Long-Term Yoga and Aerobic/Strength Exercise Adherence in Older Women with Knee Osteoarthritis: A Mixed Methods Approach.

Hatha yoga (HY) and aerobic and strengthening exercise (ASE) programs are recommended for optimal management of osteoarthritis. However, evidence on long-term adherence to these programs and factors that influence it is lacking in older adults. The purposes of this study were to (1) describe and compare long-term HY and ASE adherence in community-dwelling older women with knee osteoarthritis 12 months post-HY/ASE intervention programs; (2) identify benefits and facilitators of, and barriers to, long-term adherence; and (3) examine other self-care interventions used after completing HY or ASE programs. Adherence was defined as following the prescribed HY/ASE program or incorporating the practice into daily habits. Five semistructured focus group interviews and 12 months of exercise diaries were obtained from 28 women (mean age 71.2 years). Long-term adherence to the prescribed HY or ASE regimen was relatively high, albeit adapted to individual needs, priorities, and preferences. Over the 12-month follow-up period, participants spent on average 3.5 days/3.1 hours per week on exercise. Most participants remained physically active by modifying their prescribed programs and integrating elements of the interventions into their own exercise regimens. Facilitators to long-term adherence were perceived benefits, having an exercise routine/habit, and program structure/instruction. Poor health status, lack of time, and exercise preferences were identified as barriers. Participants used a variety of self-care interventions including oral supplements and alternative diets for managing their osteoarthritis. This work suggests that exercise programs for osteoarthritis that incorporate individual preferences, flexible hours, and easy-to-follow instructions are most likely to result in long-term adherence.

Knowledge and clinical dialogues about complementary health approaches among nurse practitioners specialized in geriatrics.

BACKGROUND: In the United States, people over the age of 65 years will account for 20% of the population by 2030, and these elders are more likely to have chronic comorbid complex health problems. Sixty-three percent use complementary health approaches (CHAs) but less than half disclose their use to their health care providers. Nurse practitioners (NPs) are the fastest growing population of primary care health providers. PURPOSE: This study identifies to what degree NPs with specialized training in geriatrics understand CHAs, use them themselves, encourage their patients to access them, and engage in CHA clinical dialogue. METHODS: Cross-sectional online survey collecting quantitative and narrative data; US NPs with specialized training in geriatrics (n = 170, mean age 52 years, SD: 9.0, range: 29-73). RESULTS: Although NPs are knowledgeable about some CHA and believe they are beneficial for older adults to use, they want more education to help understand the effects of a variety of CHA, be more aware of possible treatment interactions, and to integrate CHA into the current health care system. Patient factors (impaired cognitive function, acute health problems, and not open to CHA), provider factors (inadequate CHA knowledge, limited referral paths and resources), and system factors (limited accessibility and availability of CHA in in-patient setting, CHA not covered by insurance, and limited clinical time) disrupt NPs from assessing and discussing CHA with their patients. IMPLICATIONS FOR PRACTICE: There is a need to develop and implement NP practice guidelines for CHA clinical management for older adults and provide educational opportunities to incorporate CHA into clinical practice.

Hatha yoga training improves standing balance but not gait in Parkinson's disease.

Background and purpose: Complementary therapies, such as yoga, have been proposed to address gait and balance problems in Parkinson's disease (PD). However, the effects of yoga on gait and static balance have not been studied systematically in people with PD (PWP). Here we evaluated the effects of a 12-week long Hatha yoga intervention on biomechanical parameters of gait and posture in PWP. Methods: We employed a pilot randomized controlled trial design with two groups of mild-to-moderate PWP (immediate treatment, waitlist control; N  = 10 each; Mean Hoehn and Yahr score = 2 for each group). Baseline Unified Parkinson's Disease Rating Scale (UPDRS) motor scores, and gait and postural kinematics including postural sway path length, cadence, walking speed, and turning time were obtained. The immediate treatment group received a 60-min Hatha yoga training twice a week for 12 weeks, while the waitlisted control group received no training. After 12 weeks, gait and postural kinematics were assessed (post-test for treatment group and second-baseline for waitlist group). Then, the waitlist group received the same yoga training and was evaluated post-training. Results: After Hatha yoga training, UPDRS motor scores improved with an 8-point mean decrease which is considered as a moderate clinically important change for mild-moderate PD. Sway path length during stance decreased significantly (mean reduction: -34.4%). No significant between-group differences or improvements in gait kinematics were observed. Conclusion: This study showed that a 12-week Hatha yoga training can improve static balance in PWP. We found no evidence that it systematically improves gait performance in PWP.

