Running Head: ARTHRITIS AND HEALTHY AGING 1

Arthritis and Healthy Aging

Lanita Adams
Nursing 428
Fall 2016
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Arthritis

Arthritis affects the joints but is not limited to the joints. According to the Arthritis

Foundation (n.d.c) arthritis is a term that covers over 100 different types of joint diseases. The

hallmarks of arthritis are inflammation, swelling and stiffness (Arthritis Foundation, n.d.c).

Many forms of arthritis are autoimmune and others can be caused by infections, wear and tear,

genetics, and other inflammatory agents. There are many different types of arthritis and related

diseases including rheumatoid arthritis, osteoarthritis, psoriatic arthritis, gout, and fibromyalgia.

Other types you may be familiar with are lupus, Paget’s disease, carpal tunnel, Lyme disease,

and rheumatic fever (Arthritis Foundation, n.d.b).

Some types of arthritis can have an early onset and among aging people arthritis is quite

prevalent. Osteoarthritis is common in older adults and accounts for 46 million patient visits each

year (Abyad, Boyer, 1992). One of the most common areas for osteoarthritis is the knee (Abyad,

Boyer, 1992). Because of the prevalence of obesity, the complications that come with it, and the

process of aging hip fractures have come to be a significant concern for disability in the elderly.

Another factor that plays into arthritis in elderly women is how menopause effects the bones and

joints and leads to their deterioration.

Mobility

People with arthritis may not want to be mobile because of the pain in their joints and

body. Is it healthy for them to exercise? According to the Mayo Clinic (2016) lack of exercise is

actually worse for people with arthritis because it leads to muscle stiffness and increases pain.

Part of what plays into that is how strength in muscles and tissues surrounding the joints is

crucial to maintaining support for your bones. The benefits of exercise go beyond treating the

pain and include improving sleep, maintain bone strength, increasing energy, controlling weight,
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improving balance (Mayo Clinic staff, 2016). Exercise also helps with mood as a result of many

of these things.

A study published by the NIA press office (1996) showed that not only does exercise

help with knee osteoarthritis pain it also reduces disability and improves physical performance

along with the other benefits of exercise. The study involved participants age 60 and older and

there were two different exercise programs with 68% compliance in the aerobic training group

and 70% compliance in the weight resistance training group. One of the challenges was keeping

the more sedentary and overweight participants motivated. The study was done over 18 months

with three of the months in a facility and fifteen months in the home environment led by an

exercise leader. Gradual but consistent improvements were seen in relief from arthritis symptoms

this plays into why it is important for people with arthritis to exercise consistently over time to

keep their arthritis symptoms controlled.

Poirot (n.d.) talks about important things to avoid and include in a workout routine that is

safe and effective and alleviating arthritis symptoms. Poirot (n.d.) says that a warm up is

important to help prevent muscle stiffness the next day because the blood flow and increased

body temperature obtained from a warm up helps loosen joints which can also prevent injury

during the workout itself. Stretching is also important because it helps with range of motion and

helps with releasing muscles that are tight and pulling on joints so that they are out of alignment

(Poirot, n.d.). This stretching described above is to be done before the actual workout and then

stretching and deep breathing should also be done after the workout to help get the heart rate,

blood pressure, and breathing safely down to normal and also help with healing, recovery and

flexibility. It is important to hydrate and go at a pace and use resistance that is not too advanced

for your abilities. Don’t go for resistance that is difficult before 12 to 15 repetitions and only add
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weight after what you are doing has become easy. In order to know how much to exert your body

at the right level of intensity work calculate your target heart rate by subtracting your age from

220 and then multiply that number by 40% that is your low target heart rate and when you

multiply it by 70% you get your high target heart rate. By working in between 40% and 70% of

your target heart rate pain levels have shown improvement and weight loss has been achieved

(Poirot, n.d.). This might not be what your body is ready for when someone with arthritis begins

to work out and it is important not to push your body to the point of damaging it.

Mental Health

It can be challenging to be in a good mood when you are in pain especially chronic pain.

The Arthritis Foundation (n.d.a) uses Dr. Buxton’s description of how negative feelings,

emotional and physical cab be intensified by depression and anxiety. The mood we are in when

we are in pain can either magnify the pain or make it worse and being in pain can put us in a

depressed or anxious state in the first place so it is no wonder that people with arthritis tend to be

depressed, anxious, or both. The cycle of being in pain, pain making daily tasks more difficult,

and the mind being in a depressed state can cause a person with arthritis to have poor mental

health.

