM use among Chinese older adults in the United States. A national study from 2002 conducted by the NIH estimated that 27.7% of older adults and 48.6% of Asian older adults had used CAM within the last year.8 A study of Chinese-American adults recruited from community health centers reported that approximately 63% of participants disclosed lifetime use of TCM,9 although the existing literature regarding CAM or TCM use in the United States is not sufficient to provide insight into TCM use of Chinese older adults. First, studies reporting on Asian-American older adults should not be equated with Chinese because of the heterogeneity of Asian Americans.10 The Chinese community constitutes the largest and oldest Asian-American subgroup in the United States,10 and the demographic characteristics of this population are different from those of other Asian-American subgroups. Second, many U.S.-based studies focus on CAM, rather than the subgroup of TCM, and these are not equivalent. For Chinese older adults, it is more appropriate to examine TCM because of cultural relevance. Last, many of these studies recruit from clinical settings, which may eliminate data from those who do not seek Western treatments.
The intersection between TCM use and Western medical practices also warrants further examination. Many TCM users do not disclose use to their Western physicians,9 which is cause for concern, given possible side effects and interactions between prescribed medication and TCM modalities.6 It is likely that Chinese older adults still address their health in traditional and cultural ways once they immigrate;11 some physicians believe that integration of CAM modalities into regular care, through referrals or prescriptions, improves the physician–patient relationship.12 Therefore, it is vital that TCM use of Chinese older adults be examined to gain insight into current health behaviors and culturally relevant medical care.
To provide an overall estimate of the use of TCM by Chinese older adults in the United States, this study aimed to evaluate the use of TCM by Chinese older adults in the greater Chicago area and examine the associations between TCM use, sociodemographic characteristics, and health measures.
METHODS
Population and Settings
The Population Study of Chinese Elderly in Chicago (PINE) is a population-based epidemiological study of U.S. Chinese older adults aged 60 and older in the greater Chicago area. The purpose of PINE is to collect community-level data of U.S. Chinese older adults to examine cultural determinants of health and well-being. A synergistic community-academic collaboration between Rush Institute for Healthy Aging, Northwestern University, and many community-based social services agencies and organizations throughout the greater Chicago area initiated the project.13
The Population Study of Chinese Elderly in Chicago implemented culturally and linguistically appropriate community recruitment strategies strictly guided using a community-based participatory research approach.13 More than 20 social service agencies, community centers, health advocacy agencies, faith-based organizations, senior apartments, and social clubs served as study recruitment sites, where eligible participants were approached during routine social service and outreach efforts serving Chinese-American families in Chicago and surrounding suburban areas. All participants provided consent, and trained bicultural research assistants interviewed them in English or Chinese dialects, according to the respondents’ preference. Of 3,542 eligible participants, 3,158 agreed to participate in the study, a response rate of 89.2%. Approximately 10 research assistants collected data from 2011 to 2013. Each interview lasted approximately 1.5 hours, and data were collected using web-based forms. A data manager worked closely with the investigative team to ensure the quality and completeness of the data. Details of study design can be found in existing publications.13
The Population Study of Chinese Elderly in Chicago is representative of the Chinese aging population in the greater Chicago area with respect to important demographic attributes.14 The institutional review board of the Rush University Medical Center approved the study.
Sociodemographic Characteristics
Basic demographic information was collected, including age, sex, education level (years), annual income (<$5,000, $5,000–10,000, >$10,000), marital status, number of children, living arrangement (alone, with 1 person, with 2–3 persons, with ≥4 persons), language preference, and country of origin (China, Hong Kong or Macau, Taiwan, other), years living in the United States, and years residing in their current community.
