title: An evaluation of the impact of seniors on a rheumatology referral clinic: demographics and pharmacotherapy.
abstract: The aging population is impacting subspecialty areas outside of geriatrics. Rheumatic diseases increase with age. Therapy for these diseases can add to polypharmacy and negatively impact other comorbidities. This is a retrospective chart review of all patients attending a rheumatology subspeciality clinic over 1 year. Referrals were prescreened and excluded probable degenerative axial and peripheral disease and chronic pain syndromes. Data were collected on demographics, diagnoses, and medications. Two hundred ninety-five new patients were seen. Seventy-eight (26%) were seniors (age, >65 years) with a mean age of 73 years (65-90). Comparing the >65 to <65 age groups, the prevalence of inflammatory arthritides (rheumatoid arthritis (RA), psoriatic arthritis, palindromic rheumatism) was comparable: 48% vs 53%; however, osteoarthritis and polymyalgia rheumatica were twice as common in the older group. Comorbidities in the >65 age group included hypertension (31%), osteoporosis (27%), diabetes (15%), hypothyroidism (11%), and coronary artery disease (9%). Only one patient had documented dementia. There were no cases of uncontrolled hypertension identified, and all patients were receiving a mixture of anti-hypertensives. Eighty-one percent of osteoporosis patients were on antiresorptives, but only 40% of prednisone users were taking bisphosphonates. For RA, treatment was somewhat comparable between the groups, with all but two patients receiving disease-modifying antirheumatic drugs. Eleven percent were on biologics. Seniors comprise a significant number of referrals. Pharmacotherapy differs in seniors, with more use of prednisone and a probable contribution of polypharmacy. This study highlights the need for reciprocal knowledge by both geriatricians and rheumatologists to optimize the management of these complex patients.
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, Faculty of Medicine, University of Alberta, B139 Clinical Sciences Building, 8440 112 Street, Edmonton, Alberta, Canada. angela.juby@albertahealthservices.ca
authors.forename: Angela
authors.initials: A
authors.lastname: Juby
authors.forename: Paul
authors.initials: P
authors.lastname: Davis
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001168:Arthritis / Q000150:complications / Q000188:drug therapy*; D002170:Canada; D003324:Coronary Artery Disease / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007037:Hypothyroidism / Q000150:complications; D008297:Male; D010024:Osteoporosis / Q000150:complications; D012017:Referral and Consultation; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy*
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids