Sep 09, 2019

Aged care residents not receiving beneficial gout medication

 

Researchers have found that 10 per cent of people living in residential aged care have gout, but more may have the condition and are not receiving medication that could help them.

Dr Amy Nguyen, Postdoctoral Research Fellow at the Centre for Health Systems and Safety Research, Macquarie University, told HelloCare their research has shown that most people who have gout also have other serious health conditions, including hypertension, heart disease and diabetes.

What is gout?

Gout is a common type of arthritis that causes intense pain, swelling, and stiffness in a joint, most commonly the base joint of the big toe. It can be extremely painful. 

Gout occurs when too much uric acid crystallises and deposits in the joints. Attacks can come on quickly, and they often occur without warning in the middle of the night. Gout usually returns over time. 

Hypertension, cardiovascular, and obesity are risk factors for gout, which can usually be treated with medication.

Gout is the most common form of inflammatory arthritis in men. Women become more susceptible to the condition after the menopause.

Patients not taking medication to prevent gout attacks

Dr Nguyen said aged care residents may not be receiving beneficial medication that can prevent painful gout attacks.

She said their study identified gout by searching for key words and medications used to treat gout in electronic medical records, and in data from the Aged Care Funding Instrument (ACFI).

Dr Nguyen said the true number of people in residential aged care with gout may actually be higher than their data is showing.

“Because gout may be low priority for residents, gout might not be recorded under ACFI or on the resident’s electronic health record,” she said. 

“In terms of medications, gout patients are largely not on the long-term medications to prevent the gout attacks. These reasons lead us to believe that gout is underrepresented in this population.”

Gout considered “low priority”

Gout is an incredibly painful condition, so we asked Dr Nguyen how the condition could be being missed in aged care.

“Gout can only be officially diagnosed by a joint aspiration, which can be quite uncomfortable – so formal diagnoses does not always occur. 

“Also, gout may be being missed as it is a lower priority for patients who have multiple conditions which may be perceived as more ‘serious’. 

“Another issue with gout is the intermittent nature of the condition. Because the majority of patients only have gout attacks intermittently, this is when their gout is on their (and their doctor’s) mind. During the periods in between, gout may fall off the radar.”

Gout can lead to permanent joint damage

Patients often lack detailed information about their gout. 

“Literature in gout management has shown that most gout patients’ knowledge of their condition is inadequate – particularly that gout is a chronic condition that can require long term medications to properly manage it, and that it can lead to permanent joint damage and is associated with other chronic conditions,” Dr Nguyen said. 

Residents in aged care facilities who are living with dementia or have difficulty communicating may not be able to express that they are in pain, which can mean gout is missed, said Dr Nguyen.

“Unrecognised pain such as those that may be experienced by residents with dementia who are unable to express that they are feeling pain, can also be another compounding factor, Dr Nguyen said.

Look at residents “as a whole” to manage gout

Successfully managing gout in residential aged care involves “looking at the patient as a whole,“ Dr Nguyen said. 

“In this population where multimorbidity is common, many of them (residents) are on multiple medications that can interact or cause other conditions,” Dr Nguyen said. 

“This means that all conditions and the medications they take for each need to be accounted for when clinicians are treating patients. For example, as uric acid is cleared by the kidneys, some medications that impact this can cause a build up of uric acid and therefore cause gout. This is compounded by the fact that gout patients usually also have renal impairments.” 

Dr Nguyen said they will next look at the residents who do have gout to to see if they are being managed in accordance with official gout guidelines.

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