Health and Well-Being Measures
Overall health status was measured on a 4-point scale according to answers to the question. “In general, how would you rate your health?” Quality of life was assessed on a 4-point scale by asking. “In general, how would you rate your quality of life?” Health change in last year was measured on a 5-point scale according to answers to the question “Compared with 1 year ago, how would you rate your health now?” Health changes were then categorized into three groups: better health, same health, worse health. Questions were taken from the Medical Outcome Study 36-item Short-Form Health Survey (SF-36), which is validated for use in community-dwelling older adults15 and was selected to minimize burden. Depressive symptoms were measured using the Patient Health Questionnaire (range 0–27).16 Anxiety symptoms were measured using the Hospital Anxiety and Depression Scale—Anxiety (range 0–21).17 Analyses of these scales in the study population are available elsewhere.18-21
TCM Use over the Last Year
Traditional Chinese medicine use was assessed in participants on a 5-point Likert-type scale (0 = none, 1 = at least once in the previous year, 2 = at least once a month, 3 = at least once a week, 4 = at least once a day) by asking, “How many times per year do you use…?” Usage of eight kinds of TCM was asked about: prescribed oral herbal products, over-the counter (OTC) oral herbal products, prescribed herbal topical products, OTC herbal topical products, acupuncture, massage therapy, tai chi, and any other type of traditional medicine (e.g., qigong, cupping, and other forms of unspecified exercise). This instrument is adapted from a study of Chinese immigrants in the United States and their use of TCM.11
Data Analysis
Descriptive univariate statistics were used to summarize sociodemographic characteristics and the use of TCM in the last year in the sample population. The prevalence of each TCM modality was calculated. Chi-square tests were used to compare the bivariate sociodemographic differences between the groups with any TCM use and no TCM use and to compare the self-reported health differences between the eight modalities of TCM. To examine the association between health status and quality of life and each modality of TCM use, multivariate logistic regression models were used to control for potential confounding factors. Model 1 was adjusted for age and sex. Model 2 added additional socioeconomic variables, including education and income. Odds ratios (ORs), 95% confidence intervals (CIs), and significance levels were reported for multivariate analyses. Very good and good health status or quality of life was used as a reference group. Statistical analyses were conducted using SAS version 9.2 (SAS Institute Inc., Cary, NC).
RESULTS
Sample Characteristics
Of 3,158 participants enrolled in PINE, 58.0% were female, and 84.1% had an annual income of less than $10,000. Seventy-six percent reported any use of TCM within the last year (Table 1). Younger participants were more likely (77.7%) than older participants to report TCM use than older participants (70.5%) (P = .002), and women (79.4%) were more likely than men (71.9%) (P < .001). Participants with 1 to 6 years of education reported more TCM use (78.8%) than those without any formal education (71.8%) (P = .02), and those with the lowest income reported more TCM use (77.3%) than those with the highest income (75.3%) (P = .02) Participants who had lived in the United States a shorter amount of time were more likely to report TCM use (77.3%) than those who had lived in the United States the longest (73.9%) (P = .03). Individuals with fair overall health were more likely to report TCM use (78.9%) than those with good overall health (74.1%) (P = .03), and individuals with good quality of life (79.1%) were more likely than those with fair quality of life to report TCM use (74.3%) (P = .01). Participants with any TCM use did not have significantly different mean depressive symptom scores (2.57 vs 2.90, P = .11) or mean anxiety symptom scores (2.67 vs 2.59, P = .87) than those with no use.
Table 1.
