Evaluation of the ability to detect symptoms of osteoarthritis and prescription of analgesics in older adults with different degrees of cognitive impairment.
Patients consecutively admitted to a Geriatric Evaluation and Rehabilitation Unit (GERU) for disability due to orthopedic, neurological, or cardiopulmonary diseases, after a surgical intervention, or for behavioral disturbances of dementia. Subjects with a recent orthopedic intervention were excluded. Eight hundred eighty-eight patients were analyzed (mean age 78.4 +/- 7.2 years, 69.5% female) and divided into 4 groups according to cognitive impairment: severe (Mini-Mental State Examination, MMSE 0-12), moderate (MMSE 13-18), mild (MMSE 19-24), or absent (MMSE 25-30).
Patients underwent a geriatric multidimensional assessment; the diagnosis of musculoskeletal pain was based on patients' direct report, objective signs (inflammatory signs around the joints), and "pain behaviors" (reductions in activity, social withdrawal, self-protective maneuvers, increased alterations in facial expressions or body postures, observable displays of distress). Analgesic drugs were registered on discharge in subjects with symptomatic osteoarthritis.
Of the patients admitted to GERU, 16.8% (n = 149) had osteoarthritis; this percentage is different according to cognitive impairment (MMSE 0-12: 1%, MMSE 13-18: 8%, MMSE 19-24: 17.4%, MMSE 24-30: 34.1%, P < .001). If patients admitted for osteoarthritis are excluded, the new diagnoses of pain due to osteoarthritis are 306 (41.4%), without differences between cognitive status groups. On discharge, analgesic drugs are prescribed to 28.8% of patients with symptomatic arthritis (n = 131); the percentage is lower in patients with severe cognitive impairment in comparison with subjects with better cognitive functions.
There is a poor attention to chronic pain due to osteoarthritis in community-dwelling elders with cognitive impairment. In a rehabilitative setting, an accurate evaluation of objective signs allows the diagnosis of symptomatic osteoarthritis. However, the link between the diagnosis and the treatment is not direct, since the prescription of analgesics is lower in patients with a more severe cognitive impairment.