Self Management of Arthritis in Older Adults

Reporting results of their ongoing study into self-management of arthritis in older adults, Gail Davis, RN, EdD and Terri White, RN, PhD, FNP-C, both of Texas Woman’s University, have already identified tools and telling statistics that can aid clinicians in their efforts to improve the lives of patients with arthritis.

Patients identified the following strategies as ones in which they engage during self-management: weight-bearing exercise, rest, keeping a positive attitude, range of motion and flexibility exercise, use of pain medications, distraction, function-assisting aids, and pacing activities.

Patients indicate that physical methods such as exercise, hot & cold therapies, and massage are the most helpful strategies, followed by cognitive-behavioral therapy (distraction, staying positive), and the use of pain medications. This finding surprised Davis and White who expected medication to be the primary means of self-management.

However, this makes sense when considering what Davis and White have identified as challenges in, and barriers to treatment. Because this population ranges in age from 66-93 and all live in retirement communities, lack of access and convenience present major obstacles to seniors receiving education about arthritis and its management.

There were many reservations about medications—not taking them for fear of negative side effects, not wanting to add another pill to their daily regimen, not sure of the safety of drug combinations—and this played into an overall sense of frustration on the part of seniors who indicated a willingness to help themselves, but were largely unaware of how to do so.

This reality supports recent research showing low senior participation in self-management programs, but also underscores the importance of the role that providers play in the education of these patients about self-management strategies.

A lack of participation and education can lead to arthritis sufferers devising their own ineffective and possibly damaging strategies. Some of the “best” approaches that Davis and White reported people using if they had not participated in self-help groups: screaming into pillow, crying, pounding on the arms of a chair, eating chocolate, drinking margaritas, and following the dubious suggestions of others like eating raisins soaked in gin.

Meanwhile, participation in such programs (Davis and White discussed the Arthritis Foundation Self-Help Course and Chronic Disease Self-Management Program) often leads to increased self efficacy and is associated with positive changes in self-reported health outcomes such as decreased pain, fatigue, number of physician visits, and health distress. Davis and White found that this was true, but only through a delicate approach.

Education improved subjects’ quality of life, but was put to better use if the patient was involved in individual goal planning. While the goals should be set by the patients themselves in order to be meaningful, Davis and White recommend coordinating with someone to ensure that the action plan is short term and realistic. However, they say recommendations should be made as recommendations rather than directives.

Davis and White enhanced their efforts through follow-up phone calls, but indicate that there needs to be further exploration into the most effective means of goal setting in primary care. Questions of rating patient commitment levels and establishing appropriate means of follow-up (mailings, phone calls, email) remain to be answered.