Full Project – Challenges of osteoarthritis and its management in older adults above 65

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CHAPTER ONE

INTRODUCTION

1.1     Background to the study

Osteoarthritis (OA) is a type of joint disease that results from the collapse of the articular cartilage and the underlying bone (Arden, 2015). Joint pain and stiffness are the most common symptoms (WHO, 2012). At first, symptoms may appear after exercise, but over time they can become constant. Other symptoms may include swelling of the joints, decreased freedom of movement and, if the back is affected, weakness or numbness of the arms and legs. The joints most commonly affected are those near the tips of the fingers, at the base of the thumb, neck, lower back, knees and hips. The joints on one side of the body are often more affected than on the other. As a general rule, symptoms develop over several years. They can affect work and normal daily activities. Unlike other types of arthritis, only joints are affected (WHO, 2012).

Causes include previous joint injuries, joint or abnormal limb development, and hereditary factors (Glyn-Jones, 2015). The risk is higher in overweight people with legs of different length or in jobs that exert great pressure on the joints (Glyn-Jones, 2015; Vingård, 2016). It is believed that osteoarthritis is caused by mechanical stress on the joint and low-grade inflammatory processes (Berenbaum, 2013). It develops when cartilage is lost and the underlying bone is compromised (WHO, 2012). Since pain can complicate training, muscle atrophy can occur (Glyn-Jones, 2015; Conaghan, 2014). The diagnosis is usually based on signs and symptoms. Medical images and other tests are sometimes used to help or rule out other problems. Unlike osteoarthritis, which is primarily an inflammatory disease, joints do not heat up or turn red in osteoarthritis (WHO, 2012).

Treatment includes exercise, efforts to reduce joint stress, support groups and analgesics (WHO, 2012). Efforts to reduce joint tension include rest and the use of a cane (McAlindon et al., 2014). Weight loss can help those who are overweight. Analgesics may include paracetamol (paracetamol) and NSAIDs such as naproxen or ibuprofen. Long-term opioid use is generally not recommended due to lack of information about benefits, addiction and other side effects (McAlindon et al., 2014). If pain interferes with normal life despite other treatments, joint replacement surgery can be helpful. An artificial joint usually lasts 10 to 15 years (Di Puccio and Mattei, 2015).

Osteoarthritis is the most common form of arthritis and affects approximately 237 million people (3.3% of the world’s population) (March 2014). Among those over 60, approximately 10% of men and 18% of women are affected (Glyn-Jones, 2015). This is the cause of approximately 2% of the years of disability (March 2014). Australia affects around 1.9 million people and affects 30 to 53 million people in the US. UU (Elsternwick, 2013, Cisternas, 2016). It is more common in both sexes as people get older. Osteoarthritis (OA) is a global joint disease characterized by pain, joint stiffness and decreased function. Osteoarthritis (OA), sometimes called degenerative joint disease or degenerative arthritis, is the most common chronic joint disease and affects approximately 27 million Americans (WHO, 2012). OA can affect any joint, but it is more common in the knees, hips, lower back and neck, in the joints of small fingers and in the feet of the thumb and big toe. In normal joints, a solid, rubbery material called cartilage covers the end of each bone. The cartilage provides a smooth and slippery surface for the movement of the joint and acts as a cushion between the bones. In OA, the cartilage breaks down and causes pain, swelling and problems with the movement of the joints. As OA worsens over time, bones can collapse and develop growth called spores. Pieces of bone or cartilage can detach and float in the joint. In the body, an inflammatory process occurs and cytokines (proteins) and enzymes are created that further damage the cartilage. In the later stages of OA, the cartilage wears out and the bones rub against the bone, causing joint damage and more pain. It becomes imperative to study the management of osteoarthritis among the elderly and risk prone individuals as well as to identify the challenges in effectively managing or treating the disease condition.