Characteristics of Population Study of Chinese Elderly in Chicago Study Participants According to Traditional Chinese Medicine Use in the Past Year
| Characteristic | N | Any Use | No Use |
P- Value |
|---|---|---|---|---|
| Age, n (%) | .002 | |||
| 60–69 | 1,323 | 1,028 (77.7) | 295 (22.3) | |
| 70–79 | 1,161 | 905 (78.0) | 256 (22.0) | |
| ≥80 | 674 | 475 (70.5) | 199 (29.5) | |
| Sex, n (%) | <.001 | |||
| Male | 1,327 | 954 (71.9) | 373 (28.1) | |
| Female | 1,831 | 1,454 (79.4) | 377 (20.6) | |
| Education, years, n (%) | .02 | |||
| 0 | 195 | 140 (71.8) | 55 (28.2) | |
| 1–6 | 1,179 | 929 (78.8) | 250 (21.2) | |
| 7–12 | 1,103 | 843 (76.4) | 260 (23.6) | |
| ≥13 | 662 | 483 (73.0) | 179 (27.0) | |
| Income, $, n (%) | .02 | |||
| <5,000 | 1,040 | 804 (77.3) | 236 (22.7) | |
| 5,000–9,999 | 1,617 | 1,233 (76.3) | 384 (22.8) | |
| ≥10,000 | 465 | 350 (75.3) | 69 (24.7) | |
| Marital status, n (%) | .66 | |||
| Married | 2,236 | 1,705 (76.3) | 531 (23.8) | |
| Not married | 916 | 700 (76.5) | 216 (23.6) | |
| Living arrangement, n (%) | .12 | |||
| Alone | 679 | 514 (75.7) | 165 (24.3) | |
| With 1 other person | 1,317 | 1,001 (76.0) | 316 (24.0) | |
| With ≥2 other people | 1,161 | 892 (76.8) | 269 (23.2) | |
| Number of children, n (%) | .90 | |||
| 0 | 128 | 98 (76.6) | 30 (23.4) | |
| 1–2 | 1,271 | 975 (76.7) | 296 (23.3) | |
| ≥3 | 1,751 | 1,331 (76.0) | 420 (24.0) | |
| Years in the United States, n (%) | .03 | |||
| 0–10 | 844 | 652 (77.3) | 192 (22.8) | |
| 11–20 | 964 | 759 (78.7) | 205 (21.3) | |
| ≥21 | 1,335 | 986 (73.9) | 349 (26.1) | |
| Years in the community, n (%) | .22 | |||
| 0–10 | 1,812 | 1,373 (75.8) | 439 (24.2) | |
| 11–20 | 738 | 583 (79.0) | 155 (21.0) | |
| ≥21 | 598 | 445 (74.4) | 153 (25.6) | |
| Country of origin, n (%) | .58 | |||
| China | 2,929 | 2,242 (76.5) | 687 (23.5) | |
| Other | 229 | 166 (72.5) | 63 (27.5) | |
| Language preference, n (%) | .01 | |||
| Cantonese or Toisanese | 2,418 | 1,870 (77.3) | 548 (22.7) | |
| Mandarin | 706 | 517 (73.2) | 189 (26.8) | |
| English | 34 | 21 (61.8) | 13 (38.2) | |
| Overall health, n (%) | .03 | |||
| Very good | 139 | 103 (74.1) | 26 (25.9) | |
| Good | 1,097 | 813 (74.1) | 284 (25.9) | |
| Fair | 1,320 | 1,042 (78.9) | 278 (21.1) | |
| Poor | 602 | 450 (74.8) | 152 (25.3) | |
| Quality of life, n (%) | .01 | |||
| Very good | 216 | 158 (73.2) | 58 (26.9) | |
| Good | 1,382 | 1,093 (79.1) | 289 (20.9) | |
| Fair | 1,457 | 1,083 (74.3) | 374 (25.7) | |
| Poor | 101 | 74 (73.3) | 27 (26.7) | |
| Health changes over last year, n (%) | .55 | |||
| Improved | 277 | 217 (78.3) | 60 (21.7) | |
| Same | 1,534 | 1,159 (75.6) | 375 (24.5) | |
| Worsened | 1,345 | 1,031 (76.7) | 314 (23.4) | |
| Psychological distress, mean±standard deviation | ||||
| Depressive symptoms (range 0–27) | 2.6 ± 4.0 | 2.9 ± 4.4 | .11 | |
| Anxiety symptoms (range 0–21) | 2.7 ± 3.3 | 2.6 ± 3.1 | .87 | |
P-values based on chi-square statistics.
