Older people in rural areas prefer self-care than health care providers

A survey of older rural adults found a high degree of medical skepticism, the belief that one knows and can control their own health better than a medical professional can, reports a recent study in the Journal of Health Care for the Poor and Underserved. For some, these beliefs correlate with a higher tendency toward self-care.

The researchers evaluated survey responses from 198 people, either African American or White and over 65 years old living in three rural counties in North Carolina. To determine levels of medical skepticism, they were asked whether they believed they could overcome illness without the help of a medical professional, whether they thought home remedies were often better than prescribed drugs, and if they felt they understood their health better than most doctors.

They were also asked about their use in the past year of various home remedies including honey, vinegar, baking soda, olive oil, whiskey, or petroleum jelly; vitamin or mineral supplements; herbal remedies such as garlic or ginseng; supplements such as fish oil; or of alternative medical practitioners such as chiropractors, physical therapists, or massage therapists, or self-care practices such as meditation, relaxation techniques or exercise.

"What we hypothesized was that people with high levels of medical skepticism would be more likely to use complementary therapy," said Ronny A. Bell, Ph.D., professor of epidemiology and prevention at Wake Forest School of Medicine in Winston-Salem, N.C., and a lead author on the study.

59.6 percent of respondents said they believed that their own behavior determined their health, while 19.7 percent said they could overcome illness without help. Overall, people who had reported use of any self-care therapy were more than four times more likely to report they could overcome illness without help from a health care provider. No other significant correlations between medical skepticism and the use of complementary therapies were found, but most people reported using home remedies, vitamins or mineral supplements or a self-care therapy. The researchers say more research is needed to determine the motivations behind the use of complementary therapies.

Health professionals need to communicate with their elderly and rural patients about folk remedies and supplements and about their attitudes toward health professionals, say the researchers. "We are trying to make a case for getting a feel for a patient's orientation to the health care they are receiving," Bell said. "If a doctor has a hard time getting a patient to follow medical advice, it may be because he or she does not think it will make a difference for them. [Doctors] have to ask about complementary therapies," he added. For instance, many folk remedies and supplements can cause side effects and can interact with prescribed medicines.

"The findings are not surprising," said Leigh F. Callahan, Ph.D., professor of social medicine at the Thurston Arthritis Research Center of the University of North Carolina at Chapel Hill.

"Older people in rural areas often live where their parents and grandparents lived and complementary treatments and folk remedies are handed down in the family," she noted. Folk remedies are often used to treat arthritis and conditions that cause chronic pain or that interfere with sleep, she noted."You want clinicians to have good overview of what is someone is taking, prescribed or not."

Source: Wake Forest School of Medicine

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