He, Zhang, Lin, Bruffaerts, Posada-Villa, Angermeyer, ... & Benjet (2008) conducted a

study to see how prevalent mental disorders were in people with arthritis. The surveys used in

the study were carried out in 17 countries around the world. When adjustments were made to

take into account age and sex they came up with their results. The results showed that the

correlation between persons with arthritis was stronger for mood disorders and anxiety disorders

and weaker for alcohol abuse/dependence than people without arthritis. The beneficial thing
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about this study is that it also shows that the results were similar across countries He et. al.

(2008).

Living Situations

It is important for people with arthritis to avoid environments, whether work, living, or

entertainment, where cigarette smoking is prevalent. Smoking has shown to alter the body’s

immune system and cause changes that may contribute to the development of RA (Baka, Buzás

& Nagy, 2009). Smoking also “is considered to play a major role in the pathogenesis of

autoimmune diseases (Baka, Buzás & Nagy, 2009),” and many forms of arthritis are autoimmune

like Lupus, rheumatoid arthritis, and fibromyalgia.

No matter where you live, changes in the weather tends to cause pain in people with

arthritis. When looking for a good place to live people might consider a city that has lots of

people that specialize in arthritis, whatever type of arthritis they have. It has been proven that just

because a climate is warm and dry that people with arthritis will not still have pain when the

weather changes, and that a wet cool place could be adjusted to and work just as well for

someone with arthritis. In fact, Brody (1995) talked about a study done at Brigham and Woman’s

Hospital in Boston and stated how people with arthritis in hot dry climates can be more sensitive

to change in weather than those in wet and cold climates. Dr. Jamison involved in the study

(Brody, 1995) stated, “when the outside pressure falls, body tissues -- tendons, ligaments,

muscles and bones -- may readjust by expanding to varying degrees and, in doing so, can

trigger the sensitized nerves that send out pain signals.” This decrease in barometric

pressure actually occurs and is felt before the weather changes.

Disease Management
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Arthritis is common with the CDC (2014) estimating that one in five people have arthritis

and that is projected to increase with our population aging. Also arthritis tends to come with

comorbidities with 31% of people with arthritis are obesity, 44% have hypertension, 47% have

diabetes, and 49% have heart disease. The comorbidities lead to complex medication regimes,

difficulty participating in healthy activities, increased strain on the joints, and increased medical

costs to treat all that comes with their conditions. Comorbidities can also lead to shortened

lifespan as a study on rheumatoid arthritis (RA) showed that the increased death rate is a

“consequence of an increased prevalence of cardiovascular disease, a greater incidence of

infections, and the development of certain malignancies in patients with RA (Dougados,

Soubrier, Antunez, Balint, Balsa, Buch, ... & Hajjaj-Hassouni, 2014).”

Dougados et. al.’s (2014) study showed that patients with RA from seventeen countries

also had depression, asthma, cardiovascular events such as myocardial infarction and stroke,

solid malignancies (excluding basal cell carcinoma), and chronic obstructive pulmonary disease.

Depression was found in 15% of the 4586 patients in the study (Dougados et. al.,2014). All of

the medications needed for these comorbidities and the complications that come along with them

make it difficult for someone with arthritis to be healthy.

Patient-Centered Care Strategy

Motivational interviewing (MI) and connecting the elder adult to support groups are two

ways to maximize the elder adult’s participation in their own health. MI involves finding where

the individual is in their readiness to change and how they perceive their situation. Many of the

questions used in MI are open ended and some lead to more simple answers like how they rate

their readiness to change and then lead to asking them why they rated their readiness the way

they did and what would help them rate it higher (Sobell & Sobell, 2008). MI can be used to
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identify what the individual perceives as the benefits of changing and the results of not changing

along with the challenges they see along the way. May be the individual can identify resources

that have been helpful to them in the past such as books, support groups, documented progress

along the way, or other ways of learning more about how to properly tackle making the change a

reality for them.

Support groups are helpful for many reasons. Not all support groups need to be formal

and some of them can be established specifically for the individual by educating their caregivers,

family and friends on helpful activities for them to do to be more active, eat healthy, or take their

medications effectively for example. One of the reasons support groups are helpful is that they

give the person others to be accountable to for the desired change. If they have a goal to work out

three times a week and they have someone that they work out with they will be more likely to

stick to their goal and also they will have someone to socialize with before, during, or after the

work out and to share their progress with. If the change that they need to make is quitting

smoking their support group can do activities with them that are away from areas where smoking

is common. The support group might be a more formal group where the person goes to learn

more about their diagnosis and hear stories from other people with similar situations to them.

They can get insights on what has worked for others and even be able to help others with their

story.

Some support groups could be more medically based and involve a network of doctors

that coordinate the patient’s care so that the different aspects of the individual are addressed such

as the mental health, the circulatory issues, possible physical therapy interventions needed,

medication management, smoking cessation, and weight loss. A larger city is likely more able to

provide these resources than a rural town. There is an ever growing amount of support from the
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internet on specific types of arthritis and arthritis in general. There are different social media

resources people can use to find others with the same diagnosis as them and share stories. This

may not be especially easy for the older adult to use but some may be technologically savvy

enough to navigate these sites.