Frequencies of TCM use According to Type
Frequency of TCM use according to the eight kinds examined and sex differences are presented in Table 2. OTC topical herbal medicine was the most frequently used type of TCM (39.9%), followed by OTC oral herbal products (35.5%). Of those two types, participants most frequently reported use at least once in the previous year (18.6% and 18.0%, respectively). Prescribed oral herbal products (10.8%) and prescribed herbal topical medicines (9.1%) were used the least. Sex differences were significant for four modalities of TCM. A greater percentage of men than women did not use prescribed topical herbal medicine (93.1% vs 89.2%, P < .001), OTC topical herbal medicine (67.1% vs 55.0%, P < .001), acupuncture (91.2% vs 86.1%, P < .001), and massage therapy (89.8% vs 86.1%, P = .006).
Table 2.
Frequency of Traditional Chinese Medicine Use According to Sex and Modality
| None | ≥1 in Previous Year | ≥1/month | ≥1/week | ≥1/day | |
|---|---|---|---|---|---|
| Medicine | n (%) | ||||
| Prescribed oral herbal products | |||||
| Total | 2,815 (89.2) | 222 (7.0) | 52 (1.7) | 23 (0.7) | 45 (1.4) |
| Men | 1,196 (90.1) | 82 (6.2) | 21 (1.6) | 10 (0.8) | 18 (1.4) |
| Women | 1,619 (88.5) | 140 (7.7) | 31 (1.7) | 13 (0.7) | 27 (1.5) |
| Over-the-counter oral herbal products | |||||
| Total | 2,036 (64.5) | 586 (18.6) | 346 (11.0) | 87 (2.8) | 103 (3.3) |
| Men | 845 (63.7) | 249 (18.8) | 156 (11.8) | 33 (2.5) | 44 (3.3) |
| Women | 1,191 (65.1) | 337 (18.4) | 189 (10.3) | 54 (3.0) | 59 (3.2) |
| Prescribed topical herbal products | |||||
| Total | 2,870 (90.9) | 127 (4.0) | 104 (3.3) | 31 (1.0) | 26 (0.8) |
| Men | 1,236 (93.1) | 41 (3.1) | 38 (2.9) | 4 (0.3) | 8 (0.6) |
| Women | 1,633 (89.2) | 86 (4.7) | 66 (3.6) | 27 (1.5) | 18 (1.0) |
| Over-the-counter topical herbal products | |||||
| Total | 1,897 (60.1) | 568 (18.0) | 476 (15.1) | 138 (4.4) | 78 (2.5) |
| Men | 891 (67.1) | 224 (16.9) | 163 (12.3) | 32 (2.4) | 17 (1.3) |
| Women | 1,005 (55.0) | 344 (18.8) | 313 (17.1) | 106 (5.8) | 61 (3.3) |
| Acupuncture | |||||
| Total | 2,786 (88.2) | 314 (9.9) | 34 (1.1) | 18 (0.6) | 6 (0.2) |
| Men | 1,210 (91.2) | 102 (7.7) | 8 (0.6) | 3 (0.2) | 4 (0.3) |
| Women | 1,576 (86.1) | 212 (11.6) | 25 (1.4) | 15 (0.8) | 2 (0.1) |
| Massage therapy | |||||
| Total | 2,768 (87.7) | 233 (7.4) | 56 (1.8) | 59 (1.9) | 42 (1.3) |
| Men | 1,192 (89.8) | 85 (6.4) | 18 (1.4) | 14 (1.1) | 18 (1.4) |
| Women | 1,575 (86.1) | 148 (8.1) | 38 (2.1) | 45 (2.5) | 24 (1.3) |
| Tai chi | |||||
| Total | 2,765 (87.6) | 56 (1.8) | 30 (1.0) | 118 (3.7) | 189 (6.0) |
| Men | 1,171 (88.2) | 22 (1.7) | 14 (1.1) | 40 (3.0) | 80 (6.0) |
| Women | 1,593 (87.1) | 34 (1.9) | 16 (0.9) | 78 (4.3) | 109 (6.0) |
| Other traditional medicine | |||||
| Total | 2,418 (76.6) | 16 (0.5) | 16 (0.5) | 109 (3.5) | 599 (19.0) |
| Men | 1,038 (78.2) | 6 (0.5) | 8 (0.6) | 40 (3.0) | 235 (17.7) |
| Women | 1,379 (75.4) | 10 (0.6) | 8 (0.4) | 69 (3.8) | 364 (19.9) |
TCM Modality Frequency Use According to Self-Reported Health Measures
The frequency of any TCM use according to specific TCM modality stratified according to health status and quality of life along with regression models is presented in Table 3. After adjusting for age, sex, education, and income, fair or poor health status was associated with greater use of OTC topical herbal medicine (OR = 1.18, 95% CI = 1.02–1.37), acupuncture (OR = 1.33, 95% CI = 1.06–1.68), and massage therapy (OR = 1.53, 95% CI = 1.21–1.93). After adjusting for age, sex, education, and income, fair or poor quality life was associated with less use of prescribed herbal products (OR = 0.69, 95% CI = 0.55–0.87), acupuncture (OR = 0.69, 95% CI = 0.55–0.87), tai chi (OR = 0.62, 95% CI = 0.50–0.78), and other traditional medicine (OR = 0.47, 95% CI = 0.40–0.56).
