---
title: "Acupuncture in older adults"
url: "https://acuiq.com/wiki/safety/older-adults"
updated: 2026-10-13
last_verified: 2026-10-13
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "safety"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-13"
reading_minutes: 8
sources: 13
---

# Acupuncture in older adults

_What safety surveys report by age, what the BackInAction trial counted in 800 people aged 65 and over, Medicare's coverage rule, and the case reports on falls, burns and infection in older people with diabetes._

This page reports what the safety literature says about acupuncture in people aged 65 and over: the surveys that give rates by age, the one large randomised trial run only in that age group, and the case reports of burns and infections in people with diabetes. Most safety surveys enrol people of all ages and report a single rate, so the age-specific evidence is thinner than the overall evidence. How often reactions follow treatment at any age is on [After a treatment](/wiki/safety/after-a-treatment).

## Do older patients have more adverse events?

The surveys that reported by age did not find a higher rate in older patients. A [2021 study by Uehara and colleagues](https://pmc.ncbi.nlm.nih.gov/articles/PMC8716478/) reviewed the records of 615 patients at four teaching clinics of a Japanese acupuncture and moxibustion college over six months, covering 4,369 sessions. It recorded an adverse event in 9.6% of sessions, half of them minor bleeding. Patients in their 70s had an event in 65 of 669 sessions (9.7%) and patients in their 80s in 26 of 343 (7.6%), against 8.6% for those under 30; no age group differed significantly from the youngest. The factors the authors did find were female sex, which raised the odds, and the therapist's experience, where more years in practice lowered them.

A [2009 survey by Park and colleagues](https://pubmed.ncbi.nlm.nih.gov/19954337/) asked 1,095 outpatients at two Korean hospitals, whose average age was 58, about their reactions to treatment. Patients over 70 were the group most likely to report no reaction at all, 31 of 187 (16.6%). The only adverse event reported was bleeding, in 8.4% of participants.

The largest surveys give one rate for all ages. In the German cohort reported by [Witt and colleagues in 2009](https://pubmed.ncbi.nlm.nih.gov/19420954/), 229,230 patients had an average of 10 treatments each for chronic pain, allergic rhinitis, asthma or period pain; 8.6% reported at least one adverse effect and 2.2% one that needed treatment. Two British surveys published together in 2001 found no serious adverse events: one of [31,822 consultations with doctors and physiotherapists](https://pmc.ncbi.nlm.nih.gov/articles/PMC48133/) by White and colleagues, and the York survey of [34,407 treatments by traditional acupuncturists](https://pmc.ncbi.nlm.nih.gov/articles/PMC48134/) by MacPherson and colleagues.

## Deaths during a course of treatment

A second German cohort, reported by [Endres and colleagues in 2004](https://pubmed.ncbi.nlm.nih.gov/15689300/), followed 190,924 outpatients treated by 12,000 doctors for headache, low back pain or arthritis of the hip or knee, and asked the doctors to report every serious event during treatment, related or not. They reported 9 deaths. From German death rates adjusted for the patients' age, sex and time in the study, the authors expected 180, and concluded that serious events had been reported at about one twentieth of their real rate. A [2021 systematic review by Bäumler and colleagues](https://pmc.ncbi.nlm.nih.gov/articles/PMC8422480/) records that those nine patients were aged 67 to 87 and that their deaths were rated unlikely to be related to acupuncture and attributed to existing illness. The Endres figures show how far a voluntary report can fall short in a population where serious illness is common, which is a limit on every count of rare events on this page.

## The BackInAction trial

BackInAction is the one large randomised trial of acupuncture run only in people aged 65 and over. [DeBar and colleagues reported it in JAMA Network Open in September 2025](https://pmc.ncbi.nlm.nih.gov/articles/PMC12432643/). It enrolled 800 people with chronic low back pain across four US health care systems, mean age 73.6, and assigned them to usual medical care alone, a standard course of 8 to 15 sessions over 12 weeks, or that course followed by 4 to 6 maintenance sessions. Licensed acupuncturists in the community gave the treatment, and the protocol allowed no electroacupuncture, moxibustion, heat, cupping or herbs. The trial excluded people with a recent vertebral fracture, spinal infection, a current cancer diagnosis or serious illness, severe cognitive impairment, and residents of nursing homes and hospice.