Conclusion

Arthritis is something many of us may have to deal with as we age. It is in many forms

and effects the joints in different ways. It can lead to different complications like surgeries,

fractures, disabilities, depression, and make staying healthy more of a struggle. Staying active is

important for pain management and overall health but is beneficial if done properly and can be

harmful if hydration, stretching, and incremental increases in difficulty are not included. Pain can

be a very real struggle for someone with arthritis and environmental and lifestyle factors play

into how much pain a person has. People with arthritis often have multiple medical conditions or

comorbidities that complicate and impair an individual’s ability to be healthy.

It does not have to be doom and gloom. There are many things that people can do to help

with the pain, the depression, and the other health problems that may accompany arthritis.

Exercise helps with the mental and physical effects of arthritis and can also help reduce the

likelihood of obesity, heart disease, diabetes and hypertension. Good habits that come along with

proper exercise like deep breathing, proper hydration, slowly building up to being able to

accomplish more, and working on your schedule to fit exercise in all can be used to tackle life’s

challenges and improve physical and mental health.

Keeping the patient involved in the decisions that are made about their health can really

help them feel empowered to take action and improve their situation. Having support groups

introduced to them and finding out what motivates them so they are reaching their goals for
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health are helpful ways to keep them encouraged to enjoy life and have less pain and limitations.

Motivational interviewing helps those that suffer with arthritis take responsibility for their own

recovery.
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References

Abyad, A., Boyer, J. T. (1992). Arthritis and Aging. Current opinion in rheumatology 4(2).

Retrieved from http://journals.lww.com/co-

rheumatology/Abstract/1992/04000/Arthritis_and_aging.4.aspx

Arthritis Foundation (n.d.a) The Emotion–Pain Connection. Retrieved from

http://www.arthritis.org/living-with-arthritis/pain-management/understanding/arthritis-

pain-emotions.php

Arthritis Foundation (n.d.b) Types of arthritis. Retrieved from http://www.arthritis.org/about-

arthritis/types/

Arthritis Foundation (n.d.c) Understanding arthritis. Retrieved from

http://www.arthritis.org/about-arthritis/understanding-arthritis/

Baka, Z., Buzás, E., & Nagy, G. (2009). Rheumatoid arthritis and smoking: putting the pieces

together. Arthritis research & therapy, 11(4), 1. Retrieved from https://arthritis-

research.biomedcentral.com/articles/10.1186/ar2751

Brody, J. A. (1995). For chronic pain sufferers, change, not weather, may hurt. Retrieved from

http://www.nytimes.com/1995/06/07/us/for-chronic-pain-sufferers-change-not-weather-

may-hurt.html

CDC. (2014). Arthritis meeting the challenge of living well. Retrieved from

http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2014/arthritis-aag-

2014.pdf

Dougados, M., Soubrier, M., Antunez, A., Balint, P., Balsa, A., Buch, M. H., ... & Hajjaj-

Hassouni, N. (2014). Prevalence of comorbidities in rheumatoid arthritis and evaluation

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of their monitoring: results of an international, cross-sectional study (COMORA). Annals

of the rheumatic diseases, 73(1), 62-68.

He, Y., Zhang, M., Lin, E. H. B., Bruffaerts, R., Posada-Villa, J., Angermeyer, M. C., ... &

Benjet, C. (2008). Mental disorders among persons with arthritis: results from the World

Mental Health Surveys. Psychological medicine, 38(11), 1639-1650. Retrieved from

https://www.cambridge.org/core/journals/psychological-medicine/article/mental-

disorders-among-persons-with-arthritis-results-from-the-world-mental-health-

surveys/0A3F4EE23EC54494C339B5AC55F8D5DC

Mayo Clinic Staff (2016). Exercise helps ease arthritis pain and stiffness. Retrieved from

http://www.mayoclinic.org/diseases-conditions/arthritis/in-depth/arthritis/art-20047971

NIA press office (1996). Exercise - A safe and effective new treatment for knee osteoarthritis.

Retrieved from https://www.nia.nih.gov/newsroom/1996/12/exercise-safe-and-effective-

new-treatment-knee-osteoarthritis

Poirot, L. (n.d.) Avoiding common workout mistakes. Retrieved from

http://www.arthritis.org/living-with-arthritis/exercise/how-to/exercise-program-tips.php

Sobell, L., & Sobell, M. (2008). Motivational interviewing strategies and techniques: Rationales

and examples. Retrieved from

http://www.nova.edu/gsc/forms/mi_rationale_techniques.pdf