Life satisfaction and its correlates in older women with osteoarthritis

The Association of Osteoarthritis and Related Pain Burden to Incident Alzheimer's Disease and Related Dementias: A Retrospective Cohort Study of U.S. Medicare Beneficiaries

BACKGROUND

Emerging evidence suggests osteoarthritis (OA) and related symptom burden may increase risk for Alzheimer's disease and related dementias (ADRD). However, longitudinal studies are sparse, and none have examined the potential mediating effects of mood or sleep disorders.

OBJECTIVE

To determine the association of OA and related pain to incident ADRD in U.S. elders.

METHODS

In this retrospective cohort study, we used baseline and two-year follow-up data from linked Medicare claims and Medicare Current Beneficiary Survey files (11 pooled cohorts, 2001-2013). The study sample comprised 16,934 community-dwelling adults≥65 years, ADRD-free at baseline and enrolled in fee-for-service Medicare. Logistic regression was used to assess the association of OA and related pain (back, neck, joint, neuropathic) to incident ADRD, explore the mediating inlfuence of mood and insomnia-related sleep disorders, and (sensitivity analyses) account for potential survival bias.

RESULTS

Overall, 25.5% of beneficiaries had OA at baseline (21.0% with OA and pain); 1149 elders (5.7%) were subsequently diagnosed with ADRD. Compared to beneficiaries without OA, those with OA were significantly more likely to receive a diagnosis of incident ADRD after adjustment for sociodemographics, lifestyle characteristics, comorbidities, and medications (adjusted odds ratio (AOR) = 1.23 (95% confidence interval (CI) 1.06, 1.42). Elders with OA and pain at baseline were significantly more likely to be diagnosed with incident ADRD than were those without OA or pain (AOR = 1.31, CI 1.08, 1.58). Sensitivity analyses yielded similar findings. Inclusion of depression/anxiety, but not sleep disorders, substantially attenuated these associations.

CONCLUSION

Findings of this study suggest that: OA is associated with elevated ADRD risk, this association is particularly pronounced in those with OA and pain, and mood disorders may partially mediate this relationship.

Effects of Mantra Meditation versus Music Listening on Knee Pain, Function, and Related Outcomes in Older Adults with Knee Osteoarthritis: An Exploratory Randomized Clinical Trial (RCT)

OBJECTIVE

Disease-modifying treatments for OA remain elusive, and commonly used medications can have serious side effects. Although meditation and music listening (ML) have been shown to improve outcomes in certain chronic pain populations, research in OA is sparse. In this pilot RCT, we explore the effects of two mind-body practices, mantra meditation (MM) and ML, on knee pain, function, and related outcomes in adults with knee OA.

METHODS

Twenty-two older ambulatory adults diagnosed with knee OA were randomized to a MM (N=11) or ML program (N=11) and asked to practice 15-20 minutes, twice daily for 8 weeks. Core outcomes included knee pain (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Numeric Rating Scale), knee function (KOOS), and perceived OA severity (Patient Global Assessment). Additional outcomes included perceived stress (Perceived Stress Scale), mood (Profile of Mood States), sleep (Pittsburgh Sleep Quality Index), and health-related quality of life (QOL, SF-36). Participants were assessed at baseline and following completion of the program.

RESULTS

Twenty participants (91%) completed the study (9 MM, 11 ML). Compliance was excellent; participants completed an average of 12.1±0.83 sessions/week. Relative to baseline, participants in both groups demonstrated improvement post-intervention in all core outcomes, including knee pain, function, and perceived OA severity, as well as improvement in mood, perceived stress, and QOL (Physical Health) (p's≤0.05). Relative to ML, the MM group showed greater improvements in overall mood and sleep (p's≤0.04), QOL-Mental Health (p<0.07), kinesiophobia (p=0.09), and two domains of the KOOS (p's<0.09).

CONCLUSIONS

Findings of this exploratory RCT suggest that a simple MM and, possibly, ML program may be effective in reducing knee pain and dysfunction, decreasing stress, and improving mood, sleep, and QOL in adults with knee OA.

The impact of lower limb chronic oedema on patients' quality of life

This study aimed to explore patients' perceptions regarding the impact that lower limb chronic oedema has on their quality of life (QoL). A quantitative descriptive design was used to collect data from patients with lower limb chronic oedema. A condition-specific validated questionnaire was distributed to a purposive sample (n = 122) through manual lymphatic drainage/vascular/health clinics in Ireland. Results indicated that patients with lower limb chronic oedema experience a wide range of physical problems such as limb heaviness (74%, n = 66), weakness (44%, n = 40) and pain (38%, n = 34). Additionally, difficulties with walking (53%, n = 48), standing (51%, n = 46) and bending (45%, n = 40) were reported. Concerns regarding poor body image were strongly evident (76%, n = 68). Difficulties finding clothing/footwear to fit oedematous limb(s) were reported (59%, n = 53), in addition to finding clothes that participants would like to wear (64%, n = 58). Emotional symptoms of irritability (42%, n = 38), anxiety (41%, n = 37) and tension (40%, n = 36) were reported. Over half of the participants (55%, n = 49) stated that their chronic swelling affected their social functioning and their ability to engage in leisure activities. This study has identified that lower limb chronic oedema has significant psychological, social and physical implications for persons' QoL.

