Gamze Muz; RN, PhD; Kamuran Özdil; RN, PhD
Introduction • Integrative health practices are extensively used in addition to pharmacologic treatments by elderly individuals who has chronic diseases to relieve or overcome symptoms.
Methods • This qualitative study was performed on 12 elderly individuals with the aim of determining the reasons for the use of integrative health practices and identifying their thoughts regarding these practices. Face to face interview method was used for data collection. Data were collected with information forms that include informations about elderly individuals and semistuctured interview forms. All interviews with elderly individuals are made with in-depth interview method. The data was evaluated using qualitative content analysis.
Results • As a result of in-depth interviews, three main themes and eight sub-themes were identified, with the main themes being the feelings before using integrative health practices, the sources of information, and the experiences after use. The majority of the individuals reported that they used integrative health practices due to feelings of helplessness/hopelessness, depression and fear; that their sources of information were not professional sources; and that, in the end, the majority of them experienced negative emotions. It can hence be recommended that healthcare personnel should carefully evaluate the elderly.
Conclusion • In this study; It is determined that elderly individuals were using integrative metods in addition to pharmacologic methods for symptom management. It can hence be recommended that healthcare personnel should carefully evaluate the elderly in geriatric assessment. (Altern Ther Health Med. 2020;26(5):33-37)
Gamze Muz; RN, PhD, Assistant Professor, Department of Internal Nursing, Semra ve Vefa Küçük Faculty of Health Sciences, Nevsehir Haci Bektas Veli University, Nevsehir, Turkey. Kamuran Özdil; RN, PhD, Assistant Professor, Aged Care Program, Nevsehir Haci Bektaş Veli University, Health Services Vocational School, Nevsehir, Turkey.
Corresponding author: Kamuran Özdil, RN, PhD
E-mail address: [email protected]
Elderly individual population is increasing and life time is extended depanding on treatments of chronic diseases by means of developments in technology and living conditions. It is announced that 22% of world population will be elderly individuals in 2030, when circumstances about Turkey reviewed, elderly individual population was 8.7% in 2018 and this ratio is expacted to be 10.2% in 2023.1-5 Due to the fact that the number of chronic diseases increases as people age, elderly individuals are often prescribed with multiple drugs. However, the administration of multiple drugs also leads to many systemic side effects among the elderly. As a result, they tend to seek integrative health practices for reasons such as challenging and costly care and treatment options, the lack of confidence in medical treatment, feeling good and the fear of possible side effects.6-12 It is seen that integrative health practice using ratio was changing between 54% and 98% for elderly individuals.13-16 A review of the literature on why the elderly prefer integrative practices reveals reasons such as controlling symptoms such as pain, increasing the quality of life, and feeling healthier.17,18 Especially since the elderly believe that the products they use will help them recover, while lacking information about their harmful effects, they tend not to share this information with healthcare personnel.19,20 It is observed that the ratios of polypharmacy and drug interactions are increasing among the elderly due to use of herbal or supportive products in addition to multiple drug administration.21 Given the increase in the use of integrative health practices by individuals who suffer chronic diseases, healthcare personnel and in particular nurses who are also part of this group should offer holistic care to these patients. It is important for health personnel to increase the patients’ level of knowledge regarding the positive effects, side effects and reliability of the methods used, and to provide guidance to the patients in a safe manner.22,23 In literature, quantitive studies were existent about usage of integrative health practice by elderly individuals,3,5,13,15,16 qualitative studies could not be seen in accordance with best information available. This study was planned depending on importance of the subject and the use of these method by elderly individuals. The aim of this study was designed to determine the views of the elderly who use integrated health practices at home.
- What are the emotions that lead the elderly to use integrative therapies?
- What are the information sources of elderly on integrative therapies?
- What are experiences after using integrative therapies?
Materials and Methods
This study is a qualitative phenomenological study conducted to determine the thoughts of the elderly who use integrated health practices in the elderly who stay at home by visiting home.
Study Population and Sample
In determining the location of the research, Avanos district with the highest number of individuals over 60 years old has been chosen based on the data of TÜİK.23 Since qualitative studies do not have a specific sample size, the study sample consisted of 12 randomly-selected elderly individuals who used integrative health practices and who accepted to take part in the study.
- Living in Avanos region
- Elderly individuals who can understand the questions,
- 65 and over and using integrative health practice,
- Elderly individuals who volunteered to participate in the study were included in the study.
Ethical Aspects of the Study
To conduct the study, approvals were obtained from the institution and the Nevsehir Haci Bektas Veli University’s Ethics Committee (Decision Number:2018.01.15). The aim of this study was separately explained to each one of the participants, and their consents were obtained concerning their participation in the study. The names of the participants were kept confidential, with the participants being assigned numbers on their interview statements instead of having their real names indicated.
