Abstract
Osteoarthritis and depression are both key barriers to healthy aging and greatly heighten the risk for many negative health issues that seriously impact life quality. When combined what are the implications?
This mini review examines 2023 data pertaining to osteoarthritis and depression and older adults and a possible theoretical framework of stress that may direct our approaches in the future.
Articles published between January 1 and August 15 2023 that addressed the current topic of interest and that were extracted from
As in the past, very few tangible theory-based prospective analyses that employ valid measures of depression and examine any association of any form of osteoarthritis longitudinally and in a consistent manner prevail. Several reports use the same or similar large cohort to draw upon, and find various degrees of clinical implications, but this may not embrace the need for more inclusivity, sampling strategies, control and diversity issues, as well as embracing the role of cognitions positive and negative.
Without efforts to develop sound research designs of diverse and carefully differentiated osteoarthritis substantive samples it is impossible to delineate the origin or implications of the osteoarthritis-depression linkage reported currently or arrive at a deep understanding of its relevance, to life quality and public health costs. What is needed to protect against or minimize either or both these clinically related disabling correlates in the aged population warrants timely study.
Author Contributions
Copyright© 2023
Marks Ray.
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Introduction
Depression, now considered among the most disabling health challenges facing many in the older adult population can occur as a definable long standing health trait if certain clear diagnostic criteria are met or as a reactive mood state of varying magnitude and chronicity that often accompanies those diseases most prevalent in older adults, such as osteoarthritis Currently said to occur in at least one third of older adults This does not include those features that can contribute to both health challenges such as obesity, especially when combined with prolonged depression The pervasive idea that osteoarthritis is inevitable, and relatively untreatable with the exception of pharmacologic drugs, injections, and surgery may of course prove very stressful to contemplate in its own right among many in the aging population and its public health burden may be compounded if depressive features of the disease remain undermined. Clearly, if one takes into account results of a recent preclinical study showing the presence of chronic pain in young adult mice has the propensity to induce mood alterations and supra-spinal observable biochemical changes as well as aggravating alterations already evident in older adult animals, it appears even young adults may incur more disadvantage in later life if this topic remains understudied and thus is often ignored. Moreover, although often deemed to be an emotional and possibly controllable emotional response or trait feature of some elderly persons, treatment with morphine known to counteract pain, while preventing the development or minimizing possible pain derived anxio-depressive disorders and nerve inflammation Another intriguing novel finding is that there appears to be an observable bidirectional association between osteoarthritis and multiple psychiatric disorders, as well as findings of a shared genetic architectures between knee osteoarthritis and depression/stress-related disorders, thus providing a possible array of unconventional targets that might be pursued as far as furthering an insightful mechanistic exploration of this topic and its intervention potential In the interim therefore it seems reasonable to assert that unrelieved states of suffering, including feelings of hopelessness, and low self-worth, may in turn, increase or produce unwanted stress and frustration levels, while adversely impacting coping ability, sleep, energy levels, and appetite, as well as serving as a risk factor for pain, bone loss, osteoporotic fractures In light of the severe impact of osteoarthritis of any joint, plus excessive symptomatic as well as excess actual biological depression as mentioned above, and its possible unique and combined detrimental impact on motivation, as well as health seeking and promoting behaviors, as well as intervention efficacy, this mini review elected to selectively focus on whether initiatives to minimize osteoarthritis and depression have yet emerged to any degree, given the fairly well established observations that predates this current 2023 time period and a failure to advance osteoarthritis or depressive symptom care to any meaningful degree via non pharmacologic means. It investigated whether: a. We have solid evidence for or against recommendations to address emotional factors in osteoarthritis, including stress and coping b. Whether the data indicate if the While other frameworks exist, this aforementioned health behavior explanatory and guiding framework developed by Lazarus and Folkman
Materials And Methods
To attain the aims of this review, we attempted to locate salient data housed on Key concepts of the * Exposures to one or more actual or perceived chronic stressors such as an intractable personal or existential health threats. * A possible limited ability to reduce or conceive reducing this threat. * A series of negative beliefs about the self-and the situation. * A limited ability to access ongoing social support. * Ineffective or suboptimal coping strategies/style. Likely moderators in this regard that were sought are age, resources, dispositions, culture, degree/duration of any impairment, degree of potential resilience and socioeconomics
Discussion