Its safety findings, as the authors report them:

- hospital admissions were 25 (9.4%) in the standard course, 23 (8.6%) in the course with maintenance and 18 (6.8%) with usual care alone, and there were fewer than 5 deaths, none judged related to treatment;
- one admission, for cellulitis of the leg treated with intravenous antibiotics, was judged possibly related to the treatment;
- 71 minor adverse events were reported in 52 of the 534 people offered acupuncture (9.7%), most often pain or discomfort where a needle went in.

The authors write that these rates and types of events were similar to those in acupuncture studies of adults generally.

## Medicare coverage

The trial was designed in response to a call from the Centers for Medicare & Medicaid Services (CMS), which runs Medicare, the US public insurance for people aged 65 and over. CMS's [national coverage determination 30.3.3](https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=373), effective 21 January 2020, covers up to 12 visits in 90 days for chronic low back pain, defined as pain lasting 12 weeks or more with no identifiable systemic cause and not linked to surgery or pregnancy. Eight more sessions are covered for patients who improve, with no more than 20 in a year, and treatment must stop if the patient is not improving. Acupuncture for any other condition, dry needling included, is not covered. The evidence for the efficacy of acupuncture for back pain is on [Low back pain](/wiki/evidence/low-back-pain).

## Fainting and falls

Bäumler's review pooled prospective studies and found that pneumothorax, strong cardiovascular or vasovagal reactions, and falls or other trauma were the most frequent serious events possibly related to acupuncture, each at one to three cases per million treatments. The review's authors name elderly patients, with pregnant women and people with heart disease, as the groups in whom deciding whether to treat needs particular medical competence. Who faints, and what to do when someone does, is on [Fainting during treatment](/wiki/safety/fainting-during-treatment).

## Medicines and implants

Anticoagulant and antiplatelet drugs, and the cohort studies of bleeding in people taking them, are on [Bleeding and anticoagulants](/wiki/safety/bleeding-and-anticoagulants). Pacemakers, defibrillators and other implanted devices, and what the case reports say about passing current through needles near them, are on [Electrical stimulation and implants](/wiki/safety/electrical-stimulation-and-implants).

## Burns, diabetes and infection

The York survey counted one moxibustion burn in 34,407 treatments, which it classed as an avoidable practitioner error. The burn-unit series describe a younger population than this page covers: 59 patients in a [2016 Korean series by Yoon and colleagues](https://pubmed.ncbi.nlm.nih.gov/27156790/) had an average age of 49.1, and 27 of them had done the moxibustion themselves. Single case reports describe people aged 55 to 71 with diabetes in whom a burn or a needle site led to a serious infection:

- a 71-year-old farmer with type 2 diabetes and narrowed leg arteries developed a [third-degree burn of the lower leg](https://pubmed.ncbi.nlm.nih.gov/42261283/) from a moxibustion patch, which became infected after she treated it herself and needed debridement and a skin graft, reported by Wang and colleagues in 2026;
- a 61-year-old man with type 2 diabetes and peripheral neuropathy, damage to the nerves of the limbs, had moxibustion for back pain, and a second-degree burn on his lower back became the entry point for [MRSA that spread to his spine, liver and lungs](https://pubmed.ncbi.nlm.nih.gov/42272806/); after six weeks of vancomycin the infection was controlled but he remained paralysed in both legs, reported by Liang and colleagues in 2026, who call for screening people with diabetes for nerve damage before heat treatment;
- a 55-year-old woman with diabetes developed [necrotising fasciitis of the knee](https://pubmed.ncbi.nlm.nih.gov/15094988/) after acupuncture for osteoarthritis and recovered after extensive surgery, reported by Saw and colleagues in 2004, who note that many older people with diabetes and joint disease consider acupuncture.

The causes of moxibustion and cupping burns across all ages are on [Burns from moxibustion and cupping](/wiki/safety/burns-from-moxibustion-and-cupping).

