Spotlight on Aging: Osteoarthritis

Many myths about osteoarthritis remain. For example, people think that it is an inevitable part of aging, like gray hair and skin changes, that it results in little disability, and that treatment is not effective.

Osteoarthritis does become more common with aging. For instance, as people age, the following occur:

• The cartilage that lines the joints tends to thin.

• The surfaces of a joint may not slide over each other as well as they used to.

• The joint may be slightly more susceptible to injury.

However, osteoarthritis is not an inevitable part of aging. It is not caused simply by the wear and tear that occurs with years of joint use. Other factors may include single or repeated injury, abnormal motion, metabolic disorders, joint infection, or another joint disorder.

Effective treatment, such as pain medications (analgesics), exercises and physical therapy, and, in some cases, surgery, is available.

Ligament damage is also common with aging. Ligaments, which bind joints together, tend to become less elastic as people age, making joints feel tight or stiff. This change results from chemical changes in the proteins that make up the ligaments. Consequently, most people become less flexible as they age. Ligaments tend to tear more easily, and when they tear, they heal more slowly. Older adults should have their exercise regimen reviewed by a trainer or doctor so that exercises likely to tear ligaments can be avoided.

Nonsteroidal anti-inflammatory drugs (NSAIDs) that are rubbed into the skin over the affected joint may be a preferred option for older adults with osteoarthritis involving superficial joints such as the hands and knees. Less of the NSAID is absorbed than if it is taken by mouth, which minimizes the risk of side effects. Oral NSAIDs should be used for as short a period as possible given the risk of gastrointestinal bleeding and kidney dysfunction, which are increased in older adults. Acetaminophen is a reasonable alternative when oral NSAIDs cannot be taken, but acetaminophen is less effective than NSAIDs as an analgesic.

More potent analgesics, such as tramadol, may occasionally be required, but doctors prescribe them only when necessary, to avoid problems with side effects and possible addiction. In addition, these medications can cause confusion in older adults.