Table 3.
Use of Traditional Chinese Medicine and Self-Reported Health Measures
| Total | Very Good | Good | Fair | Poor | Model 1 | Model 2 | |
|---|---|---|---|---|---|---|---|
| Medicine | n (%) | Very Good or Good Versus Fair or Poor, Odds Ratio (95% Confidence Interval) |
|||||
| Overall health | |||||||
| Prescribed oral herbal products | 1.13 (0.90–1.43) | 1.11 (0.88–1.41) | |||||
| Any | 342 | 13 (3.8) | 113 (33.0) | 140 (40.9) | 76 (22.3) | ||
| None | 2,816 | 126 (4.5) | 984 (34.9) | 1,180 (41.9) | 526 (18.7) | ||
| Over-the-counter oral herbal products | 0.89 (0.77–1.03) | 0.87 (0.75–1.01) | |||||
| Any | 1,122 | 38 (3.4) | 425 (37.9) | 490 (43.7) | 169 (15.1) | ||
| None | 2,036 | 101 (5.0) | 672 (33.0) | 830 (40.8) | 433 (21.3) | ||
| Prescribed topical herbal products | 1.21 (0.93–1.56) | 1.21 (0.93–1.57) | |||||
| Any | 288 | 9 (3.1) | 89 (30.9) | 135 (46.9) | 55 (19.1) | ||
| None | 2,870 | 130 (4.5) | 1,008 (35.1) | 1,185 (41.3) | 547 (29.3) | ||
| Over-the-counter topical herbal products | 1.21 (1.04–1.40)a | 1.18 (1.02–1.37)a | |||||
| Any | 1,260 | 39 (3.1) | 419 (33.3) | 568 (45.1) | 234 (18.6) | ||
| None | 1,897 | 100 (5.3) | 678 (35.7) | 751 (39.6) | 368 (19.4) | ||
| Acupuncture | 1.32 (1.05–1.66)a | 1.33 (1.06–1.68)a | |||||
| Any | 372 | 9 (2.4) | 115 (30.9) | 160 (43.0) | 88 (23.7) | ||
| None | 2,786 | 130 (4.7) | 982 (35.2) | 1,160 (41.6) | 514 (18.4) | ||
| Massage therapy | 1.50 (1.19–1.89)c | 1.53 (1.21–1.93)c | |||||
| Any | 390 | 11 (2.8) | 108 (27.7) | 179 (45.9) | 92 (23.6) | ||
| None | 2,768 | 128 (4.6) | 989 (35.7) | 1,141 (41.2) | 510 (18.4) | ||
| Tai chi | 0.87 (0.70–1.07) | 0.86 (0.69–1.07) | |||||
| Any | 393 | 18 (4.6) | 147 (37.4) | 169 (43.0) | 59 (15.0) | ||
| None | 2,765 | 121 (4.4) | 950 (34.4) | 1,151 (41.6) | 543 (19.6) | ||
| Other traditional medicine | 0.88 (0.75–1.05) | 0.86 (0.73–1.03) | |||||
| Any | 740 | 42 (5.7) | 264 (35.7) | 305 (41.2) | 129 (17.4) | ||
| None | 2,418 | 97 (4.0) | 833 (34.4) | 1,015 (42.0) | 473 (19.6) | ||
| Quality of Life | |||||||
| Prescribed oral herbal products | 0.72 (0.57–0.90)b | 0.69 (0.55–0.87)b | |||||
| Any | 342 | 18 (5.3) | 179 (52.3) | 138 (40.4) | 7 (2.0) | ||
| None | 2,814 | 198 (7.0) | 1,203 (42.8) | 1319 (46.9) | 94 (3.3) | ||
| Over-the-counter oral herbal products | 0.97 (0.84–1.12) | 0.93 (0.80–1.08) | |||||