Aging Adults' Preferences for Wellness Program Activities and Delivery Characteristics: A Cross-Sectional Survey.

BACKGROUND: Lifestyle wellness programs help prevent and manage chronic diseases, yet few are designed for aging adults. PURPOSE: Identify characteristics associated with aging adults' preferences for wellness program activities and delivery characteristics. SUBJECTS/METHODS: Cross-sectional, self-administered survey of a convenience sample of 386 adults aged ≥55 years. Logistic regression models identified characteristics influencing preferences. RESULTS: Current healthy behaviors, gender, and age influenced many preferences, while BMI, multiple chronic conditions, self-rated general health status, and quality of life did not. DISCUSSION: Incorporating aging adults' preferences for wellness programs will help design appealing and engaging programs.

Effects of yoga on oxidative stress, motor function, and non-motor symptoms in Parkinson's disease: a pilot randomized controlled trial.

OBJECTIVE: To examine the feasibility, acceptability, and preliminary effects of Hatha yoga on oxidative stress, motor function, and non-motor symptoms among individuals with Parkinson's disease (PD). METHODS: The study has a pilot randomized controlled trial design with two arms: an immediate treatment group and a wait-list control group. The yoga-for-PD program was implemented via twice weekly 60-min group-based classes for 12 weeks. Participants were assessed at baseline, 12 weeks, and 6 months post-intervention. Outcome measures included oxidative stress, motor function, physical activity, cognitive function, sleep quality, and quality of life. Data on program acceptability and yoga adherence were collected during the intervention and at 6 months post-intervention. RESULTS: Participants (n = 20) had a mean age of 63 years (SD 8, range 49-75) and disease duration 4.8 years (SD 2.9, range 1-13). All participants had mild-moderate disease severity; 18 (90%) were on dopaminergic medications. Seventeen participants (85%) attended at least 75% of the classes and 4 (20%) attended all classes. Most participants (n = 17) reported they "definitely enjoyed" the intervention program. No adverse events were reported. At 12 weeks, there were no major differences in blood oxidative stress markers between the two groups. Motor function based on the Unified Parkinson's Disease Rating Scale was better in the treatment group, but their scores on sleep and outlook in Parkinson's Disease Quality of Life (PDQUALIF) Scale and the physical activity levels based on the Longitudinal Aging Study Amsterdam Physical Activity Questionnaire were worse than those of the control group. In within-group comparisons, motor function, cognitive function, and catalase improved but three PDQUALIF domains (social and role function, sleep, and outlook) and physical activity level worsened by the end of the yoga intervention program compared to baseline. The response rate for the 6-month follow-up survey was 74% (n = 14) with six participants (43%) who signed up for a yoga class and four (29%) who practiced it independently. Health problems were the main barrier to yoga practice. CONCLUSION: Yoga is feasible and acceptable and may serve as a complementary method for improving motor function in PD. Further research using a larger sample size is needed to determine its impact on oxidative stress and non-motor symptoms. TRIAL REGISTRATION: ClinicalTrials.gov Registration Number: NCT02509610031.

Yoga and Quality of Life in Women with Primary Dysmenorrhea: A Systematic Review.

INTRODUCTION: Primary dysmenorrhea is a prevalent condition causing quality of life (QOL) reduction for many women, resulting from pain as well as parallel social and psychological distress. Yoga reduces pain and sympathetic reactivity, thus promoting QOL. This article reports a systematic review of the evidence for the effectiveness of yoga as a QOL improvement method for women with primary dysmenorrhea. METHODS: The PRISMA guidelines were used in preparation of this review. Ovid MEDLINE, PsycINFO, CINAHL, Scopus, PubMed, ScienceDirect, Cochrane Database of Systematic Reviews (CDSR), and Cochrane Central Register of Controlled Trials (CENTRAL) were screened through January 2017 using the keywords yoga, meditation, menstrual cycle, dysmenorrhea, pelvic pain, and prostaglandins. English-language randomized controlled trials (RCTs) and quasi-experimental studies regarding yoga, primary dysmenorrhea, and QOL were eligible; all yoga styles were included. Two independent reviewers rated the methodological quality of each study selected for review using the Downs and Black checklist; possible scores ranged from 0 to 32. Ratings were established through consensus. RESULTS: The search yielded a total of 378 articles, of which 14 (age range 13-45 years, N = 1409) met the criteria for final review: 8 RCTs and 6 quasi-experimental studies. Downs and Black ratings were predominantly moderate in quality with moderate risk of bias, ranging from 15 to 23 (RCTs) and 10 to 17 (quasi-experimental studies). Statistically significant improvements along most QOL domains, including physical pain, sleep, concentration, negative feelings, social relationships, work capacity, and overall QOL, were identified after a yoga intervention. Results indicate preliminary evidence for yoga as a safe and effective QOL improvement method for women with primary dysmenorrhea. DISCUSSION: Practitioners may consider yoga for management of primary dysmenorrhea. However, future research using larger RCTs of high methodological quality is needed to ascertain the magnitude of yoga's clinical significance.

