Osteoarthritis Among Middle Age Females

Osteoarthritis Among Middle Age Females

Osteoarthritis

Osteoarthritis among middle aged females

The issue of osteoarthritis is one that presents many challenges to the nurse and to the healthcare professionals at all levels. The general demographic of this condition is largely female and tends to occur particularly in women over the age of forty. The literature on this topic also emphasizes the complexity of treating osteoarthritis. This is due to the wide range of external factors that are necessary for a full comprehension of this condition.

This paper will firstly provide a brief overview of the subject with the intention of focusing on factors that impact the treatment of middle-aged female patients. Aspects that will be dealt with include demographics and pervasiveness as well as extraneous factors that affect the patient in terms of quality of life as well as treatment protocols. These will include social as well as political, economic and other factors.

Following from this analysis, the Implications in practice for professionals, the community and nursing will be explored. This will be followed by a discussion on various political action plans or strategies that are or should be implemented with the aim of improving the treatment and understanding of this condition.

CONTENT

History and Description of the Issue

A common definition is this disease is provided by Walker ( 2009). "Osteoarthritis is a degenerative disorder of the synovial joints that results in localised loss of hyaline cartilage, remodeling of underlying bone and osteophyte formation at the joint margins" (p.35). The disease is also characterized by a range of common symptoms, which include "…joint pain, stiffness and limited range of movement" (Walker, 2009, p. 35). While the disease can negatively affect any synovial joint, it usually impacts the hands, hips as well as lumbar or cervical spine and the shoulders and feet (Walker, 2009, p. 35).

A central facet of osteoarthritis in terms of nursing care and the larger social and political implications of the disease that will be discussed in this paper, is that nurses may often encounter patients with osteoarthritis even though this may not be the main reason for seeking health care (Walker, 2009, p. 35) in other words, the condition can be a contributing aspects in other healthcare issues that the patient may exhibit. In this regard it is also important to note that Osteoarthritis is a complex disorder which becoming more prevalent among the middle to older age groups. Furthermore, "Biomechanical factors such as intra-articular fractures and sports injuries, such ascruciate ligament tears in the knee or lateral ligament damage in the foot, may predispose individuals to developing osteoarthritis as a result of joint instability" (Walker, 2009, p. 35)

Importantly, experts also note with a great deal of consistency that, "The incidence of osteoarthritis increases with age and affects women more than men" (Walker, 2009, p. 35). Another factor that should be borne in mind is that, "The co-existence of OA and obesity has been realized by epidemiologists for decades & #8230; Epidemiological data suggest that obesity is of very large importance for the development of knee OA" ( Bliddal et al. 2006, p. 323).

It is therefore obvious from the brief points mentioned above that osteoarthritis is a condition that is complicated in terms of its epidemiology and history of treatment. The complexity of his condition becomes clear when we consider the research studies that indicate the extent of the contributing factors that can cause this disease. For example, genetic inheritance is one of the factors linked to the pervasiveness of this condition." Familial studies have demonstrated that inheritance is a considerable factor, especially in hand and generalized osteoarthritis" ( Schroeder, 2010). However, there are also social issues that are important to take into account in understanding and treating osteoarthritis. These will be discussed in detail in the following sections of this paper.

In terms of signs and symptoms, pain and stiffness usually occur but pain may in fact be absent in some cases. While pain is usually only felt in association with movement, in extreme forms of osteoarthritis pain can even occur when the individual is at rest. One of the implications of this is restriction of movement and the ability to care for oneself - which has obvious nursing implications. Clinical features can include "…crepitus, reduced range of movement, joint instability, joint line tenderness, pain on movement or when the joint is being stressed, and mild synovitis…( Schroeder, 2010).

Pervasiveness and Demographics

According to Schroeder (2010), an alarmingly high number of adults suffer from various forms of arthritis. The figure is as high as twenty-two percent or forty-six million individuals in the United States alone (Schroeder, 2010). This figure increases with age and "…50% of adults 65 years and older report an arthritic diagnosis" (Schroeder, 2010). Research also indicates that arthritic diagnoses are not limited to adults but also affect children.

