Challenges in the management of older patients with inflammatory rheumatic diseases

M. van Onna*, A. Boonen*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

The rise in the number of people aged 65 years and older living with inflammatory rheumatic diseases such as rheumatoid arthritis is causing considerable challenges for clinicians. As patients get older, they are at an increased risk of multiple chronic diseases, a situation termed multimorbidity. Multimorbidity inevitably drives polypharmacy, where by a patient requires treatment with multiple medications. In addition, advancing age, multimorbidity and polypharmacy all place a patient at an increased risk of developing geriatric syndromes, which are clinical conditions in older people that do not fit into disease categories and include malnutrition, sarcopenia and frailty. Geriatric syndromes further increase the risk of adverse outcomes, including the accrual of additional morbidity, nursing home admission and mortality. Patients with inflammatory rheumatic diseases are especially prone to developing geriatric syndromes. Some predisposing risk factors for geriatric syndromes, such as joint swelling and functional limitations, are also inherent to rheumatic inflammatory disease itself. The frequent coexistence of multimorbidity, polypharmacy and geriatric syndromes in this patient group requires individually tailored interventions to preserve patient independence and overall functioning. To prepare for the changing demography, rheumatologists should gain more insight into the implications of multimorbidity, polypharmacy and geriatric syndromes for the management of older patients with inflammatory rheumatic diseases.In this Review, the authors discuss the challenges of multimorbidity, polypharmacy and geriatric syndromes in older patients with inflammatory rheumatic diseases. They note that individually tailored interventions are needed in this patient group in order to preserve patient independence and overall functioning.
Original languageEnglish
Pages (from-to)326-334
Number of pages9
JournalNature Reviews Rheumatology
Volume18
Issue number6
Early online date21 Mar 2022
DOIs
Publication statusPublished - Jun 2022

Keywords

  • ELDERLY-PATIENTS
  • COGNITIVE IMPAIRMENT
  • GERIATRIC SYNDROMES
  • PSORIATIC-ARTHRITIS
  • SERIOUS INFECTIONS
  • RISK-FACTORS
  • FRAILTY
  • PREVALENCE
  • POPULATION
  • ETANERCEPT

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