What can be done to help older adults diagnosed with osteoarthritis that is increasingly exponentially to remain independent and active, an increasingly desirous state from many perspectives in the face of multiple health challenges and limited disease mitigation successes or recipes? While several standard approaches have been employed for some considerable time with some degree of success, a possible improvement in this regard may yet be realized by a focus on psychological disease correlates.

In this regard increasing evidence appears to support a role for better stress control and intervention efforts to improve coping ability and confidence perceptions (eg., 12) and avert a cycle of decline both physical as well as psychological. As mentioned above, ample research shows the controllability of a chronic stressor such as osteoarthritis may well determine the prognosis and outcome of the disease, and the ongoing ability of the individual to function independently-as indicated. Even if surgery is required an older adult with a high degree of pain control may heal more optimally than a similar case that has poor pain control and confidence to manage successfully. They may also have less progressive joint damage than a similar patient who has not been involved proactively in mediating or moderating their health behaviors and thoughts as well as a possible lower degree of health care resource needs and costs of care, while averting a possible cascade of negative long term outcomes including a low quality of life 26515253.

Romer 24 has revealed that the stressors associated with osteoarthritis involve physical, psychological, as well as social aspects of their lives. In particular, pain, disability and dependence on others were identified as major stressors. The majority of the respondents that were studied appraised the personal significance of having osteoarthritis as stressful both in terms of actual loss and potential loss in the future, and felt angry on occasion as a result as well as frustrated, discouraged, fearful and helpless. No differentiation was made between stress due to osteoarthritis and non osteoarthritis sources, but both may have been implicated, and could have been impacted to some degree via thoughts directed towards hope or some form of prayer 30.

Although not yet a mainstream osteoarthritis treatment standard, increasing numbers of researchers point to the importance of an affected individual s active involvement in their self care, including the importance of dealing successfully and in a timely way with pervasive, transient, and future anticipated degrees of disability, pain and stresses 1754. Moreover, it appears the possible additive non disease based stresses of aging, along with pain and other health conditions, and life situations as regards the disease prognosis, implies a more insightful approach to offset or allay excess disability by considering the value of both behavioral and cognitive management approaches in addition to physically oriented care strategies 55 as the standard of care. Indeed, even if the benefits of careful mental health assessments are not at all mainstream or validated, they appear to be strongly advised for dealing with osteoarthritis associated pain and other symptom challenges 395657.

This proposed integrated intervention process is arguably not a simple one however, and potentially requires dedicated time and careful long term guidance by a well informed health professional or team, rather than any singular reliance on generic stand alone or remotely delivered sets of customized directives. A considerable body of research indicated that what is especially needed in this regard are careful comprehensive evaluations including assessments of the patients beliefs, fears of movement and pain, plus beliefs about the origin and expected outcome of their disease.

The provider s willingness to help clients to better understand their options, how stress might effect their joints adversely, for example excess stress might lead to eating behaviors that increase body mass markedly and adversely, while conveying the idea that contrasts possible benefits of actively attempting to cope and promote their wellbeing might reduce their pain and enhance their functional abilities. Additionally, patient education that addresses erroneous beliefs and misconceptions that prevail concerning osteoarthritis, especially the role of active movement as an osteoarthritis causative factor appears imperative to explore and understand 5658.

Indeed, without adequate subjective as well as objective patient evaluations and assessments that do not overlook one or more cognitive disease correlates it may be impossible to provide targeted and precise help, such that the destructive osteoarthritis process may continue unabated, and prove overwhelming, and hazardous. For example, in the case of the circulation of unproven remedies or beliefs that surgery alone can restore function and eliminate pain but no other efforts are of possible help, even carefully construed management programs that are integrated suitably may be delivered too late in the disease cycle. In addition, communications that present an ageist portrayal of the older adult, or are not geared to the older versus younger adult, plus those that assume the older adult can duly grasp, interpret and act on medical information and can hence make sound decisions may well prove of more harm than good. At the same time, a combination of fatalism and inaction and/or erroneous beliefs and fears may preclude the emergence of a needed degree of affirmative mental toughness that has been observed to have a favorable bearing on orthopedic disease outcomes 59. To the contrary, efforts to reduce or mitigate stress, pain, and anxiety along with efforts to strengthen mental health toughness can be expected to enhance general self efficacy as well as coping confidence, plus the motivation to persevere with and adopt a set of regular health promoting self care practices 50. Indeed, evidence points to the paramount importance of efforts directed towards fostering pain and disease coping skills even if surgery is forthcoming at some point 50555960.