| Any | 1,122 | 49 (4.4) | 519 (46.3) | 517 (46.0) | 37 (3.3) | ||
| None | 2,034 | 167 (8.2) | 863 (42.4) | 940 (46.2) | 64 (3.1) | ||
| Prescribed topical herbal products | 0.94 (0.73–1.20) | 0.89 (0.70–1.14) | |||||
| Any | 288 | 16 (5.6) | 138 (47.9) | 130 (45.1) | 4 (1.4) | ||
| None | 2,868 | 200 (7.0) | 1,244 (43.4) | 1,327 (46.3) | 97 (3.4) | ||
| Over-the-counter topical herbal products | 1.06 (0.92–1.23) | 0.99 (0.85–1.14) | |||||
| Any | 1,260 | 58 (4.6) | 574 (45.6) | 591 (46.9) | 37 (2.9) | ||
| None | 1,895 | 158 (8.3) | 808 (42.6) | 865 (45.6) | 64 (3.4) | ||
| Acupuncture | 0.70 (0.56–0.87)b | 0.69 (0.55–0.87)b | |||||
| Any | 372 | 19 (5.1) | 199 (53.5) | 137 (36.8) | 17 (4.6) | ||
| None | 2,784 | 197 (7.1) | 1,183 (42.5) | 1,320 (47.4) | 84 (3.0) | ||
| Massage therapy | 0.80 (0.64–0.99)a | 0.81 (0.66–1.01) | |||||
| Any | 390 | 31 (7.9) | 189 (48.5) | 151 (38.7) | 19 (4.9) | ||
| None | 2,766 | 185 (6.7) | 1,193 (43.1) | 1,306 (47.2) | 82 (3.0) | ||
| Tai chi | 0.57 (0.46–0.71)c | 0.62 (0.50–0.78)c | |||||
| Any | 393 | 33 (8.4) | 214 (54.5) | 132 (33.6) | 14 (3.6) | ||
| None | 2,763 | 193 (7.0) | 1,168 (42.3) | 1,325 (48.0) | 87 (3.1) | ||
| Other traditional medicine | 0.47 (0.40–0.56)c | 0.47 (0.40–0.56)c | |||||
| Any | 740 | 74 (10.0) | 404 (54.6) | 250 (33.8) | 12 (1.6) | ||
| None | 2,416 | 142 (5.9) | 978 (40.5) | 1,207 (50.0) | 89 (3.7) | ||
Model 1 adjusted for age and sex.
Model 2 adjusted for age, sex, education, and income.
Reference group is very good or good reported overall health or quality of life.
P<.05
.01
.001.
DISCUSSION
To the knowledge of the authors, this is the first population-based epidemiological study to report TCM use within the last year in Chinese older adults. Seventy-six percent had used TCM within the last year. Herbal products were the most frequently used modality, and participants reported the most daily practice of tai chi or use of other forms of TCM. Prescription TCM was the least-reported TCM modality. Women were more likely to use TCM than men, especially topical herbal medicine, acupuncture, and massage therapy. Poorer health status was associated with greater TCM use, particularly acupuncture and massage therapy, and better quality of life was associated with greater TCM use, especially through prescribed herbal products, tai chi, and other traditional medicine.