Development and Evaluation of a Yoga Intervention Program for Parkinson's Disease.

Preliminary research indicates that yoga could be a valuable tool for people suffering from Parkinson's disease (PD). However, little has been published about the process by which the yoga interventions were designed and evaluated. This study elaborates on the process of developing and testing a bi-weekly, 12-week yoga program to determine its safety and feasibility for people with PD. The lead yoga teacher used input from a focused literature review to design an initial draft of the intervention program. This draft was reviewed by a group of yoga experts ( n = 6) to develop the final intervention program. This 12-week intervention was implemented in 19 participants with PD (mean age 63 ± 8, range 49-75) via twice-weekly yoga classes. Through this comprehensive development process, a series of 24 individual 1-hour yoga sequences was created. These sequences included yoga postures (asana), breathing techniques (pranayama), and mindfulness meditation principles specifically chosen to address concerns unique to the PD population. The feasibility of the program was supported with excellent attendance: 90% of participants attended > 75% of the classes, with four participants attending 100%. No adverse events were reported. This development process produced a safe and enjoyable yoga program specific for the needs of people with PD. However, this methodology could serve as a template for future studies on how to develop safe and effective yoga interventions for other populations.

Effects of Non-Pharmacological Treatments on Quality of Life in Parkinson's Disease: A Review.

Parkinson's disease is a neurodegenerative chronic condition with a declining trajectory and lack of a cure, making quality of life an important aspect of care. The purpose of this literature review was to analyze the state-of-the-science on the effects of non-pharmacological treatments on quality of life in person's with Parkinson's disease. Literature search was conducted using keywords in electronic databases up to September 1, 2016 and cross-searching the references of identified articles. Of the 259 articles generated, 26 met the eligibility criteria and were included in this review. The majority of studies (77%) were Level I evidence and 23% Level II evidence. The levels of study quality were: strong (50%), moderate (15%), and weak (35%). The interventions varied across studies with 15 studies evaluating a similar intervention. About 58% of the studies showed that the interventions improved quality of life. In conclusion, a variety of non-pharmacological interventions have been increasingly studied for their effects on quality of life in Parkinson's disease, showing initial promising results. However, most interventions were only examined by a limited number of studies and the minimal and optimal intervention doses needed for improving quality of life are yet unknown.

Managing knee osteoarthritis with yoga or aerobic/strengthening exercise programs in older adults: a pilot randomized controlled trial.

Although exercise is often recommended for managing osteoarthritis (OA), limited evidence-based exercise options are available for older adults with OA. This study compared the effects of Hatha yoga (HY) and aerobic/strengthening exercises (ASE) on knee OA. Randomized controlled trial with three arms design was used: HY, ASE, and education control. Both HY and ASE groups involved 8 weekly 45-min group classes with 2-4 days/week home practice sessions. Control group received OA education brochures and weekly phone calls from study staff. Standardized instruments were used to measure OA symptoms, physical function, mood, spiritual health, fear of falling, and quality of life at baseline, 4 and 8 weeks. HY/ASE adherences were assessed weekly using class attendance records and home practice video recordings. Primary analysis of the difference in the change from baseline was based on intent-to-treat and adjusted for baseline values. Eight-three adults with symptomatic knee OA completed the study (84% female; mean age 71.6 ± 8.0 years; mean BMI 29.0 ± 7.0 kg/m2). Retention rate was 82%. Compared to the ASE group at 8 weeks, participants in the HY group had a significant improvement from baseline in perception of OA symptoms (-9.6 [95% CI -15.3, -4]; p = .001), anxiety (-1.4 [95% CI -2.7, -0]; p = .04), and fear of falling (-4.6 [-7.5, -1.7]; p = .002). There were no differences in class/home practice adherence between HY and ASE. Three non-serious adverse events were reported from the ASE group. Both HY and ASE improved symptoms and function but HY may have superior benefits for older adults with knee OA. Trial registration The full trial protocol is available at clinicaltrials.gov (NCT02525341).

