Quality of care provided for elderly osteoarthritic patients needs improvement

Osteoarthritis is a debilitating disease affecting up to 80% of elderly adults. Among those living on their own, it is the leading cause of an inability to engage in daily activities, especially if the knee or hip is affected.

A recent study published in the April 2006 issue of Arthritis Care & Research evaluated the quality of care provided for elderly osteoarthritic patients and found that it was in need of improvement.

Led by David A. Ganz, researchers from the RAND Corporation, the Greater Los Angeles Veterans Health Care System and the University of California, Los Angeles collected data from older patients participating in an intervention to improve care for three other health problems (falls and mobility disorders, cognitive impairment, and urinary incontinence). The main study, known as ACOVE-2, took place in two medical groups in the western United States and involved 644 patients age 75 or older who screened positive for at least one of the three health problems.

The present study was a continuation of ACOVE-2, involving 339 patients who indicated they had been diagnosed with arthritis. Interviews of these patients took place at the conclusion of ACOVE-2, which ran from April 2002 to May 2003 in one medical group and from July 2002 to August 2003 in the other. Patients were interviewed about the duration and location of joint pain and the number of prescription medications they were taking, and they were asked other questions used to measure quality of care for osteoarthritis. The quality of care questions included measures of treatment such as annual assessment, exercise therapy, education about the condition and referral to an orthopedic surgeon. The questions also included measures of medication safety, such as whether patients were informed of risks associated with various medications.

The results showed that 57% of the patients interviewed received adequate arthritis care overall. Only 44% of patients were adequately informed about medication safety, however. "Quality improvement efforts in osteoarthritis might best be targeted at assuring safe medication use in this population, particularly given the substantial risk of adverse drug events in these patients who were taking a mean of 6 prescription medications," the authors note.

The limitations of the study include the limited patient population (age 75 or older from 2 medical groups in 1 state) and the fact that identifying patients with a history of falls and/or mobility disorders for the original study may have skewed the patient population to include more individuals who had used exercise therapy. Also, the patient interviews were conducted at the end of the 13-month study period, when patients may not have been clear on the details of the medical care they had received.

Nevertheless, the results of this study show that the quality of osteoarthritis care for older adults is suboptimal. The authors conclude: "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."