In the United States and Canada and in other countries there has also been a concomitant increase in reports of patients with osteoarthritis. This is linked to the increase in other contributing factors such as obesity and poor fitness levels. As one pundit states: "10 million individuals already have osteoporosis and 18 million more have low bone mass, placing them at increased risk for this disease. One out of every two women and one in eight men over 50 will have an osteoporosis-related fracture in their lifetime" (Osteoarthritis: The most common form, this disease affects 20.7 million Americans (usually over age 45).

An important fact that is stressed by many healthcare experts is that this disease is not necessarily a natural consequence of ageing. There are other factors that need to be considered, particularly with regard to the middle-age groups. Women are demographically more prone to most forms of osteoarthritis, except for hip osteoarthritis, which has the same degree of prevalence in men. It has been found that this form of arthritis is "… a major health problem in postmenopausal women, and the condition is more debilitating in this population" (Wright et al. 2008. p.1736)

Epidemiology and Research

Epidemiology as the study of factors affecting the state of health or illness of a certain population is important in order to understand the interventions and the necessary management of diseases and health problems in a particular social environment. This leads to the analysis of causal factors in osteoarthritis. In terms of the high incidence of this condition among older women, one of the causal factors that have been isolated is a deficiency of the hormone estrogen, which is linked to bone deterioration and loss of calcium." This often occurs at menopause in women" (Osteoarthritis: The most common form, this disease affects 20.7 million Americans (usually over age 45).

It is important to point out that osteoarthritis can be classified as primary or secondary. Primary osteoarthritis is "…an idiopathic phenomenon, meaning there is no apparent initiating factor. Primary osteoarthritis is related to the aging process and the individual may be asymptomatic" (Schroeder, 2010). However, what is of special concern is secondary osteoarthritis. This form of osteoarthritis is mainly caused by additional factors, such as obesity, repeated trauma, congenital abnormalities, diabetes, gout or surgery to the joint structure (Schroeder, 2010).

This has wide ranging implications not only for policy and politics, but also for nursing praxis. As one study remarks, " a good knowledge of this condition, its effects on functional ability and the consequences of living with it will assist healthcare professionals to support patients and aid their recovery from medical or surgical co-morbidities (Walker, 2009, p. 35).

This in turn leads to various management strategies that need to take these extra or external factors into account.

5. Social and Other Determinants

In the light of the above discussion, the social determinants, such as political, environmental and health issues and forces need to be taken into account in ascertaining their effect on the female patient. This refers as well to factors pertinent to nursing, such as the context of pain and pain reduction and to the important issue of quality of life, including the limiting effects of this condition on life and experience. All of these aspects need to be taken into account, in conjunction with other social and environmental factors, in determining nursing strategies and management

For example, a middle- aged or older woman may live alone and will be constricted by her condition in various ways - which necessitates a particular set of nursing protocols. "Treatment needs to be tailored to suit different circumstances and outcomes need to be monitored. Healthcare professionals should review the effect of symptomatic osteoarthritis on individuals' function, quality of life, occupation and leisure activities periodically" (Walker, 2009. P.35).

Therefore, social, environmental, political as well as economic determinants need or be understood in relation not these patients. Notwithstanding the feminist view that women in general are prejudiced against and marginalized in most modern societies, including Canada, there are other factors that need to be taken into consideration when dealing with this demographic. For instance, a link has been established in the literature between easting disorders such as Anorexia Nervosa and various forms of arthritis in women, including osteoarthritis. (Osteoarthritis: The most common form, this disease affects 20.7 million Americans (usually over age 45).

Furthermore, if one takes into account that many of these disorders have been attributed to the way that the female body has been adversely manipulated in patriarchic society, then this can also be seen as a determining social factor that impacts women with osteoarthritis.

Psychological factors also play a role in this condition and can reduce the quality of life for the patient. As a study by Fujita et al. (2006) states, "…our study revealed several problems that have not been mentioned to date, such as an inferiority complex related to abnormal posture prior to THA and distress over body image after undergoing THA" (Fujita et al. 2006. p. 81). THA refers to total hip arthroplasty and OA to osteoarthritis.

