Koh Iwasaki
Objectives: Evaluating the traditional Chinese medicine (TCM) for elderly patients in updating Japan Geriatric Sociaty guideline according to the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
Setting: The PubMed and Cochrane databases were searched for studies of TCM in elderly patients published in English or Japanese between 1st Jan 1972 to 22nd Nov 2013, and a systematic review was performed.
Results: Fifty seven of 503 identified articles were included. Eighteen studies of TCM herbs and recipes showed from high to low Quality of Evidence (QoE) for elderly patients, and five of these with a strong or weak Recommendation Strength (RS) were included to the screening tool to alert doctors to right treatment (START), as were recipes that involved five herbs to the the screening tool for older person’s prescriptions (STOPP). The RS of 11 TCM recipes with a high to low QoE could not be evaluated because these were not available in Japan. These trials suggested that TCM could improve the symptoms of elderly patients. However, our proposition was approved by only 62.5% of committee members who did not have a conflict of interest, which is below the 80% approval needed in the guideline rules. Then the guideline committee decided to put TCM in an independent chapter, not in the grand list.
Conclusions: The GRADE system was partially available for the evaluation of traditional medicine, at least with respect to QoE. RS was not suitable in this context, as committee members had very different views and experiences of this issue.