However, even if sought, for example using artificial technology, no perfect mitigation recipe currently exists that can be duly delivered to advance management and delay regression of this complex disease where some older adults have no major problems but others may require considerable attention, especially if they appear unaware of their osteoarthritis management options, and have been using blunting: or avoidance strategies to manage their condition due to limited coping skills and confidence. A fair percent of cases may also have associated health problems such as cardiovascular disease, diabetes, or obesity, plus depression and disease severity 61 that must be factored in to any meaningful recommendation program to lower pervasive and transient day to day stressors and advance independence. On the other hand, those who receive due consideration may find they can progressively limit their pain levels proactively through one or more life affirming approaches than those who have given up hope or believe they need to rely on passive modalities and external support, or simply enter a state of denial or inaction blaming age alone for their condition. As such highly recommended are sound mutually motivated patient provider communications, along with emergent patient-centered or personalized tailored approaches 62, designed to affect perceptions of controllability of the disease and its oftentimes highly stressful overall health impact on daily life, sleep, social and cultural activities and work 58.

While the most suitable methods of fostering adaptive coping may consequently differ considerably 34, those that involve problem solving and steps towards improving emotional regulation as indicated show considerable potential as a rule, as do interventions to reduce fear, pain exaggeration tendencies and diminishing aspects of general wellbeing 16636465 especially among those who report low perceptions of their pain coping ability 6364. Linking older adults with chronic illnesses such as osteoarthritis to others in the social network especially those with similar traits and problems who are motivated to succeed and have succeeded may also prove of considerable benefit 66.

To further foster adaptive coping behaviors, a process of small doable steps and short range versus long term goal setting of doable actions is recommended so as to allow for the emergence of some tangible success, and motivation to pursue an increasing array of challenges including aging attributes 52646657. Exposure to role models, the receipt of needed resources, and opportunities to rehearse what is desirable in small progressive steps may further enable one or more adaptive coping behaviors to emerge 5267 as may efforts to foster integrated, collaborative, and culturally responsive care 58.

Resnick 68 who conducted research to better understand the factors that can influence the efficacy beliefs of older adults as regards being motivated to participate in a rehabilitation program identified 11 major themes amenable to intervention. These included: motivation and verbal encouragement, having exposure to positive role models, being able to deal effectively with patient s past experiences, and current aversive physical sensations. Additional research has shown that for purposes of enhancing exercise adherence, a problem of major concern to all patients who suffer from pain, training the individual in pain reduction skills through relaxation, distraction or imagery, and repeating the demanding activity while applying the acquired pain reduction skills may prove successful. In addition, educating patients to better manage pain and cope with disease flares, helping them to understand why and how emotional reactions can affect their disease status as well as cellular aging may be of additional specific value. To enhance self efficacy for pain control, an important stress and osteoarthritis coping outcome mediator, the development of a carefully structured plan of achievable steps that can be practiced over time, along with efforts to minimize pervasive emotionally adverse thoughts, can possibly minimize the extent of pain and dysfunction that could otherwise emerge to impact life quality, all factors considered 6869707172.

Keys to success may also include: 1) The ability of the affected individual to forge a sound and supportive client-therapist relationship that permits mutual inquiry and goal setting. 2) Encouraging activity goals that align with the etiology and pathogenesis of the disease as well as the individual s preferences and abilities, 3) Active treatment of persistent depression, 4) Mindfulness meditation, becoming better educated about the values and benefits of exercise, deep breathing, visual imagery, and being exposed to successful models.