It is well established that among the many health challenges that evolve over the course of time, osteoarthritis, the most common joint disease, causes appreciable pain and functional disability in a high percentage of people over 55 years of age. Principally due to symptomatic pathological changes in the cartilage tissue lining the surfaces of one or more freely moving joints such as the hip and knee joints, osteoarthritis can be extremely debilitating, especially if accompanied by multiple chronic medical conditions, including depression. However, although depression occurs with a high prevalence especially in the older population, many of whom may suffer from painful disabling osteoarthritis, there has been very little specific emphasis placed on the importance of evaluating and treating depression in the cycle of disability in adults with osteoarthritis. Indeed, until recently, evidence has been very sparse in examining depression in the context of osteoarthritis carefully and conclusively. The joints studied and their degree of pathology, plus the modes of assessing both osteoarthritis severity, as well as depressive symptoms is also highly non uniform and fragmented. Thus what is reported may depend on what was measured and by the type of prevailing tool applied and sample studied. With very few prospective analyses, even when assessed empirically, whether it is important to minimize depressive symptoms in older adults with osteoarthritis and if so in what regard, has been unclear at best to date. Based on the fact that persistent depression, a major health issue impacting older adults negatively may already exist, and may remain extremely challenging to eliminate for those who are in pain and trying to cope with osteoarthritis, this mini review strove to examine what is published in this regard in 2023. The aim was to pinpoint if ongoing health services and research are yet needed for advancing much needed efforts towards alleviating the burden currently experienced by many older adults and their families and caregivers as far as osteoarthritis is concerned, and in what regard, or whether robust inroads in these demanding health challenges have indeed been made or might benefit from certain principles put forth in the Taken as a whole, and even if studies to the contrary are in press or have not been published for various reasons, and are not listed in the current data bases applied, it appears that in contrast to numbers of surgical and medically oriented articles, the topic of osteoarthritis and depression remains very poorly researched. Moreover, what is published fails to address multiple methodological flaws highlighted in prior reports. As well, depression when mentioned is commonly not the primary study focus, but a secondary disease feature at best. It is hence not possible to definitively establish the pathway or pathways that are consistently implicated in osteoarthritis associated depression symptoms, nor how these can be moderated, if possible. For example, Paun Because of its complex etiologies, especially in older adults with other health issues careful timely and ongoing assessments, with valid measures especially in older adults with disabling osteoarthritis appear indicated. As such, it also seems feasible to suggest clinicians aiming at reducing the immense osteoarthritis burden and its depression associations will find efforts to evaluate and treat this set of conditions using the However, failing that, it appears health outcomes may prove less than desirable as far as influencing: a. Adherence to treatment recommendations b. The degree of prevailing/future disability c. Fatigue d. Loneliness/social isolation e. Overmedication/narcotic addiction f. Poor coping efficacy g. Resilience h. Self esteem/efficacy declines i. Stigma j. Stress management challenges As such, even if above factors are not all inclusive, it is clear many significant health determinants may emerge and converge to influence successful results of osteoarthritis management, but this may also depend on the ability to pinpoint who is at risk for cognitive declines early on, as well as by efforts to examine the attributes deemed noteworthy over time in efforts to successfully reduce stress in general, including but not limited to social, economic, and physical stress. To this end, it appears reasonable to conclude that more careful selection criteria in future well designed studies are essential for examining osteoarthritis as well as any depression correlates among older adults, and with carefully defined subgroups of sufficient cases who are followed over time, rather than heterogeneous samples observed in retrospect As per Patten et al. In the interim, it is not possible to derive any cumulative sense of direction on any aspect this current topic given the numerous sampling issues, and diverse measures employed-to discern depressive features as well as pain, alongside multiple problems related to study design. In addition, it can be argued that a failure to examine the possible role of stress, coping and control beliefs, self efficacy attributes, social circumstances, fatigue, sleep issues, fear, disability, and pain extent, and others such as body mass and heart health status uniformly and collectively-can lead to erroneous rather than robust conclusions. To overcome one or more of these shortcomings, objective data to support subjective findings are sorely needed, because symptoms of depression and pain in particular may be linked directly or indirectly to the subject s interpretation of their condition, their beliefs about their situation, their social circumstances or nature of any social network inputs and others, rather than changes in joint biology. They may be negatively influenced by prevailing myths, and social or cultural norms or their providers view points as well and not referred for treatment. They may also feel unconfident as a result of what they believe and perceive if they cannot take action and make sound decisions or feel their actions may prove futile. Others may feel efficacious, but are depressed because they may have limited health services access and social resources to draw on.