Arthritis Care Falls Short for the Elderly

Forbes

April 4, 2006

Many older Americans with arthritis aren't receiving the care they need, and when they do get medications to control their pain they often aren't told about the side effects of those drugs.
That's the conclusion of a new study in which doctors sat down and talked to patients about their care -- a departure for such research, which usually is based on information from insurance claims or medical records.

Of the 339 people aged 75 and older who were interviewed, they received the recommended care for osteoarthritis -- the most common form of the disease -- just 57 percent of the time. And only 44 percent were told about potential side effects of their medications.

That's an important omission because the frail condition of arthritis sufferers makes them vulnerable to drug side effects, said study author Dr. David A. Ganz, a research fellow in geriatrics at the University of California, Los Angeles.

The study, by researchers at Rand Health, the David Geffen School of Medicine at UCLA and the Greater Los Angeles VA Healthcare System, appears in the April 15 issue of Arthritis Care and Research.

One-third of the people in the study reported one of three major problems of old age -- falls, urinary incontinence or loss of mental function, Ganz said. Even over-the-counter medications such as acetaminophen can cause problems, with side effects such as kidney damage, stomach trouble and the risk of heart failure, he noted.

"The truth is that the side effects can be similar for all these drugs," Ganz said.
The new study is part of a larger effort to assess the quality of health-care offered to older people, and the results so far are somewhat discouraging, Ganz said. "We know that the quality of care for older people in general is not great," he said.

For arthritis, the researchers found that most of the people they interviewed were getting care from their family doctor. Only 12 percent reported having seen a rheumatologist in the previous year. When they were asked, "Did any doctor or nurse tell you about possible side effects?" a majority said, "No."
A big part of the problem is the assembly-line nature of many medical practices, Ganz said. "My take on it is that there are too many things going on at once," he said. When a frail, older person asks for help to relieve the pain of arthritis, the doctor often does it the easy way, he explained.

"But as you get old and frail and on more medications, the issue of side effects becomes more important," he said. "It's hard to make a conscientious effort when you see a patient every 15 minutes."

Part of the solution could rest with the patients themselves, Ganz said. "Part of the goal of writing this report is to make them aware from this end that they should ask simple questions, like, 'Doctor, what are the side effects of this medication?'" he said.

But the health-care provider has responsibilities, too, Ganz said. It's common for doctors to write a prescription on the computer, he said, and when writing such a prescription, the patient's potential vulnerability to side effects should be taken into account. "There should be a warning on the screen," he said.