Prevalence of musculoskeletal complaints in nursing home residents.

The prevalence of chronic pain among nursing home residents is very high and
analgesics are used in 40-50% of residents. Chronic musculoskeletal pain from
rheumatic and musculoskeletal disorders (RMDs) affects at least one in four
older persons. The most common RMDs in nursing home residents are
osteoarthritis and pain from previous fractures.[1]

There is a considerable negative impact of RMDs on general functioning in
nursing home residents. Ultimately, a downward spiral of inactivity often
ensues, which then leads to further impaired functioning, increased dependence
and reduced quality of life. Chronic pain is also associated with anxiety,
depression, reduced social participation, cognitive impairment and frequent
falls.[2]

Sssessing the symptoms of RMDs can be complex in nursing home residents due to
the presence of comorbidities, including dementia. In addition, RMDs and pain,
stiffness and weakness are often seen as a normal consequence of ageing by both
the older person itself and healthcare professionals.Taken together, this may
lead to underreporting and undertreatment of RMDs in this population. This
while pain and division of joints can often be managed well.

The prevalence of RMDs in nursing home residents with and without dementia has
not been extensively studied. Our research group recently conducted a
systematic literature search (publication in preparation); RMDs appear to be
common, but it is not accurately documented in the electronic files of the
nursing home resident. For example: only 'pain in a leg' is documented.
Subsequently, it is unclear whether this pain is caused by degenerative joint
disease or arthritis of a particular joint or a non-RMD diagnosis, such as
venous insufficiency. Nursing home residents with and without dementia differ
significantly from community-dwelling older persons. Consequently,
recommendations on the diagnosis and management of RMDs in community-dwelling
older persons cannot simply be copied to the group of nursing home residents.

References:
Reference 1: Smith TO, Purdy R, Latham SK, Kingsbury SR, Mulley G, Conaghan PG.
The prevalence, impact and management of musculoskeletal disorders in older
people living in care homes: a systematic review. Rheumatol Int 2016;36:55-64.
Reference 2: Smalbrugge M, Jongenelis LK, Pot AM, Beekman AT, Eefsting JA. Pain
among nursing home patients in the Netherlands: prevalence, course, clinical
correlates, recognition and analgesic treatment--an observational cohort study.
BMC Geriatr 2007;7:3.

Our study aims to properly document the prevalence of rheumatic and
musculoskeletal disorders and complaints in nursing home residents. We
ultimately want to use this information to optimize the (rheumatic and
musculoskeletal) care for nursing home residents.

In this prospective observational study among nursing home residents, 50
nursing home residents without dementia (group 1) and 50 nursing home residents
with dementia (group 2), >= 65 years old, will be included. All participants
will undergo a physical examination of the musculoskeletal system.

In addition:
In group 1: nursing home residents answer 3 non-burdensome questions
(assessment of general health, severity of joint complaints and pain in
general).
In group 2: if possible, the nursing home resident answers 1 non-burdensome
question (severity of joint complaints). If the nursing home resident cannot
answer this question (reliably), we use the Pain Assessment Checklist for
Seniors with Severe Dementia (PACSLAC-D).

Nursing home residents for this project are recruited from nursing homes of the
Cicero Zorggroep.

No additional materials are collected during this study. For nursing home
residents staying in nursing homes of the Cicero care group, a standard blood
sample is taken once - twice a year. This is a routine procedure. The
laboratory results (result C-reactive protein, CRP) of the blood sample closest
to the physical examination of the musculoskeletal system are included in this
study.

Duration of physical examination of the musculoskeletal system: 10 to maximum
of 15 minutes.
Answer 3 questions group 1: 1-3 minutes.
Answer 1 question (only if possible) group 2: maximum 1 minute.

Physical examination of the musculoskeletal system can cause some limited pain
in the joints for a short period of time.

With regard to participation risks and benefits: abnormalities during physical
examination of potential clinical importance will always be discussed with the
nursing home resident / legal representative and their elderly care physician.
Awareness of normally unknown pathology may affect a person*s perception of
his/her own health condition negatively. On the other hand, detection of for
instance osteoarthritis has potentially favourable effects on disease
progression and may enable early intervention.
Part of the study participants, i.e. those with dementia in group 2, are
mentally incompetent / incapacitated. In the event of clear protest /
resistance from a nursing home resident, the physical examination will be
discontinued. To determine whether there is any protest / resistance, a person
who knows the nursing home resident well is always present during the physical
examination. This can be the elderly care physician or a nurse. This person has
a good understanding of the pattern of habits and behaviours appropriate to
that person (more information under 8.4 and 11.3 of the study protocol).