Musculoskeletal disorders are the most frequent cause of disability in today’s elderly. Creating and maintaining opti- mal level of care and treatment for the increasing numbers of elderly with these conditions poses a serious challenge to present-day rheumatology. The Nijmegen-based GOS is a new approach designed to help meet this challenge. The GOS blends the specialties of rheumatology and geriatric medicine and emphasizes interdisciplinary care and treat- ment involving thorough rheumatologic diagnoses, a wide- ranging assessment of functional abilities, and tailored the treatment of identified deficiencies and disorders. The impact of the various conditions is assessed using a comprehensive approach based on the ICF model. The problems elderly rheumatoid patients encounter are complex; striving, as they are to maintain optimal health while struggling with the
many effects of aging and diminishing coping resources.
Treatment and care are accordingly complex and rely heavily on interdisciplinary cooperation and coordination. The main goal of the GOS hence is to help patients attain or maintain an optimal, adequate level of daily functioning and well- being despite the lasting presence of their disease and impair- ments through a comprehensive, interdisciplinary approach and tailored treatments or recommendations.
The self-perception of health plays a critical role in the ability of an individual to function independently. Although physical aspects are important when promoting health and empowering patients to manage their everyday lives, the psy- chosocial aspects of health warrant explicit attention as well.
Aging is accompanied by a decline in functional reserves and capabilities. The impact of this decline depends to a con- siderable degree on the person’s environmental circum- stances and on the societal attitudes toward elderly people.
The consequences of aging can be attenuated by modifica- tion of risk factors for disease.
As described in this chapter, the GOS is designed to help health professionals deal with the growing numbers of elderly patients with musculoskeletal conditions. The aim of the ser- vice is similar to that of regular rheumatologic care: to improve and preserve the quality of life by preventing unnec- essary impairment and disability, preserve independence, improve mobility, reduce chronic pain, optimize care quality, and reduce care quantity. For the majority of elderly people living independently for as long as possible is a very impor- tant issue. This is why we stress the functional approach of the GOS: its strong focus on preserving or improving peo- ple’s ability to perform activities of daily living. To this end, we have adopted a problem-oriented approach to evaluate the complaints and to set therapeutic goals.
A first, preliminary evaluation of the GOS by the referring physicians and participating patients was favorable and in support of the principles of the service. For a proper evaluation of a patient’s condition and concomitant problems, spending sufficient time with the patient is a critical factor. In our out- patient clinic, all patients are seen by a rheumatologist and a nurse practitioner with both consultations lasting at least 45 min. This should be taken into consideration when imple- menting a similar facility in other settings.
However, although the first results show the service to be a viable approach, more research is needed to study its impact on patients well-being, quality of life, and functional and dis- ease outcome. Clearly, tailoring interventions to the most common or pronounced risk factors in this patient group is likely to improve their effectiveness.
The old maxim that “prevention is better than cure” is often forgotten when dealing with the elderly in whom dis- ability is often merely attributed to aging while it is often the beginning or worsening of a disease process. As a result, many elderly do not get the treatment they need and suffer
91 10 The Gerontorheumatology Outpatient Service
from unnecessary and preventable loss of function and qual- ity of life. Although only a first step, a gerontorheumatology outpatient service, such as described in this chapter, may help amend the latter and hence enhance the lives and inde- pendence of our elderly and concurrently reduce the socio- economic burden of our public health and care services.
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Y. Nakasato and R.L. Yung (eds.), Geriatric Rheumatology: A Comprehensive Approach, 93 DOI 10.1007/978-1-4419-5792-4_11, © Springer Science+Business Media, LLC 2011
Abstract This chapter is designed to review the basics of public health, to highlight its relevance to health-care pro- fessionals, and to outline opportunities for the use of health policy in improving and protecting the health of older adults with arthritis. Many public health interventions intersect with the medical system at the level of the individual patient and complement clinical care efforts. Health policies are often designed to have broad effects at the community and population level and to help achieve national public health goals. The unprecedented pace of aging in the US popula- tion at the start of the twenty-first century offers a unique challenge and exceptional opportunity to combine the efforts of public health, the health-care system, and health policy to combat the toll arthritis takes on our communities, patients, and country. Health policies, in concert with public health and medical interventions, can be powerful tools to reduce the burden and impact of arthritis.
Keywords Health policy • Public health • Aging • Interventions
• Legislation • Advocacy • Population
Introduction
Adults aged 65 years or older account for a substantial and growing proportion of the US population. By 2030, the size of this age group is expected to double, representing ~20%
of the total population and 71.5 million people [1]. Among the factors contributing to this phenomenon are demographic changes brought on by the “baby boom” of the 1940s and 1950s, and dramatic gains in life expectancy over the twenti- eth century [2]. Unfortunately, older adults bear considerable health and economic burdens resulting from chronic dis- eases, including diminished quality of life, disability, and
health-care costs [3]. People are living longer lives, but for many that means more potential years lived with chronic health conditions such as arthritis.
Approximately 46 million US adults have arthritis, and about 37% are at least 65 years old; so, 17 million older adults, or one in every two people aged 65 years or older, have arthritis [4]. By 2030, adults aged over 65 years will make up more than 50% of the population with arthritis, and arthritis will affect more than 34 million older adults (Fig. 11.1) [4]. Arthritis-attributable activity limitation cur- rently affects two in every five older adults with arthritis [5]
and is also increasing, with a projected impact on 13.5 mil- lion older Americans by 2030 [4]. As the number and pro- portion of older adults continue to grow, increasing demands on medical and social services are inevitable as is an increase in the large and growing public health burden of arthritis.
This chapter is designed to review the basics of public health, to highlight its relevance to health-care professionals, and to outline opportunities for the use of health policy in improving and protecting the health of older adults with arthritis.