Identification of demographic factors and health problems that affect the acceptance of disease and health behaviors of patients with osteoarthritis

Introduction

Osteoarthritis (OA) is one of the most common causes of musculoskeletal system’s ailments. In the prevention of the disease and in its comprehensive treatment, proper health-related behavior becomes an extremely important factor for maintaining an optimal health condition. The aim of the study is to assess the relationship between the reported pain and the disability level, and the health-related behaviors undertaken by OA patients as well as their acceptance of the disease.

Materials/Methods

The study group consisted of 198 patients with diagnosed OA, according to ACR criteria (1988). The method used in the study employed a Pain VAS (0-10), Health Assessment Questionnaire Disability Index (HAQ DI 0-3), Acceptance of Illness Scale (AIS 8-40) and Health and Behavior Inventory (IZZ 24-120).

Results

The average age among respondents with OA has been 59.16 years of age (±15.87), duration of disease 5.5 years (±4.32). Pain experienced both during movement (r_s = 0.319, p < 0.001) and at rest (r_s = 0.382, p < 0.001) correlated positively with physical disability (HAQ DI). Studies indicated a positive linear correlation between the age and physical disability (r_s = 0.200, p = 0.005). Acceptance of the disease (AIS) depends mostly on age (r_s =  − 0.325, p < 0.001), on pain in motion (r_p =  − 0.209, p < 0.001) and at rest (r_p =  − 0.218, p < 0.001) and on the disability levels (r_p =  − 0.353, p < 0.001). Analysis of the health-related behaviors (IZZ) indicates that the average severity of declared behavior is statistically significant with physical disability (HAQ DI) (p = 0.029).

Conclusions

The acceptance of illness is significantly reduced with age and progressive levels of disability as well as with the severity of pain. The progressive levels of disability and the younger age of the respondents motivate them to engage in health beneficial behavior.

Interrelations of stress, optimism and control in older people's psychological adjustment

AIM

To investigate the influence of perceived stress, optimism and perceived control of internal states on the psychological adjustment of older adults.

METHOD

The sample consisted of 212 older adults, aged between 58 and 103 (M = 80.42 years, SD = 7.31 years), living primarily in retirement villages in Melbourne, Victoria. Participants completed the Perceived Stress Scale, Life Orientation Test-Revised, Perceived Control of Internal States Scale and the World Health Organisation Quality of Life-Bref.

RESULTS

Optimism significantly mediated the relationship between older people's perceived stress and psychological health, and perceived control of internal states mediated the relationships among stress, optimism and psychological health. The variables explained 49% of the variance in older people's psychological adjustment.

CONCLUSION

It is suggested that strategies to improve optimism and perceived control may improve the psychological adjustment of older people struggling to adapt to life's stressors.

Effects of Meditation on Symptoms of Knee Osteoarthritis

OBJECTIVE

The aim of this study was to investigate changes in knee pain, function, and related indices in older adults with osteoarthritis (OA) of the knee, following an 8-week meditation program.

METHODS

Eleven community-dwelling adults with physician- confirmed knee OA were enrolled in the study. Core outcomes included recommended measures of knee pain (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and 11-point numeric rating scale [NRS]), function (WOMAC), and perceived global status (patient global assessment). Additional outcomes included: perceived stress; stress hardiness; mood; sleep; and sympathetic activation. Following baseline assessment, participants were trained briefly in mantra meditation and instructed to meditate for 15-20 minutes twice daily for 8 weeks, and to record each practice session on a daily log. Changes over time were analyzed using paired t-tests.

RESULTS

Nine participants (82%) completed the study. Participants had statistically significant improvements in all core outcomes: knee pain (WOMAC: 47.7% ± 25.1% reduction, P = 0.001; NRS: 42.6% ± 34.6% reduction, P < 0.01); function (44.8% ± 29.9, P = 0.001); and global status (45.7% ± 36.5, P = 0.01); as well as knee stiffness (P = 0.005), mood (P = 0.05), and a WOMAC proxy for sleep disturbance (P = 0.005).

CONCLUSIONS

Findings from this pilot study suggest that a mantra meditation program may help reduce knee pain and dysfunction, as well as improving mood and related outcomes in adults with knee OA.