Effects of Yoga on Symptoms, Physical Function, and Psychosocial Outcomes in Adults with Osteoarthritis: A Focused Review.

Osteoarthritis (OA) is a highly prevalent and disabling chronic condition. Because physical activity is a key component in OA management, effective exercise interventions are needed. Yoga is an increasingly popular multimodal mind-body exercise that aims to promote flexibility, strength, endurance, and balance. Its gentle approach is potentially a safe and effective exercise option for managing OA. The purpose of this focused review is to examine the effects of yoga on OA symptoms and physical and psychosocial outcomes. A comprehensive search was conducted using seven electronic databases. Twelve reports met inclusion criteria involving a total of 589 participants with OA-related symptoms. A variety of types, frequencies, and durations of yoga interventions were reported; Hatha and Iyengar yoga were the most commonly used types. Frequency of intervention ranged from once a week to 6 days a week. Duration of the interventions ranged from 45 to 90 mins per session for 6 to 12 wks. Yoga intervention resulted in reductions in pain, stiffness, and swelling, but results on physical function and psychosocial well-being were inconclusive because of a variety of outcome measures being used.

Adherence to a Yoga Program in Older Women with Knee Osteoarthritis.

Yoga is beneficial for osteoarthritis (OA) management in older adults; however, adherence to yoga practice is unknown. The purposes of this secondary analysis were to examine: (1) yoga adherence during the intervention and follow-up periods; (2) the relationship between social cognitive theory (SCT) constructs and adherence; and (3) the impact of adherence on OA-related symptoms in 36 community-dwelling older women with knee OA. SCT was used as a framework to promote adherence to a yoga intervention program that included both group/homebased practices. Adherence to yoga was high during the intervention period but decreased over time. Although SCT was a useful framework for reducing attrition during the intervention, self-efficacy was the only construct that correlated with class attendance. Higher yoga adherence was correlated with improved symptoms, physical function, sleep quality, and quality of life. Yoga adherers were likely to be older, less educated, and had a lower body mass index than nonadherers.

Yoga adherence in older women six months post-osteoarthritis intervention.

BACKGROUND/OBJECTIVE: Osteoarthritis (OA) is a highly prevalent condition worldwide. Yoga is potentially a safe and feasible option for managing OA; however, the extent of long-term yoga adherence is unknown. The purpose of this study was to examine yoga adherence 6 months after participants completed an OA intervention program. METHODS: This follow-up study employed a cross-sectional descriptive design using survey, interview, and video recordings to collect both quantitative and qualitative data. A total of 31 participants completed and returned the survey, and 10 videotaped their yoga practice for 1 week and participated in a face-to-face interview. RESULTS: A majority of participants (n=19, 61%) reported that they were still practicing yoga 6 months after the intervention program. On average, participants reported practicing 21 to 30 minutes of yoga per day (32%) 3 to 4 days per week (47%). "Feeling good or feeling better after yoga practice" (50%) and "set aside a time" (31%) were the most common motivating factors for yoga adherence. Dealing with health problems (42%), having pain (25%), and being too busy (25%) were the major barriers. Qualitative data revealed that participants: (1) used mindful yoga movement, (2) incorporated other forms of exercise and resources during yoga practice, and (3) created personalized yoga programs. Additionally, the participants reported less OA pain, increased physical endurance, and more relaxation. CONCLUSION: Many participants adhered to yoga practice 6 months post-intervention although not at the frequency and sequence as prescribed. Feeling better after practice motivated participants, but other factors remained key barriers.

Nurse practitioner knowledge, use, and referral of complementary/alternative therapies.

PURPOSE: The study aims are to (a) describe nurse practitioners' (NPs') belief in effectiveness, knowledge, referral, and use of complementary/alternative therapies (C/ATs), (b) explore the initiation of C/AT dialogue between NPs and their patients, and (c) examine the relationships between demographic variables and NP C/AT knowledge, beliefs, use, referrals. DATA SOURCES: A mixed-method cross-sectional online survey of licensed NPs (N = 2874) from a Midwestern state was analyzed using descriptive statistics, thematic analysis, and content analysis. CONCLUSIONS: NPs (n = 410) report the most knowledge about prayer (40%) and mind-body practices (32%). Many NPs (84%) report using vitamins for personal use and 85% refer their patients for massage/bodywork. Most (95%) believe NPs should have knowledge of the most common C/AT and 81% believe C/AT have a legitimate use in allopathic medicine. NPs' knowledge, belief, use, and referral of C/AT are significantly correlated. NPs initiate C/AT dialogue with their patients 54% of the time. Factors that impact the NP and patient C/AT dialogue include patient/family openness, nature of the health problem, NP C/AT knowledge, time, and accessibility. IMPLICATIONS FOR PRACTICE: Centralized C/AT sources could help expedite C/AT referrals. Implementing workplace C/AT clinics could help build knowledge, referral, personal use, and acceptance of C/AT.

