Healthy ageing, chronic disease management Complementary and Integrative Medicine: The Greenest Approach for Health and Wellbeing of Ageing Citizens of Europe, April 2021
Executive Summary: healthy ageing position paper
From public health to disease prevention, from combating antimicrobial resistance (AMR) to viral and fungal diseases in human and animals. From the health of mothers and newborns, teenagers and adolescents, for health and wellbeing across the life course, from visioning a renewed approach to medical education in Europe to new skills and employment generation to mental health and stress reduction, from providing better and sustainable health and healthcare options in regional, urban and rural Europe to reviving the European way of life and living, Complementary and Integrative Medicine offers some of the most creative solutions.
Complementary and Integrative Medicine provides some of the safest approaches for delaying and managing age-related physiological changes and somatic disease and multiple chronic conditions (cardiovascular disease, hypertension, cancer, osteoarthritis, diabetes mellitus, osteoporosis, and numerous chronic conditions) and improving physical function (walking speed, mobility disability, disability in activities of daily living, falls, frailty, continence). Complementary Medicine has much to offer and is the best approach for promoting better health, managing and preventing several conditions. The citizens of Europe, particularly the rapidly increasing number of older citizens, deserve greater engagement and involvement from the European institutions, well-structured funding instruments and international programmes of work, community-level living labs, clinical, basic and fundamental research to realize the citizens’ wishes for a healthy life later in life.
The need for healthy ageing
In all EU member states, because of a combination of low fertility and longer life expectancy, the proportion of older people has increased in recent decades and is projected to increase further. That means that if current health policies remain unchanged, the need for healthcare and long-term care can be expected to grow exponentially.
People live longer because the healthcare system has become more proficient at treating infectious diseases and acute episodes. However, the system is challenged by chronic non-communicable diseases and the rising costs of medical treatment not accompanied by corresponding improvements in health. Although people are living longer, chronic diseases are causing illness and disability among those surviving. The best that biomedicine has so far been able to offer is some degree of management of the disease or control of symptoms – sometimes not even that.
We share the vision for healthy ageing formulated in the report ‘Healthy Ageing: A Challenge for Europe (Swedish Institute for Public Health, 2007)’: “Healthy ageing is the process of optimising opportunities for physical, social and mental health to enable older people to take part in society without discrimination and to enjoy an independent and good quality of life.”
We will, in this healthy ageing position paper, show how Complementary and Integrative Medicine can contribute to longstanding healthy ageing. Both the European citizens and the health budget will benefit.
Definition of Integrative and Complementary Medicine
We would like to start by describing what Integrative Medicine is. This concept is a paradigm shift in the way healthcare is delivered to patients. It is used to indicate a collaborative, multidisciplinary approach that requires applying the best options from different healing systems. Experts from various biomedical and complementary medicine fields combine the systems’ diagnostic and therapeutic strengths into a comprehensive and individualised treatment strategy that encourages patient participation.
It has the following characteristics:
- Is patient-centred care and focuses on healing the whole person—mind, body, and spirit in the context of the community.
- Educates and empowers people to be active participants in their own care and to take responsibility for their own health and wellness,
- Integrates the best of biomedicine with a broader understanding of the nature of the illness, healing, and wellness,
- Makes use of all appropriate therapeutic approaches and evidence-based global medical modalities to achieve optimal health and healing
- Encourages partnerships between the provider and patient, supports the individualisation of care, and
- Creates a culture of wellness.
It is necessary to explore this in some detail and outline the role of Integrative Medicine in this transformation.
Complementary Medicine (CM) methods, which are a part of Integrative Medicine, have a common aim, i.e., to restore the patients’ natural systems for fighting disease and maintaining health and are therefore highly relevant in chronic disease management.
- help reduce the need for high-impact medical interventions and the long-term dependency on conventional prescription drugs.
- help reduce the need for antibiotics, thus reducing the problem of antimicrobial resistance.
- have a high patient satisfaction, increased quality of life, and reduction of absenteeism.
- are mostly low-cost treatments and help reduce the need for high-cost interventions.
- are a safe treatment with hardly any adverse effects.