The impact of nurse prescribing on patients with osteoarthritis

Osteoarthritis (OA) is now considered one of the ten most disabling diseases in developed countries and it is estimated that worldwide, 18% of women and 9.6% of men aged over 60, suffer from OA. It is, therefore, vital to take into consideration the demographics of this disorder, including the health needs of this age group and associated problems, such as reduced mobility or immobility and the inability to perform everyday tasks associated with chronic pain. Older patients, however, are sometimes able to accept their condition and adopt a positive outlook towards their OA as a coping strategy. This association with and acceptance of pain by the patient as a normal part of the ageing process may compromise the patient's ability to undertake activities of daily living and impact their psychological wellbeing.

Identifying the Relationship Between Chronic Pain, Depression, and Life Satisfaction in Older African Americans

Empirical research on the chronic pain experience of older African Americans is scarce. Here, the authors examined the influence psychosocial indicators have on the pain experience in a sample of older African Americans. Data were collected from African Americans ( N = 247) 50 to 96 years of age (69.4 ± 9.4). All participants provided self-report data on pain indicators, demographic characteristics, social (social support, locus of control, life satisfaction) variables, and depression. Those reporting higher levels of social support and depressive symptoms experienced greater pain intensity. Pain had an indirect effect on depression as mediated through life satisfaction.These findings demonstrate the need to focus more on the means to prevent and treat pain and to ameliorate its impact on social well-being, psychological functioning, and quality of life in older adults in general and older minority adults in particular.

Coping strategies and self-efficacy as predictors of outcome in osteoarthritis: a systematic review

OBJECTIVE

 Systematically to review the literature, investigating the prognostic value of self-efficacy and coping strategies used by adults with osteoarthritis (OA) recruited within the community or primary care.

METHODS

 An online electronic search was performed from inception to August 2009, using EMBASE, CINAHL, PsycINFO and MEDLINE databases. A search of keywords and key authors was performed to find related articles, and experts in the field were contacted to identify additional literature. Three reviewers blindly assessed the quality of the included studies, using pre-determined criteria. Data on coping strategies and self-efficacy were extracted and tabulated.

RESULTS

 Eight studies were identified and included in this review. Six of the papers were rated as being of acceptable methodological quality. Strong evidence was identified for the role of self-efficacy in predicting disability, but no evidence was found for the relationship between self-efficacy and pain. Although problem-solving coping had no effect on pain, there was weak evidence that active coping strategies predict increased pain and worsened mood. There was also weak evidence demonstrating that problem avoidance, wishful thinking, social withdrawal, self-criticism and turning to religion are predictors of depressed mood. This review also presents evidence for catastrophizing, self-efficacy and passive coping strategies as predictors of mood.

CONCLUSION

 Coping strategies and self-efficacy are important prognostic factors for people with OA. This review highlights the need for further research to ascertain the predictive values of coping strategies that, to date, have been less well investigated. This may, in turn, result in a better understanding of the role of coping in OA and enable clinicians and patients to manage the condition more effectively.

Recovery from total hip replacement surgery: "it's not just physical"

In this grounded theory study we explored the process of recovery following total hip replacement (THR) surgery from the perspective of the older adult. In-depth interviews were conducted with 10 patients aged more than 65 years who had been discharged from hospital for a period of 4 to 6 months following THR surgery. Findings showed that three distinct but interrelated processes constitute the physical, psychological, and social recovery process: reclaiming physical ability, reestablishing roles and relationships, and refocusing self. Intervening conditions affecting the recovery process include comorbid conditions, the personal outlook of the patient, patients' relationships, and social support. The recovery process can lead to changes in personal and social functioning that patients might not anticipate. Awareness of potential changes will inform patient education and enable clinicians to develop strategies that facilitate THR patients' return to health.

[Pain coping strategy, pain and activity restriction among middle-aged and elderly women with knee pain]

AIM

The present study examined the association of pain coping strategy with pain and activity restriction among middle-aged and elderly women with the knee pain.

METHODS

The participants were 134 female community residents (62.1+/-8.2 years) with knee pain. The pain and activity restriction were assessed with the Japanese Knee Osteoarthritis Measure (JKOM). The pain coping strategy was evaluated using the Japanese short version of the Coping Strategy Questionnaire (CSQ). A theoretical model was developed to explain the relationships among age, pain, activity restriction, and pain coping strategy. This model was then tested using structural equation modeling (SEM).

RESULTS

The overall fit index was adequate for the final model (GFI=.980, AGFI=.946, CFI=.995, RMSEA=.022). SEM indicated that increasing age had a significant association with increasing pain, and indirect influence on progressive activity restriction. Also, aggravating pain was significantly associated with adopting more "praying or hoping", "catastrophizing", and "increasing pain behavior" as pain coping strategy, and indirectly affected progress in activity restriction.

