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Coordinating Care for Elderly Onset Rheumatoid Arthritis (EORA)

Posted by Dr. Joseph F. West on Jul 26, 2016 3:00:00 PM

Arthritis is one of the most common diseases in this country. For some, it can be temporary, but for many its is a chronic, and sometimes, debilitating disease. Arthritis can attack joints in almost any part of the body, at any age. Some forms of arthritis cause change you can see and feel such as pain, swelling, warmth and redness in your joints. Other types cause less troublesome symptoms but slowly damage your joints. Rheumatoid arthritis(RA) is a systemic, inflammatory disorder affecting primarily women with a peak incidence between 30 and 50 years of age and an average age of onset of 55 years. 
Elderly Onset Rheumatoid Arthritis (EORA), also called Late-Onset Rheumatoid Arthritis (LORA), is the development of RA in persons older than 60 years. Approximately one-third of patients with RA acquire the disease at the age of 60, and the prevalence increases with advancing age. In fact, half of all people age 65 and older have RA and many are having a difficult time managing the disease. Older people most often have osteoarthritis, rheumatoid arthritis, or gout.

RA is an autoimmune disease where the body attacks the lining of a joint just as it would if it were trying to protect the body from injury or disease. RA can attack almost any joint in the body, including the joints in the fingers, wrists, shoulders, elbows, hips, knees, ankles, feet, and neck. RA leads to inflammation in the joints which can cause pain, swelling, and stiffness. Moreover, RA can move into and damage organs such as the heart, muscles, blood vessels, nervous system, and eyes. For older adults managing one or more chronic condition, RA can present a serious risk for exacerbated decline negatively impacting mood, functionality, and quality of Life.

As a Medicare covered chronic and transitional care disease adults with EORA can realize improved physical capacity and better pain management with support of a clinical care team. Chronic Care Management (CCM) and Transitional Care Management (TCM) for EORA patients can make all the difference in ensuring consistent RA therapy, medication adherence, and appropriate care planning. Care Managers can work with the EORA patient’s primary care provider to identify rheumatological rehabilitation programs some of which may include the use of assistive devices, exercise classes, physical therapy and analgesic modalities, aquatherapy, and balance exercises. 

Many older adults with EORA also experience complications related to depression, anxiety, feelings of helplessness and low self-esteem. EORA patients, and their caregivers can benefit from CCM monthly calls, and TCM post-discharge care plans and support. Care Managers can remind patients and their caregivers of the importance of rest, eating healthy to reduce inflammation, wearing the right shoes, and using assistive devices. For example, EORA patients could benefit from walkers, canes, tools for opening jars and bottles, or even apparatuses for turning door knobs. EORA in patients is handled a little differently, but CCM and TCM Care Managers can help patients find the right solutions for boosted functionality and improved quality of life.

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Topics: TCM, Arthritis, CCM, Elderly-Onset Arthritis, Rheumatoid Arthritis


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