Arthritis Has More Impact on Younger Patients

Young and middle-aged adults report more pain, sleep disturbance, impaired mental health

http://www.medpagetoday.com/Rheumatology/Arthritis/53526?xid=nl_mpt_DHE_2015-09-14&eun=g578717d0r

In contrast with widespread misperceptions, Canadian research published in BMC Musculoskeletal Disorders has found that older adults with arthritis are less likely than their younger counterparts to report worse outcomes.

Noting adverse effects on well-being across all age groups, however, the researchers stressed that “public health messaging should emphasize the importance of timely diagnosis and treatment at all ages in order to prevent or minimize arthritis-related impairment.”

Led by Siobhan O’Donnell, MSc, an epidemiology researcher at the Centre for Chronic Disease Prevention in Ottawa, the study examined the physical and mental health effects of arthritis in older Canadian adults (75+ years) versus younger adults (20-44, 45-64, and 65-74 years).

The study analyzed poll data on 4,565 respondents from the arthritis component of the 2009 Survey on Living with Chronic Diseases in Canada – a cross-sectional follow-up survey to the larger 2008 Canadian Community Health Survey. It looked at associations between age and the prevalence of the following indicators: severe/frequent joint pain, severe/frequent fatigue, sleep limitations, instrumental activities of daily living (IADLs) limitations, high stress levels, and suboptimal general and mental health.

Respondents with arthritis were mostly female (63.1%), of working age (59.5 %), and overweight or obese (67%). After adjustment for covariates (sex, BMI, education, arthritis type, number of painful joints, disease duration, and other chronic conditions), younger (20-44) and/or middle-aged (45-64) adults were more likely than the oldest age group (75+) adults to report severe/frequent joint pain, sleep limitations, high stress levels, and suboptimal mental health. Although the oldest were more likely to report poorer general health, after covariate adjustment, age was not associated with IADL limitations, severe/frequent fatigue, or suboptimal general health.

A higher prevalence of adverse effects emerged in the two younger of the four groups. For example, more arthritis-related sleep difficulties were reported in these age brackets than in the oldest: prevalence ratio (PR) 1.6, 1.5, and 1.1, respectively – a finding in line with those of the 2007 US National Health Interview Survey. Similarly, more frequent and severe joint pain was reported in the two younger age groups: PR 1.3 versus 1.2 versus 1.0 in the oldest. Fatigue PRs across the four groups were 1.6, 1.6, 1.0, and 1.0. Impaired mental health went from a PR of 4.1 in the youngest to 3.8 ,1.5, and 1.0 in the older groups.

The authors hypothesize that the more frequent and severe pain and fatigue in younger individuals could be linked to sleep difficulties “since pain is a known mediator of sleep problems in individuals with arthritis.”

Findings related to high stress and worse self-rated mental health in younger and middle-aged arthritis sufferers are supported by previous population-based research, they noted.

In addition, data from a U.S. survey showed a decreasing age gradient in reported mental distress among arthritis sufferers 45 years and older, with the youngest age group (45-54) reporting the most distress. U.S. research also found individuals with arthritis younger than 65 years had more anxiety and depression than those who are older.

In one qualitative study, middle-age adults reported more distress and frustration than older adults because their experience of osteoarthritis was not what they expected at their stage in life, was more disruptive of activities/roles related to work and family, and threatened their future plans.

The authors note that people of middle years take on a diverse roles and if they perceive they cannot participate fully in valued areas of life, it may have negative consequences on psychological health.

Literature on primarily middle-aged adults has shown that balancing work, health, and personal life is stressful for people with arthritis, the authors noted, calling for further research on the impact of this condition on life roles.

Addressing limitations, they pointed to the cross-sectional study design, which precluded examining a potential cohort effect. In addition, older adults may stoically under-report pain, considering it a natural part of aging, whereas working-age patients may have more to gain by seeking help. “Therefore the higher frequency of reporting recurrent and severe pain among younger versus older individuals could in part be explained by a cohort effect,” O’Donnell and her colleagues wrote.

Furthermore, the self-reported source of the data opens up the possibility of unreliability as well as recall and social desirability biases, leading to misclassification of results. A large proportion of respondents (43.2%) did not even know their type of arthritis.

Lastly, the lag time of 3 to 14 months between the original larger 2008 survey and 2009 follow-up interviews may have affected an individual’s current body weight.