Quality of Osteoarthritis Care for Community-Dwelling Older Adults
What problem was studied?
Osteoarthritis (OA) is a debilitating disease that affects up to 80 percent of the elderly population. Community-dwelling older adults (meaning those who are not in assisted living or nursing homes) report arthritis to be the leading cause of inability to perform daily activities. Arthritis of the knee or hip in particular can make it difficult for older people to walk, climb stairs or even use the bathroom. Treatment for OA consists of patient education, physical therapy, medication and sometimes surgery. Although there has been little evaluation of the quality of care available for community-dwelling older adults with OA, some previous studies have suggested these people are getting less than optimal care.
What was done in the study?
To better understand the quality of care available for older people with arthritis, Arthritis Foundation Arthritis Investigator Award recipient Catherine H. MacLean, MD, PhD, and her colleagues collected information from 339 participants of a large-scale intervention designed to improve care for falls, mobility disorders, cognitive impairment and urinary incontinence in the elderly. The participants were interviewed by phone concerning their functional status and symptoms, as well as about whether they were receiving recommended care for OA. For example, if a patient reported pain in any joint for at least six months, the interviewer asked if her doctor or nurse had ever talked to her about how joint pain might progress over time, how to keep it from getting worse or how it could be treated. If a patient said she was taking a nonsteroidal anti-inflammatory drug (NSAID) on the recommendation of his doctor or nurse, the interviewer asked if the doctor or nurse had also recommended a medication to prevent NSAID-related ulcers.
What were the study results?
Analysis of the interview data showed that elderly, community-dwelling people were receiving less than optimal care for arthritis. The greatest concern raised in the study was about the safety of care – particularly medication safety.
What’s the relevance to older people with osteoarthritis?
The authors acknowledge limitations to the study, including the fact that its results were based on the responses of participants in a single U.S. state and may not necessarily be generalized to the whole country. Nevertheless, they say their data provide background and support for initiatives in the future to improve the level of osteoarthritis care for older adults. “Given the high prevalence of osteoarthritis in this older age group, even small improvements in osteoarthritis care could have large and meaningful benefits for the older population as a whole,” says Dr. MacLean.