Complementary/alternative therapies use in older women with arthritis: Information sources and factors influencing dialog with health care providers.

The purpose of this study was to describe the information sources older women with arthritis use to make decisions about complementary/alternative therapies (C/AT), and factors that influence C/AT dialog with their HCP. The purposive sample included 50 community-dwelling older women (mean age = 77.8, SD = 7.6, range 66-101) who were using C/AT for arthritis management. Eight focus groups were conducted. Qualitative data were analyzed using both manual and computer-based (Atlas.ti) methods. Participants used a variety of C/AT for arthritis management. Most did not seek C/AT information from their health care provider (HCP) but primarily relied on family and friends as resources. Common themes that influenced C/AT dialog included collaborative patient relationship with HCP, HCP unsupportive attitudes toward C/AT and lack of C/AT knowledge, and time-limited clinic visits. Clinical implications include fostering shared decision making clinical relationships, increasing HCP knowledge about C/AT, initiating C/AT dialog and offering credible C/AT information sources.

The effect of Sit 'n' Fit Chair Yoga among community-dwelling older adults with osteoarthritis.

The study measured effects of Sit 'N' Fit Chair Yoga on pain and physical and psychological functioning. A quasi-experimental research design included a yoga intervention group and an attention control group. There was greater improvement in depression and life satisfaction in the yoga group than in the control group.

Yoga for managing knee osteoarthritis in older women: a pilot randomized controlled trial.

BACKGROUND: Osteoarthritis (OA) is a common problem in older women that is associated with pain and disabilities. Although yoga is recommended as an exercise intervention to manage arthritis, there is limited evidence documenting its effectiveness, with little known about its long term benefits. This study's aims were to assess the feasibility and potential efficacy of a Hatha yoga exercise program in managing OA-related symptoms in older women with knee OA. METHODS: Eligible participants (N=36; mean age 72 years) were randomly assigned to 8-week yoga program involving group and home-based sessions or wait-list control. The yoga intervention program was developed by a group of yoga experts (N=5). The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score that measures knee OA pain, stiffness, and function at 8 weeks. The secondary outcomes, physical function of the lower extremities, body mass index (BMI), quality of sleep (QOS), and quality of life (QOL), were measured using weight, height, the short physical performance battery (SPPB), the Pittsburgh Sleep Quality Index (PSQI), the Cantril Self-Anchoring Ladder, and the SF12v2 Health Survey. Data were collected at baseline, 4 weeks and 8 weeks, and 20 weeks. RESULTS: The recruitment target was met, with study retention at 95%. Based on ANCOVAs, participants in the treatment group exhibited significantly greater improvement in WOMAC pain (adjusted means [SE]) (8.3 [.67], 5.8 [.67]; p=.01), stiffness (4.7 [.28], 3.4 [.28]; p=.002) and SPPB (repeated chair stands) (2.0 [.23], 2.8 [.23]; p=.03) at 8 weeks. Significant treatment and time effects were seen in WOMAC pain (7.0 [.46], 5.4 [.54]; p=.03), function (24.5 [1.8], 19.9 [1.6]; p=.01) and total scores (35.4 [2.3], 28.6 [2.1]; p=.01) from 4 to 20 weeks. Sleep disturbance was improved but the PSQI total score declined significantly at 20 weeks. Changes in BMI and QOL were not significant. No yoga related adverse events were observed. CONCLUSIONS: A weekly yoga program with home practice is feasible, acceptable, and safe for older women with knee OA, and shows therapeutic benefits. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01832155.

Complementary/alternative medicine use for arthritis by older women of urban-rural settings.