CONCLUSIONS

The results indicate that reducing the use of maladaptive coping strategy would be important to promote the ability of pain self-management among middle-aged and elderly women with knee pain. The present study suggests that it would be necessary to incorporate the cognitive-behavioral approaches in order to modify the use of maladaptive coping strategy in existing therapeutic exercise intervention for knee pain.

Daily stress in elders with arthritis

This study examined whether social support perceived by older people with arthritis mediated the experience of daily stress related to the physical disability of arthritis. Seventy participants completed survey questionnaires. The data were analyzed using the three-step regression analysis procedure. Daily stress was significantly correlated with physical disability and social support. Increased physical disability led to more daily stress. Also, arthritic patients with increased physical disability perceived lower levels of social support. Social support decreased the effects of physical disability on daily stress and had a significant effect on daily stress. However, social support did not fully mediate the effect of physical disability on daily stress. Caregivers should recognize that social support has a limited role in alleviating the daily stress that arthritic patients experience from physical disability. Studies are needed to develop and test stress management programs targeting various sources of daily stress.

An insider perspective of daily stress and coping in elders with arthritis

BACKGROUND

Elders living with arthritis perceive chronic daily stress associated with a loss of function. Daily stress has a significant effect on the prediction of depression and decreased life satisfaction in older persons. However, little is known about the nature of the daily stress and coping process from their personal viewpoint.

PURPOSE

This study explores stressors in daily life, coping strategies, and social support resources from the perspective of older adults with arthritis.

METHODS

Thirteen older adults with arthritis participated in semistructured, individual interviews. Content analysis of the interview transcriptions was used.

FINDINGS

Results revealed six sources of stress in the daily life of the participants: health, routine tasks, family issues, financial management, social relationships, and living conditions. Three major strategies of coping with daily stress emerged: cognitive efforts, diversional activities, and assertive actions. Participants reported a wide range of support resources to deal with daily stress.

CONCLUSION

Recommendations for health professionals in assisting clients to minimize the impact of daily stress on mental health by assessing the sources of stress, improving cognitive-behavioral coping techniques, and locating resources are given.

Control and end-of-life care: does ethnicity matter?

Patient control and autonomy are core values in Western bioethics and important components of end-of-life (EOL) care. However, the centrality of the patient as decision maker may not be relevant to culturally diverse groups of people. The purpose of this article is to present results of a literature review of patient control and ethnicity within the context of EOL care. The review revealed that the interplay between control and ethnicity in EOL care is complex and unpredictable. Implications for clinical care and future research are presented.

Treatment options for patients with osteoarthritis of the knee

Knee osteoarthritis (OA) affects many older people and may result in pain and loss of function in the knee. The article explores the wide spectrum of treatments available, including education, exercise, pharmacological agents and surgery. The evidence for these treatments is examined so that nurses have a knowledge base on which to build their practice. The importance of individual patient characteristics and available resources when deciding on treatment options is emphasized. The article is intended to be of use for both acute and primary care nurses who care for patients with knee OA.

Predictors of distress and depression in elders with arthritic pain

AIM

The aim of this paper is to report the findings of a study testing a theory of chronic pain, with financial hardship added as a contextual stimulus.

BACKGROUND

Arthritis is highly prevalent among older people, resulting in severe pain and suffering. A previous study testing a theory of chronic pain in elders with arthritis found that pain, disability and social support explained only 35% of the variance in their emotional distress. It is possible that demands, other than chronic pain, such as financial hardship, also contribute to these elders' stress and depression.

METHOD

The theory was tested with 235 elders with arthritis using a secondary data analysis strategy. Data were obtained from the study of Ageing, Status, and Sense of Control carried out in 1998 in the United States of America. Variables were constructed from original questionnaires.

RESULTS

The hypothesized model fitted the data only moderately well (chi2 = 40.04, d.f = 6, P < 0.0001; CFI = 0.88; NFI = 0.88). Disability and financial hardship positively predicted distress, while social support and age had a reverse impact on distress, which explained 24% of the variance in distress. This means that elders with higher levels of disability, more financial hardship, less social support or younger age are likely to have higher levels of distress. Distress alone explained 33% of the variance in depressive symptoms. A data-derived model was created with excellent fit (chi2 = 3; d.f. = 4; P = 0.56; CFI = 1.00; NFI = 0.99), showing that disability, social support, financial hardship and age predicted distress (R2 = 0.24). Pain, disability and distress predicted depression (R2 = 0.44).

CONCLUSIONS

The results partially supported the theory. Exploring the possibility of using depression as part of the control process and removing gender as a residual stimulus may lead to further refinement of the theory. The findings allow nurses to have a better understanding of the experiences of elders with arthritis, and thus to offer appropriate care to meet their needs.