- have shown to have increasing evidence for its effectiveness and cost-effectiveness.
Integrative Medicine, therefore, can contribute to the vision mentioned before on health ageing by:
- Improving health maintenance, health literacy, and supporting self-care
- Prevention of illness
- More personally and financially sustainable treatment methods for chronic diseases
- Integration of the services of a large cohort of CM health workers currently operating outside formal health systems
- Retraining of existing healthcare workers in CM holistic approaches to prevention and treatment.
The upsurge of Complementary Medicine (CM)
A recent study by Kemppainen et al. (2017) demonstrated that in total, 25.9% of the general population in Europe had used CM during the last 12 months. The use of CM varied greatly by country, from 10% in Hungary to almost 40% in Germany. Compared to those in good health, the use of CM was two to fourfold greater among those with health problems.
Since the proportion of older people is likely to grow, one can expect that the future demand for CM by more senior people can increase significantly.
Complementary Medicine refers to those practices that often come from older, cross-cultural perspectives of health and healing. These often focus on lifestyle re-evaluation and the mind/body interaction. In the successful primary and secondary prevention and management of chronic diseases, CM modalities have their most significant contribution. However, they may also support the treatment even in severe illness when combined with biomedicine.
Factors underlying the increased popularity of CM include the rise in prevalence of chronic diseases, an increase in public access to health information worldwide, reduced tolerance for paternalism, an increased sense of entitlement to quality of life, declining faith that scientific breakthroughs will have relevance for the personal management of the disease, increased sense of personal responsibility for health and healthcare, concern about the side effects of ever more potent drugs, and an increased interest and understanding that health involves a positive balance of all aspects of an individual’s life from the physical through the mental and emotional to the spiritual.
The Complementary Medicine Model
In the CM model, human beings are considered adaptable, self-regulating, creative biological systems. Illness/disease is a disturbed life process with causes at physical, emotional, social, mental, spiritual levels. Patients themselves take responsibility for their mental and physical health. Treatment involves mobilising and stimulating self-regulating capacity, restoring the balance in the psychosomatic system with the eventual aim: creating and maintaining the health and wellbeing and reinforcing the autonomy and resilience of the patient. Care is individualised, and the responsibility lies with both the health professional and the patient.
CM therapies are not explicitly directed at attacking the symptoms or the primary underlying pathology but reinforcing the resilience, resistance, and immune system, raising the overall health level and pushing back the disease state. Improving the level of health implies reducing the susceptibility to illness and disease and addressing any already existing disease process. As such CM approaches are not limited to simply addressing certain medical conditions but are universally applicable to patients suffering or threatened by all kinds of diseases. They can often be used as early first therapeutic options, thus significantly reducing the need for high-impact, high-cost interventions with potential adverse effects and long-term dependency on conventional medication. In the case of infectious diseases CM modalities, by their capacity to boost the immune system, can reduce the need for antibiotics and the problem of antimicrobial resistance.
Central to the CM perspective is the concept of salutogenesis. It describes an approach focusing on factors that support human health and wellbeing rather than factors that cause disease. Salutogenesis explores why some people stay healthy in the face of hazardous influences while others, faced with similar pathogenic factors or other difficulties, fall ill. Thus, the ultimate objective of health promotion is to highlight and facilitate the essential prerequisites for maintaining health. Salutogenesis provides the theoretical foundation of health promotion, including the WHO Ottawa charter, one of the most fundamental documents for the international health promotion movement.
The CM model also has its limitations, notably in severe, life-threatening diseases (sepsis, cancer, etc.). In these critical situations, biomedical interventions are indispensable and should explicitly be given primacy because the protection of life itself always has the highest priority. Sometimes the condition is too far out of balance for the self-regenerating capacity; then biomedical interventions are needed to give the body time to deal with the matter itself: setting up a broken leg, surgery, medication to reduce disruptive or harmful symptoms to a viable or acceptable level and the like. Complementary therapies are then relegated to a secondary complementary role.
Healthy ageing position paper
Read more in our Healthy Ageing position paper 'Complementary and Integrative Medicine: The Greenest Approach for Health and Wellbeing of Ageing Citizens of Europe'.