A 2002 national health survey found that 27.7% of older U.S. adults and 48.6% of Asian older adults used CAM.8 The 2007 National Health Interview Survey also found that 39.9% of Asians reported CAM use in the past 12 months.22 A study of 1,799 Chinese-American adults recruited from community health centers reported that approximately 63% of participants disclosed lifetime use of TCM.9 Chinese older adults in the greater Chicago area use TCM at higher rates than these U.S. older populations. This may be because of the cultural relevance of TCM in the study population. Chinese older adults in the greater Chicago area also have low levels of acculturation,23 which may influence adherence to traditional cultural forms of medicine.
These findings corroborate existing research, which indicates that herbal medicine is among the most commonly used forms of TCM. A study of adults in Taiwan found that the most-frequent form of TCM was herbal remedies;24 another study reported that the most-common form of TCM that older Chinese immigrants in Canada used was herbs (50.3%), followed by herbal formulas (48.7%).25 This may be because of the sheer volume of applications for herbal remedies, from health maintenance to allergy relief and beyond.26
The current study also found much higher rates of OTC versus prescribed TCM. OTC herbal remedies were the most-frequent modalities of TCM, whereas prescribed herbal remedies were the least frequent. Similar results were found in a study of U.S. Chinese immigrant adults recruited from local clinics,11 although the overall rates of prescribed TCM use were lower in the current study population, which was primarily low income, which diminishes the likelihood of regular physician visits. Their low rates of prescribed TCM usage may also be indicative of low use of Western medical services by Chinese older adults.
The low prevalence of prescribed TCM use may also point to poor integration of Chinese and Western medicine in the United States. In a study of attitudes toward TCM of Western medical doctors in Hong Kong, recommending Western medicine and TCM was rare, probably because of historical Western medicine dominance and hesitancy toward medical pluralism.27 Furthermore, Chinese older adults who have lived fewer years in the United States and have poorer health are less likely to trust their Western physicians.28 Recent literature has called for better integration of Chinese and Western medicine in the United States for Chinese individuals because of growing scientific, cultural, and anecdotal evidence of its usefulness and relevance to Chinese individuals.12 Future research should examine the relationship between TCM and Western medicine usage.
This study also found that being female was significantly associated with TCM use in Chinese older adults, especially topical herbal medicine, acupuncture, and massage therapy. In a study of Chinese and Vietnamese adults in the United States, sex was not significantly associated with TCM use,9 but in a nationally representative study of CAM use, women were significantly more likely to report CAM use than men.8 Chinese older women in the United States experience more musculoskeletal symptoms than Chinese older men, which may contribute to the use of pain-mediating practices such as acupuncture and massage therapy.29 A study of adults in Taiwan suggested that women may be more likely to use TCM than men because of sex-specific illnesses but that these differences diminish with age.30 Future longitudinal research should examine the relationship between sex and specific forms of TCM.
Poorer health was significantly associated with use of TCM, especially acupuncture and massage therapy. These findings may support existing literature, which suggests that individuals with medical conditions use TCM or alternative medicine. Ninety-eight percent of Chinese women in urban Shanghai diagnosed with breast cancer used at least one form of CAM therapy after diagnosis.31 In a study of Chinese immigrants in the United States recruited from the clinical setting, more than half reported use of TCM specifically for joint pain.11 In the current study population, it is likely that TCM was used for its perceived health benefit, which has been reported among TCM users in the United States.32 Furthermore, acupuncture and massage therapy are typically used to treat pain, which may influence subjective health status rating. Future longitudinal research should examine the use of TCM in relationship to the emergence of medical conditions and healthcare use.