Data Collection Tools
The data collection tool consisted of two sections, which were the “Information Form” that recorded descriptive information about the elderly individuals, and the semi-structured “Interview Form.” (See Table 1). The interview questions were evaluated by subject experts. The in-depth interview method was used in collecting the data. The interviews were performed in an empty room found in the houses of the elderly individuals, which were assumed to be places where it would be easier to communicate with them. The interviews were carried out at the time when the elderly individuals felt the readiest to speak. The interviews were performed by having the interviewer and interviewee sit at the same level; by having them face one another; by actively listening to the interviewee; and by guiding the interview with question forms. The responses of the elderly are provided verbatim in the results section. Although the aim in the semi-structured interviews was to have a one-to-one conversation with the persons and to record their statements using a voice recorder, the individuals actually refused to be recorded, and the data was hence collected by writing it on the interview forms instead. Written records are read again to the elderly individuals at the end of the interview and their opinions on additions or statements to be removed were obtained. During the interviews, once there began to be repetitions of what we heard before and what was said in the previous interviews, this meant that the saturation point was reached.24 The interviews were concluded when the data reached the saturation point. The interviews lasted for an average of 30 to 35 minutes.
Table 1. Semi-structured Interview Questions
|Which methods do you use other than the treatment recommended by your doctor?|
|Are you informed about the method you are using? Who suggested these methods to you?|
|Do you believe that these methods have an effect on the control of your disease?|
|Did you share this information with any health personnel?|
Evaluation of the Data
Content analysis method was used in evaluating the data. During the interviews, one researcher asked questions to the elderly individuals as the moderator, while the other researcher took brief notes on the verbal and non-verbal responses of the elderly individuals. The data collected with the semi-structured interview forms was analyzed following the completion of the interviews. The researchers determined the compatibility of the raw data with codes and themes. The resulting codes were classified by the researchers, and suitable themes were derived. Following this, all of the interview data were coded. All of the data was then interpreted by the relevant experts and with the support of the literature, and converted into a report. The data was read multiple times during the evaluation. Quantitative data in the information form was evaluated in a computer environment and expressed in numbers and percentages.
It was determined that the mean age of the elderly individuals was 72.50 ± 5.72, and that 66.7% were female and married, and 75% of them lived with their spouses. It was found that these elderly individuals had at least one chronic disease. When these diseases were examined it is determined that elderly individuals had high blood pressure for all (n = 12), 9 of them had diabetes mellitus, 2 of them had depression, 1 of them had cancer, 4 of them had chronic diseases about musculoskeletal system. As a result of in-depth interviews, three main themes and five sub-themes were identified, with the main themes being the feelings before using integrative health practices, the sources of information, and the experiences after use (See Table 2).
Table 2. Themes and Sub-themes for the Integrative Health Practices of the Elders
|1. Emotions felt when using integrative health practices||Helplessness/Depression/Fear|
|2. Sources of Information||TV/Visual media
|3. Experiences after using integrative health practices||Regret / Anger/ Uncertainty
Theme 1: Emotions felt when using integrative health practices
In this study, the elderly stated that they used integrative health practices mostly due to helplessness, depression and fear.
Helplessness/Depression/Fear. The majority of the participants stated that they used these methods due to feelings of helplessness, depression and fear. Participants said:
My back and belly ached so bad that I was obliged [to use it]. I heard that my neighbor went and benefited from massage, so I went there as well… (Female, 68 age, looked very helpless).
What else could we do? Both my spouse and I are old, [and I thought] if this is for our health, we might as well do it…. (Female, 68 age), (looked unhappy).
I had a traffic accident three months ago. I became confined to the bed, and there plenty of prostheses implanted on my body. My husband is also old, and he is my only caregiver, so I decided to use mineral supplement. (Female, 67 age), (There was tiredness expression on his face).
I used it for depression. I was fed up with this problem, my girl. My husband and kids, they all kept telling me that I should stop complaining, and that I must be thankful for my situation, and I got tired of hearing this… So I bought the herbs that I heard on TV… (Female, 65 age, (she had a tearful expression).
I drink garlic juice once a day after paralysis because “I have hypertension, which is why I had a stroke. I am afraid of what would happen if I remain completely paralyzed. My spouse is sick too, so who is going look after my spouse… (Male, 82 age), (looked unhappy).
Theme 2: Sources of information
The elderly individuals stated that they obtained information from neighbors, relatives and the visual media about using these methods.
TV/Visual media. The majority of the participants stated that they did what they saw on television. The statements of the participants were as follows:
This is an old habit of mine: I read the calendar pages and cut out the news on newspapers to store them. I have an agenda, and I keep all the cut outs in it. (Female, 75 age), (she smiled and waited to be appreciated for her actions).