1.2     Statement of problem      

An estimated 8.5 million people are affected in the United Kingdom, and older people have higher levels of disability than any other disease (McAlindon et al., 2014). Almost one in five women over 60 is affected and 60% of people over 64 suffer from moderate to severe OA in at least one joint. The prevalence of OA increases with age and, as life expectancy increases, the incidence will increase. A document published in the USA UU In 1995, he suggested that the number of people with disabilities related to OA will increase by 66% by 2020 (Arden, 2015). The treatment of the disease has particular consequences in terms of primary care, since more than 2 million adults consult their primary care physicians every year with symptoms attributed to OA (Vingård, 2016). Currently, there is no cure for OA, and the extent of the problem burdens the patient and society in terms of morbidity and cost. Although OA occurs in people of all ages, osteoarthritis occurs more frequently in people older than 65 years. Common risk factors include increased age, obesity, previous joint injuries, overuse of the joint, muscles and weak muscles of the thigh. A 2012 baseline survey conducted by the WHO in California found that one in two adults developed symptoms of knee OA during their lifetime, one in four adults with 85 years of OA symptoms of the hip and one in 12 older than 60 years ,

The aim of the administration is to control pain, optimize the function and modify the OA process, and educate the patient about his illness and treatment. The latter is the basis of the treatment program. Education is particularly important when the patient suffers from a chronic disease such as OA, since effective long-term management depends on the patient’s willingness to work together and their ability to follow treatments such as exercise. Many patients also require drug therapy in the form of analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs), which can have undesirable side effects, especially in the elderly. In fact, education has been highlighted as one of the “essential” elements of the treatment, based on evidence-based guidelines for the management of OA, and is one of the EULAR recommendations for the management of OA of the knee based on evidence (Berenbaum, 2013; Conaghan, ed. 2014)). Education and the provision of information are not only an essential element of management, but are also the responsibility of the doctor and are considered one of our fundamental ethical, legal and professional obligations (Di Puccio and Mattei, 2015). However, providing education can be time consuming and, therefore, costly, and it is important to evaluate its effectiveness. One way to do this is to measure the knowledge of patients before and after informing / providing information. The quickest and easiest way to do this is to complete questionnaires and surveys. Hence, this study seeks to assess the challenges of osteoarthritis and its management in older adults above 65 in Awuda community, Anambra state.

1.3     Objectives of the study

The overall purpose of this study is to assess the challenges of osteoarthritis and its management in older adults above 65 in Awuda community, Anambra state. The specific objectives are as follows;

1. To determine the knowledge of osteoarthritis among the elderly in Awuda community
2. To assess the risk factors associated with osteoarthritis among the elderly in Awuda community
3. To determine the knowledge of treatment and management of osteoarthritis among the elderly in Awuda community
4. To identify the challenges to osteoarthritis management among the elderly in Awuda community

1.4     Research Questions

The research questions are formulated based on the objectives and statement of problem to include;

1. What is the level of knowledge on osteoarthritis among the elderly in Awuda community?
2. What are the risk factors associated with osteoarthritis among the elderly in Awuda community?
3. What is the level of knowledge on the treatment and management of osteoarthritis among the elderly in Awuda community?
4. What are the challenges to osteoarthritis management among the elderly in Awuda community?

1.5     Significance of the study

The findings of this study would have implications for healthcare practice by informing the elderly, healthcare workers and community members on osteoarthritis, causes and symptoms, predisposing risks factors, control measures and implication of lack of treatment and management. Also, the study will be useful to medical practitioners especially the nurses in creating awareness on the control measures so as to reduce the occurrence and complications associated with this disease. The public would also benefit from the literature and findings from the study for behavior modification and healthy lifestyle adoption. Furthermore, findings and recommendations of the study will help health stakeholders in the formulation of policies and educational programmes as it relates to osteoarthritis and its management and control. Finally, in order to correct for the paucity of data on the subject matter, information gathered from this study will serve as a source of literature and guide for future research and as well serve as empirical reference for further studies.

1.6     Scope of study

The focus of this study is to assess the challenges of osteoarthritis and its management in older adults above 65 in Awuda community, Anambra state. Awuda community was used as the study area, and elderly adults above 65 years as the respondents for data collection and analysis. Variables considered include level of knowledge on osteoarthritis among the elderly in Awuda community, risk factors associated with osteoarthritis among the elderly, level of knowledge on the treatment and management of osteoarthritis among the elderly, and the challenges to osteoarthritis management among the elderly in Awuda community, Anambra state.

1.7     Operational definition of terms

Management: this refers to the activities and sets of behaviors that serve as strategies to curtail the effect of a disease condition, in this case, osteoarthritis.

Older Adults: refers to elderly individuals who are 65 years and above in Awuda community.

Osteoarthritis: degeneration of joint cartilage and the underlying bone, most common from middle age onward. It causes pain and stiffness, especially in the hip, knee, and thumb joints.

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Full Project – Challenges of osteoarthritis and its management in older adults above 65