## What the sources cannot tell you

The surveys that report by age are small: the Japanese study had 33 patients in their 80s, and the Korean survey asked about reactions rather than counting events. The largest cohorts give one rate for all ages, and Bäumler's review found that most of the prospective studies it pooled treated pain in middle-aged patients. BackInAction excluded the frailest people, those in nursing homes, hospice or with severe cognitive impairment, and gave no electroacupuncture or moxibustion, so its rates describe needling alone in people well enough to travel to a clinic. The case reports on burns and infection carry no denominator. AcuiQ's entries record what a study prescribed, not the age or health of the people who received it; [What AcuiQ does not do](/wiki/method/what-acuiq-does-not-do) sets out that limit.

### Sources

1. Uehara A, Yoshimoto T, Kaneko Y, et al., Patient- and therapist-related risk factors for adverse events in acupuncture and moxibustion in Japan: multicenter survey of acupuncture and moxibustion teaching clinics, Medical Acupuncture 2021 — https://pmc.ncbi.nlm.nih.gov/articles/PMC8716478/
2. Park SU, Ko CN, Bae HS, et al., Short-term reactions to acupuncture treatment and adverse events following acupuncture: a cross-sectional survey of patient reports in Korea, Journal of Alternative and Complementary Medicine 2009 — https://pubmed.ncbi.nlm.nih.gov/19954337/
3. Witt CM, Pach D, Brinkhaus B, et al., Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form, Forschende Komplementärmedizin 2009 — https://pubmed.ncbi.nlm.nih.gov/19420954/
4. White A, Hayhoe S, Hart A, Ernst E, Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists, BMJ 2001 — https://pmc.ncbi.nlm.nih.gov/articles/PMC48133/
5. MacPherson H, Thomas K, Walters S, Fitter M, The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists, BMJ 2001 — https://pmc.ncbi.nlm.nih.gov/articles/PMC48134/
6. Endres HG, Molsberger A, Lungenhausen M, Trampisch HJ, An internal standard for verifying the accuracy of serious adverse event reporting: the example of an acupuncture study of 190,924 patients, European Journal of Medical Research 2004 — https://pubmed.ncbi.nlm.nih.gov/15689300/
7. Bäumler P, Zhang W, Stübinger T, Irnich D, Acupuncture-related adverse events: systematic review and meta-analyses of prospective clinical studies, BMJ Open 2021 — https://pmc.ncbi.nlm.nih.gov/articles/PMC8422480/
8. DeBar LL, Wellman RD, Justice M, et al., Acupuncture for chronic low back pain in older adults: a randomized clinical trial, JAMA Network Open 2025 — https://pmc.ncbi.nlm.nih.gov/articles/PMC12432643/
9. Centers for Medicare & Medicaid Services, National coverage determination 30.3.3: Acupuncture for chronic lower back pain (cLBP), effective 21 January 2020 — https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=373
10. Yoon C, Cho YS, Park S, Chung SP, Choi YH, Epidemiology of burns caused by moxibustion in Korea, Burns 2016 — https://pubmed.ncbi.nlm.nih.gov/27156790/
11. Wang R, Yu J, Guan Y, Xu X, Cai X, Pseudomonas oryzihabitans: an emerging opportunistic pathogen causing severe burn wound infection after improper moxibustion patch use in an elderly diabetic farmer, Infection and Drug Resistance 2026 — https://pubmed.ncbi.nlm.nih.gov/42261283/
12. Liang H, Mao ZF, Huang JY, et al., Case report: moxibustion-induced burns leading to disseminated methicillin-resistant Staphylococcus aureus infection in a patient with type 2 diabetes mellitus, Frontiers in Endocrinology 2026 — https://pubmed.ncbi.nlm.nih.gov/42272806/
13. Saw A, Kwan MK, Sengupta S, Necrotising fasciitis: a life-threatening complication of acupuncture in a patient with diabetes mellitus, Singapore Medical Journal 2004 — https://pubmed.ncbi.nlm.nih.gov/15094988/