Resources for Geriatric Rheumatology
- ACR 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip and Knee: www.rheumatology.org/practice/clinical/
guidelines/PDFs/
ACR_OA_Guidelines_FINAL.pdf - American Geriatrics Society: www.americangeriatrics.org
- Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults: www.americangeriatrics.org/files/documents/
beers/2012BeersCriteria_JAGS.pdf - Health Literacy Consulting: Helen Osborne’s website featuring various articles and podcasts about better patient communication and education: http://healthliteracy.com and www.healthliteracyoutloud.com
- Herpes Zoster (Shingles) Vaccine Guidelines for Immunosuppressed Patients: www.rheumatology.org/publications/hotline/
2008_08_01_shingles.asp - Number of Older Americans: Contains a number of facts and figures on the elderly population growth in the United States: www.agingstats.gov/Main_Site/Data/
2010_Documents/Population.aspx
With the first crop of baby boomers turning 65 last year—part of the so-called silver tsunami that will cause the elderly population to double by 2030—there’s no question that rheumatologists are going to be treating older patients more frequently.
By 2050, the U.S. population over the age of 85 is expected to reach 19 million, compared with only 5.7 million in 2008, according to the U.S. Census Bureau.
Rheumatology patients in their late 70s, 80s, 90s, and 100s have some special considerations compared to the younger population.
“Older patients tend to have more comorbidities and resultant polypharmacy, making management issues for rheumatologic conditions more challenging,” says Una Makris, MD, assistant professor in the department of internal medicine in the division of rheumatic diseases at the University of Texas Southwestern Medical Center in Dallas.
This means you’ll often find nonrheumatic comorbidities—for example, cardiovascular disease and diabetes—in addition to multiple rheumatological conditions, says Yuri Nakasato, MD, a rheumatologist at Sanford Health Systems and the University of North Dakota in Fargo. For example, a common scenario might be a patient with rheumatoid arthritis (RA), severe osteoarthritis (OA), and gout.
With individuals living longer, clinicians are now also observing the aging of rheumatic diseases, says Dr. Nakasato. This can include more sites of disease—for example, OA in the knees, hands, hips, and spine, Dr. Makris says.
“In the past, there was increased mortality. With that now decreasing, we’re seeing patients getting older,” Dr. Nakasato says. This adds another layer to the complexity of treatment.
At the same time, clinicians are treating patients for conditions that are occurring for the first time in their older age, such as elderly onset RA, says Raymond Yung, MB, ChB, chief of the division of geriatric and palliative medicine in the department of internal medicine and codirector of the geriatrics center at the University of Michigan in Ann Arbor. Drs. Nakasato and Yung recently coedited a textbook called Geriatric Rheumatology (Springer, 2011).