Introduction

Of all the chronic diseases associated with 'getting old', osteoarthritis is one of the most common. Among all adult Americans, it is the number one cause of disability and cost to individuals, employers, and society as a whole. Osteoarthritis is known to occur more frequently among those who are over-weight, have low bone density, a history of joint trauma, repeated stress joint injuries, and among those who have family members with the disease. Women are twice as likely than men to have arthritis. Among women, African Americans are twice as likely as Caucasians to have the disease.

But perhaps most dramatic of all, is the estimate that 80% of all Americans 75 years old and older have osteoarthritis. Studies of elderly, arthritic Americans has consistently found a high degree of suffering, a diminished quality of life, and a high incidence of depression. This study examines a previously ignored relationship, namely does the severity of the arthritis correspond to the severity of depression?

Method

Using a convenience sample of fifty community dwelling adults, all 60 years or older, who were diagnosed with osteoarthritis and seen at out-patient arthritis clinics of two urban hospitals. The majority of participants were Caucasian and married. The average age was 70.5 years and they had been diagnosed an average of 19 years prior to the study. Most participants had at least two other chronic diagnoses and they took an average of 6 medications each day for their arthritis alone.

All information was gathered through lengthy interviews with each participant using well-validated tools. The revised version of the Arthritis Impact Measurement Scales (AIMS-2) was a used to determine the severity of the arthritis in terms pain and disability (Meenan, et al., 1992). The presence and degree of depression was evaluated using the Center for Epidemiological Studies Depression Scale (CES-D) (Radloff, 1977). Reliance on family assistance and/or community services in their homes was determined through questioning about specific personal, household, and social tasks. Finally, using the Quality of Life Survey (QOLS), the respondents satisfaction with life was assessed (Flanagan, et al., 1978).

The AIMS-2 asks respondents about their ability to perform four activities of daily living (bathing dressing, toileting, and eating) and four household activities (shopping, preparing meals, doing housework, and laundry). Utilization of services in the home, such as meals on wheels, homemaking and personal assistance, transportation, therapy, and support groups.

Using a Likert-type scale scoring, respondents were asked to indicate the frequency of 20 symptoms in the previous week. The range was zero to three with zero indicating the symptom occurred rarely, if at all, and three that the symptom was present most of the time. Total scores for the 20 items could range from 0 to 60, with high scores indicating depression.

Results

Most of the respondents had chronic moderate to severe arthritic pain in more than one joint and required some assistance, particularly for household chores. Nearly half of this sample had some depression, with 12% indicating severe depression. Nevertheless, the majority indicated feeling that their quality of life was acceptable. This seeming contradiction may be in part due to the extensive informal support through family and friends this study sample reported.

Comment

There is a growing recognition of the prevalence of depression among older adults. Depression is crippling disease which can be caused by physical illness and in turn, can cause somatic complaints and exacerbate physical illness. It is reasonable then to evaluate all elderly arthritics for depression and intervene appropriately. Pain management and support for continued socialization are important aspects of care for all patients with chronic disease, including osteoarthritis.