Transcript Slide 1

Resource Review for Teaching
Chronic Illness and Aging
Section 5: Osteoarthritis—
A Chronic Incapacitating Disease
Victoria Rizzo, PhD
Columbia University School of Social Work
Osteoarthritis (OA) Prevalence
 26.9 million people aged 25 years and older have doctor
diagnosed OA.
 By 2030, 72 million people aged 65 and older (20% of the
population) will be at increased risk for OA (CEDC,
2007b).
 OA is the leading chronic illness cause of disability (19
million people in 2005) (CDC, 2008A).
Changing Trajectory of Osteoarthritis
 Increases in obesity from 15% in 1980 to 33% in 2004
have the potential to significantly increase number of older
adults diagnosed with OA.
 Freedman & colleagues (2007) predict national increase of
16% in doctor diagnosed OA between 2005 and 2030.
 14 states will see increases of 30% to 87% in doctor
diagnosed OA cases by 2030.
Osteoarthritis in Older Adults
 In 2006, women 85 years and older represented 60% of
all doctor-diagnosed arthritis reported (CDC, 2008a).
 Women report greater physical limitations, psychological
stress, and knee/ hip pain that requires surgery than men.
 Black patients have fewer surgeries but many more
complications and higher mortality rates than their white
counterparts (Theis, Helmick, & Hootman, 2007).
Sex-specific prevalence of doctor-diagnosed arthritis
by age group, National health Interview Survey, 20032005
Source: Centers for Disease Control. (2008a). Chronic Disease-Arthritis-at-a-glance. Retrieved
from http://www.cdc.gov/nccdphp/publications/AAG/arthritis.htm
Factors affecting the
Impact of OA in Older Age
 OA is a significant public health issue for older adults.
 Older adults underutilize programs proved to be effective
in managing OA.
 The Arthritis Foundation Self-help Program (Lorig & Fries,
2000), a course designed for people diagnosed with all
types of arthritis, is among the most popular disease
management courses offered.
 Despite the effectiveness of these disease management
courses, only 11% of persons with arthritis participate in
them.
Critical Challenges of OA
in Older Adults

Managing OA and co-morbidities: More than half of
adults diagnosed w/OA also have heart disease and/or
diabetes.

Increasing participation in disease management
programs for OA: For example, only 1% of eligible
people participate in New York State.

Development & implementation of interventions (e.g.,
care coordination) to address biopsychosocial issues that
impact OA and are not addressed with current
interventions.
Biopsychosocial Health Needs
 Vary by intensity of osteoarthritis symptoms & disease
duration.
 Physical stresses include pain, stiffness, decreased
mobility, and decreased ability to participate in work and
leisure activities.
 Psychological distress can include depression and/or
anxiety, & social isolation.
 OA patients request a need for information about
diagnosis, its implications, & available treatments.
 OA patients request strategies for coping with the
consequences of OA: fear, depression, uncertainty, pain,
fatigue.
Relational Concerns of the
Older OA patient
 Patients are concerned about relationships with family &
friends as their abilities to fully participate in the home
and work environment decrease. They may feel socially
isolated and lonely.
 As patients become more physically disabled, their social
networks may become smaller and more fragmented.
Biopsychosocial Needs & Formal
Services to Address Needs
1) Information about illness, treatments, health,
and services for patients and caregivers:

Provision of information, e.g., on illness, treatments,
effects on health, biopsychosocial services, and helping
patients/families understand and use information.

Varies by intensity of osteoarthritis symptoms and
disease duration.
Biopsychosocial Needs & Formal
Services to Address Needs
2) Help in coping with emotions accompanying
illness and treatment:

Peer Support Programs.

Counseling/psychotherapy to individuals or groups.

Pharmacological management of psychological symptoms.

Pharmacological treatment for depression/anxiety coupled
with psychotherapy and pain coping skills training.
Biopsychosocial Needs & Formal
Services to Address Needs
3) Help in managing illness:

Comprehensive disease management/self-care programs.

Coordinated care programs that organize patient care to
facilitate more appropriate delivery.

Development & implementation of outreach strategies to
engage vulnerable populations in disease management
programs.
Biopsychosocial Needs & Formal
Services to Address Needs
4) Assistance changing behaviors to minimize
impact of disease and delay/prevent disease
progression:


Behavioral/health promotion interventions such as:

Provider assessment/monitoring of health behaviors
such as diet, smoking, exercise.

Brief physician counseling.
Patient education on risk reduction.
Biopsychosocial Needs & Formal
Services to Address Needs
5) Material and logistical resources such as
transportation, home care, assistive equipment,
home modification:

Provision of resources, improvement of home
environment.

Help to provide and manage resources needed to allow
patient to remain in the community with maximum
independent and quality of life .
Biopsychosocial Needs & Formal
Services to Address Needs
6) Help in managing disruptions in work, activities,
family life, and social network & Preparing for
care transitions due to disease progression:

Family/caregiver education, counseling.

Assistance with activities of daily living (ADLs), and
instrumental activities/chores (IADLS).

Legal protections and services.

Social network development.

Social network maintenance over time (friends & family).
Biopsychosocial Needs & Formal
Services to Address Needs
7) Financial advice and/or assistance & identifying
sources of funding for many non-covered
equipment items and non-prescription NSAIDS:

Financial planning/counseling including management of
activities such as bill paying.

Insurance counseling/advocacy.

Eligibility assessment for other benefits (SSI and SSDI).

Supplemental financial grants.

Ongoing assistance with out of pocket expenses, such as
assistive devices and home modifications.
Social Work Role:
Care Coordination
Currently, health system’s focus on OA patients’
biopsychosocial needs is:

Medical treatment of the disease, (e.g., joint
replacements, & pharmacological interventions),
and

Management of the disease through evidenced-based
programs (e.g., the Arthritis Foundation Self-help
Program) to delay or prevent progression of the disease.
Social Work Role:
Care Coordination
Limitations of disease management programs include a lack of:

Access to information concerning diagnosis and its implications
and available treatments,

Continuity of care,

Coordination of care,

Strategies for coping with symptoms, such as pain, fatigue, and
loss of independence,

Ways to adjust to consequences of the disease, such as fear,
depression, and uncertainty (der Ananian et al., 2006), and

Ability to successfully recruit the populations that could benefit
the most from them (Rizzo et al., 2006, 2007).
Social Work Role:
Care Coordination
Barriers to participation in programs are:

Physical (pain, mobility, co-morbidity, arthritis-related
illness, and fatigue),

Psychological (attitudes/beliefs, perceived negative
outcomes, and depression), and

Social/environmental (insufficient advice from physicians
regarding the benefits of exercise, competing
roles/responsibilities, lack of available exercise
programs, lack of transportation, and weather. (Der
Ananian et al., 2006; Schoster et al., 2005).
Social Work Role:
Care Coordination
Social workers need to develop and implement care
coordination programs that:
 Incorporate better screening and assessment of functional
impairment, pain, depression, and anxiety of patients with
osteoarthritis when they implement the treatments
described in the program’s manual (e.g., the Arthritis
Foundation Self-help Program).
 Educate patients about their diagnosis and it implications as
well as available treatments. Include the disease as a part
of the routine assessment of all older adults practitioners
work with, given its increasing prevalence with age.
Social Work Role:
Care Coordination

Advocate for the delivery of disease management
programs in tandem with social work intervention
strategies for coordination of care in health facilities and
in nontraditional settings that may attract underserved
populations (e.g., churches, community centers, and
libraries).

Develop and implement better outreach and screening
and assessment strategies for use with the most
vulnerable and underserved populations (e.g., people of
color, people of low income, frail older adults with few
social supports).