In conjunction with this aspect is the real problem of coping with pain and disability that this condition brings. As the above-mentioned study states, "Coping with pain and physical disability seem to be predominant features of patients with advanced-stage OA…Baird (2000) characterized the experience of elderly female patients with OA as "living with pain" and "living with difficulty…" (Fujita et al. 2006. p. 81). This aspect is underlined by an important study from the University of Ontario entitled Personal experience of living with knee osteoarthritis among older Adults ( 2006). The authors of this study found that, among others, "…experiencing mobility limitations devalues self-worth" (Maly and Krupa, 2006, p. 1423). The study also emphasizes that there has been relatively little research on this aspect and on the related and concomitant factors that impact the patient. This is an important aspect as it refers to the actual experience of this condition among older women. The following quotation provides some insight into these experiences.

For & #8230; females, the pain associated with knee OA was the most intense pain of their lives. One woman spoke at length about the experience of pain. Nobody likes pain, believe me . . . With this, how long does it go? When is it going to stop? I can't handle this no more . . . Pain is dominant, it, it took over everything. Your brain becomes so taken and your mind, you think pain, you see pain, you feel pain, you LIVE pain. You're just lost. Its constantly your focus in life. (Maly and Krupa, 2006, p. 1426)

Implications for Professionals, Community and Nursing Practice

One implication that can be clearly derived from the varied determinants is that a receptive and involved mode of nursing is required. This refers to a "…therapeutic relationship between patients and health professionals" which should focus on a "…positive approach to rehabilitation" (Walker, 2009. P.35). A related implication for nursing practice is that the nurse should encourage and motivate the individual's ability to manage her condition. This is aimed at increasing the patient's sense of self- empowerment as well as reducing"… reliance on health services and pharmacological therapies" (Walker, 2009. P.35). Nurses also have the responsibility of providing knowledge and information to the patient that can increase her quality of life.

However what should always be borne in mind is the complexity of this condition and the variety of aspects that need to be catered to. Community nursing is an important area in this regard as it is through this more intimate form of contact that the various social and environmental factors affecting this condition can be addressed. For example, there is a paucity of common knowledge about this condition among sufferers that the community nurse can remedy. Many people believe that forms of arthritis are not able to be treated and they are often not aware of remedies and available treatments. The community nurse may also be able to deal with challenges and issues that are not formally received.

In essence, health professionals at all levels have to be aware of the areas of concern in this condition, especially among older female patients. A more comprehensive and inclusive approach and strategy is essential in dealing with these problematics. This will be explored in the following sections.

Political Action Strategy

Osteoarthritis is a political issue for a number of reasons. First, it can be related to aspect of female marginalization and advancement in society. In other words, the fact that the older women is sometimes prejudiced against is exacerbated by the issues and effects of osteoarthritis. However, osteoarthritis is a political issue in many other senses as well and one of these is the area of medical treatment and the use of alternative medicines and medical treatments.

It is well-known that conventional medicines are not particularly effective when it comes to this condition. This has led to the adoption, with some degree of success, of alternative medical treatments for this condition. White and Kawakita ( 2006) state that;

…. acupuncture for osteoarthritis of the knee has a biological effect, has a large clinical effect in practice, has negligible risk, and has a cost effectiveness which is well within the usual acceptable limit. On the present evidence, acupuncture is likely to offer an alternative to treatment with non-steroidal anti-inflammatory drugs (NSAIDs). (White and Kawakita, 2006, p. 71)

However, these treatments are often not subscribed to by the scientific and medical fraternity as well as by the culture, and this imposes a barrier to effective treatment. Coupled with this is the fact that these alternative treatments are often less expensive than conventional medicine. White and Kawakita ( 2006) conclude that, "On present evidence, acupuncture is likely to provide a replacement for NSAIDs, being at least equally effective, probably more cost effective, and much safer" ( p.72).

The above is one example of the political context of the treatment of osteoarthritis that the nursing and healthcare professional has to take into account in the creation of an action plan or strategy. Any action plan should therefore be cognizant of the many political, environmental and cultural factors that may impact the patient. What is also clear is that any action plan or strategy must take place on a number of different but interrelated levels which will include all the stakeholders. One could also include aspects such as differences in race as a factor in osteoarthritis. For example, it has been found that this illness is more severe among African-Americans than whites. Therefore, differences in the experience of this condition can be related to "…personal experience, cultural definitions, and the social interactions that develop around illness" (Silverman, Myrna et al. 2008)