PURPOSE: This study described the use of complementary/alternative medicine (CAM) for arthritis management among community-dwelling older women in urban, suburban, and rural areas. DATA SOURCES: A descriptive qualitative approach using focus group method was employed. A purposive sample of 50 women ages 66-101 who managed arthritis with CAM participated in eight semistructured focus groups: rural (n=22), suburban (n=17), and urban areas (n=11). Data were transcribed verbatim. Inductive analytic process and computer software were used for data analysis. CONCLUSIONS: A wide variety of self-help CAM were reported. Supplements were the most commonly used CAM across all locations; rural participants reported the greatest variety of CAM use. Physical symptoms, dissatisfaction with conventional medicine, perceived safety and convenience of CAM, and a desire for personal control over one's health motivated CAM use. Most participants did not fully disclose their CAM use to their primary healthcare provider (HCP). IMPLICATIONS FOR PRACTICE: Results suggest a strong need for primary HCP to purposely dialogue with their clients on CAM use when designing, organizing, and delivering arthritis care. Information on safe CAM use and greater options for effective arthritis management with CAM are needed. The value of group-based model for treating arthritis deserves further exploration.

Complementary/alternative therapy use in older women with arthritis.

The purpose of this study was to describe the experiences of using complementary/alternative therapy (C/AT) in community-dwelling older women with arthritis. A descriptive qualitative approach using focus groups for data collection was conducted with a purposive sample of 27 older female C/AT users (mean age = 77.8, range = 65 to 93). Content analysis was used to identify themes, which included (a) acceptance of the incurable nature of arthritis, (b) high use of nutritional supplements, (c) use of multiple C/AT to manage symptoms, (d) physical symptoms and limited treatment options motivated C/AT use, (e) most C/AT were perceived as effective, (f) C/AT knowledge was limited among users, and (g) older women did not fully disclose their C/AT use to their primary care physician. Findings revealed that older women are motivated to use C/AT, particularly nutritional supplements, to manage arthritis symptoms without seeking medical advice from their physician. Strategies are needed to improve communication between health care providers and older patients on C/AT use for optimal management of arthritis and prevention of adverse events.

The Faculty Learning About Geriatrics (FLAG) program: bringing together experts in geriatric nursing education.

Strengthening geriatric content in schools of nursing is a key initiative for the Minnesota Hartford Center of Geriatric Nursing Excellence. The first Faculty Learning About Geriatrics (FLAG) program was implemented in the summer of 2008. Selected nursing faculty from across the Upper Midwest and tribal colleges have successfully completed the FLAG program in the last 2 years. Participants completed a 5-day summer institute at the University of Minnesota and a 1-year mentorship program. The FLAG program is designed to broaden expertise in geriatric nursing through building teaching and academic leadership skills and to increase content knowledge through collaboration with academic and geriatric leaders. This article provides an overview of the educational experience of FLAG participants who have earned the title of FLAG program fellow. The perspectives of the FLAG mentors and fellows are highlighted.

Use of complementary and alternative therapies in community-dwelling older adults.

OBJECTIVES: Although complementary and alternative medicine (CAM) use is becoming increasingly prevalent in the United States, knowledge regarding complementary and alternative therapy use in older adults is limited. The purposes of this study were to (1) assess the prevalence and patterns of CAM use in a probability-based sample of older adults; (2) describe the characteristics of older CAM users; and (3) identify factors associated with complementary and alternative medicine use/nonuse. METHODS: A cross-sectional survey design was used. An age-stratified sample of community-dwelling adults ages>or=65 (N=1200) was randomly selected from the Minnesota Driver's License/Identification Tape using names from the Twin Cities seven-county metropolitan area. The mailed questionnaire included items on demographics, health status, health care utilization, CAM modality use, reasons for use, costs, and complementary and alternative therapy use satisfaction. Descriptive statistics, chi-square tests, and regression analysis were performed. RESULTS: Overall, 62.9% (N=445) of the respondents reported use of one or more complementary and alternative medicine modalities with an average of three modalities (SD+/-1.9, range 1-11). The top five CAM modalities used were nutritional supplements (44.3%), spiritual healing/prayer (29.7%), megavitamins (28.3%), herbal supplements (20.7%), and chiropractic (17.8%). Maintaining health and treating a health condition were the primary reasons for CAM use. The most common conditions treated were arthritis (44.4%) and chronic pain (23.5%). Demographic variables were not significantly different between CAM users and nonusers. CAM users reported more unhealthy days than nonusers did. Overall satisfaction with CAM use was high (80%). Symptoms of a health problem and desire for personal control over health motivated CAM use. The main barriers to CAM use were lack of reason to use and knowledge about CAM. Only 53% of users disclosed CAM use to their primary care providers. CONCLUSIONS: CAM use is common in older adults, especially those with health problems. The widespread use of oral supplements combined with not disclosing CAM use to primary care providers is a concern.