I write down what I hear, so that I don’t forget what I hear and what they say on television. (Female,65 age.)
Neighbor/Relative. The elderly individuals stated that they used the practices/products they heard from their relatives and neighbors. The participants said:
I trusted it and used it because my son sent mineral supplement to me… (Female, 67 age)
My neighbors advised me to use herbal mixture. Actually, it is available in a ready-made form. But there is no need to pay for it, I thought, since I can prepare it at home. (Female, 75 age)
I had a neighbor, she prepared herbal medicine and it made her feel better. How could I have known? I thought that if this is good for others, it should be good for me as well. Such ignorance on my part… (Female, 72 age), (looks worried).
Theme 3: Experiences on integrative health practices
The elderly individuals stated that they felt regret, anger, uncertainty but also positive effects after they used these practices/products.
Regret/anger/ uncertainty: Individuals who experienced side effects stated that they felt regret and that they will never use these practices/products again. One of the participants said:
The doctor told me that I almost had a gastric bleeding. Fortunately, they took me rapidly to the hospital, otherwise I would have died… It apparently does no good for my disease, which is why I will never use any drug other than what my doctor prescribes (Female, 72 age), (looks regretful).
Hope is eternal; cancer has spread to every part of my body. I do not know if mineral supplement will do any good, since I started it late anyways… I have already lived out my life, what difference does it make if I die of cancer now? (Male, 82 age), (There was tiredness expression on his face).
I don’t know; I didn’t see a doctor to have my x-ray taken. But thank God, my pain has subsided, I don’t know if this is because of herbal supplement or the drugs. (Female, 75 age)
Positive Effects: Individuals stated that they had positive effects after using these practices/products.
Of course there was a positive effect, I am better now. I can clean my house, meet with neighbors. I can perform my salah and pray every day… (Female, 65 age), (she had a positive expression on her face, looking optimistic)
I think herbal medicine was beneficial, my blood sugar used to drop too low, we had to call the ambulance and I often barely made it to the hospital. (Male, 72 age).
Of course it is beneficial, when I applied this ointment, it started getting better on the second day…. (Female, 67 age), (she had a positive expression on her face, looking optimistic).
The majority of the patients who participated in the study used integrative health practices due to hopelessness, helplessness and fear. In a study conducted by Sagkal et al. in rural areas, the elderly stated that their reason for using these practices/products was “to try every possible treatment to treat their disease.”16 Based on this result, it can be said that the feeling of helplessness is one of the emotions that these elderly individuals experienced. An examination of the sources of information that were used before using these practices/products revealed that these sources included for the majority of the participants the visual media, neighbors, relatives and individuals who have similar diseases. In a qualitative study on patients with diabetes, Chang et al. stated that the persons who potentially influenced the use of these practices were spouses, friends, relatives and the media.25 In the studies conducted, it was reported that similar to this research, it used integrative health practice outside the control of health personnel.12,26 Cakmak and Nural reported that the factors that influence the use of these practices include the patient’s willingness to participate in the treatment process; the patient’s lack of satisfaction or benefit with the treatment that is applied; and easy access to visual and published media.27 The advertisement of non-pharmacological products in the visual media, in particular, increases the patients’ interest in these products, guiding the patients to use them.28 When we examined the experiences regarding integrative health practices in this study, it was observed that the individuals experience regret/anger and feelings of uncertainty, while some of the elderly individuals had positive outcomes. According to several studies, the positive effects of these products include a decrease in negative symptoms of the disease, feeling better, etc.15,29-33
However, it is said that these methods may cause negative effects on the patients if there are no scientifically concrete proofs, and that they may especially result in drug interactions in elderly individuals with multiple drug use.17,34-36 According to the results described in a systematic review, individuals who use herbal treatments experience negative effects.37 However it is denoted that integrative health practices were useful by elderly individuals in accordance with this results, it is specified in literature that many negative results can be seen depending on multiple drug use of elderly individuals.13,38
In conclusion, according to the results of in-depth interviews, the elderly persons tended to use integrative health practices due to the feelings of helplessness/hopelessness, depression and fear they experienced. It was determined that they generally obtained information on such practices via the visual media and their spouses, friends and relatives, and that they generally felt hopelessness, regret and dissatisfaction after using these practices/products. Based on these results, it can be suggested to nurses who has an important share in medical professionals that getting a detailed geriatric story, determining integrative method usage situation while evaluating treatment and nursing. In addition, it should be specified to elderly individuals to consult with medical personnel about integrative method usage.
Limitations of the Study
The results of the study can only be generalized to the individuals who were interviewed.
Authors’ disclosure statement
The author declares no conflict of interest. This study not financial support
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