Alternatively, reporting higher quality of life is significantly associated with TCM use. Furthermore, after adjusting for critical sociodemographic characteristics, better quality of life was significantly associated with use of prescribed oral herbal products, tai chi, and other traditional medicine. This may occur for multiple reasons. Quality of life is a subjective concept regarding life as a whole, which many factors, including physical and psychological health status, age, social network, and culture, influence. Herbal products, tai chi, and other traditional medicine may be related to preventative health care, which affects physical and psychological health. Herbal products include items such as tea and certain foods, which may also be related to dietary preferences and practices. What “other forms of TCM” comprised for participants was not recorded, but it is likely that it includes various types of exercise.11 These TCM modalities may also have significant cultural and personal relevance for many Chinese older adults, which may affect their subjective assessment of quality of life. TCM use in Chinese older adults corresponded to health and well-being in different ways based on the type of TCM, suggesting that TCM may be relevant for treatment and maintenance of health in older age for Chinese adults.
This study had some limitations. Data were not collected regarding reasons for TCM use. In addition, it is likely that access to TCM practitioners or availability of Chinese goods influenced the rate of TCM use. Second, information was not recorded about Western medication prescriptions or who prescribed TCM, so it is not possible to determine whether using TCM was associated with less or any use of Western health care. Third, this study is representative of Chinese older adults in the greater Chicago area, but this should not be generalized to the larger U.S. Chinese population because of variations in demographic characteristics and location-specific barriers. Last, this study is cross-sectional, so it was not possible to determine any causation for TCM use.
Despite these limitations, these findings have important implications for researchers, clinicians, and policy-makers. To the knowledge of the authors, PINE is the largest epidemiological study to examine TCM use of Chinese older adults in the United States. The current study reflects the continued relevance of TCM for Chinese immigrants and its association with poor health status. Because TCM use may be inversely related to Western medicine use,32 this combined information indicates a need for research to examine TCM modalities more closely, including their interactions with Western medicine, proper use, and possible integration into regular healthcare practices, which may benefit Chinese older adults and help to address certain health disparities.
This study also suggests that greater awareness in clinical practice of alternative medicine practices of Chinese older adults could be beneficial. A majority of Chinese older adults use some form of TCM, particularly when experiencing poor health status. Especially because TCM users are unlikely to disclose use to their physicians,9 clinical professionals need to pursue this line of inquiry, because of high rates of use and possible interactions with Western medicine.6 Integration of TCM into regular clinical practice may be warranted. Chinese older adults have a high prevalence of medical conditions and low rates of screening and treatment.33 The current study shows that Chinese older adults who report better quality of life also report use of TCM, suggesting the cultural relevance of TCM. Integration of TCM and Western medicine may also improve the physician–patient relationship and adherence12.
In summation, this study indicates high use of TCM by Chinese older adults in the United States. These findings call for further investigation of the reasons for use by Chinese older adults, especially in several subgroups, including those with poorer health status and those with better quality of life. Professionals in the clinical setting should have greater awareness of possible TCM use by Chinese patients and look to integrate TCM as a possible way toward patient-centered health care.
ACKNOWLEDGMENTS
We are grateful to Community Advisory Board members for their continued effort in this project. Particular thanks are extended to Bernie Wong, Vivian Xu, and Yicklun Mo with the Chinese American Service League (CASL); Dr. David Lee with the Illinois College of Optometry; David Wu with the Pui Tak Center; Dr. Hong Liu with the Midwest Asian Health Association; Dr. Margaret Dolan with John H. Stroger Jr. Hospital; Mary Jane Welch with the Rush University Medical Center; Florence Lei with the CASL Pine Tree Council; Julia Wong with CASL Senior Housing; Dr. Jing Zhang with Asian Human Services; Marta Pereya with the Coalition of Limited English Speaking Elderly; and Mona El-Shamaa with the Asian Health Coalition.
Dr. Dong was supported by National Institute on Aging Grants R01 AG042318, R01 MD006173, R01 NR 14846, R01 CA163830, R34MH100443, R34MH100393, and RC4 AG039085; a Paul B. Beeson Award in Aging; the Starr Foundation; the American Federation for Aging Research; the John A. Hartford Foundation; and the Atlantic Philanthropies.
Footnotes
Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.
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