Quality of Life of Older People with Osteoarthritis A Descriptive Literature Review

NURSING DEPARTMENT, MEDICINE AND HEALTH COLLEGE

Lishui University, China

FACULTY OF HEALTH AND OCCUPATIONAL

STUDIES

Department of Caring Sciences

Quality of Life of Older People with Osteoarthritis

A Descriptive Literature Review

Author：Xie Dinglu (Louise) Wang Xiaonan (Joy)

Student thesis, Bachelor degree, 15 credits

Nursing

Abstract

Background: The incidence rate of osteoarthritis is increasing worldwide. The joint pain and stiffness caused by osteoarthritis seriously affect the daily life of the older people. However, there is no absolute treatment for persons with osteoarthritis, and the main goal is to improve the quality of life..As nurses, we should provide more helpful strategies to improve the quality of life from the perspective of the older people.

Aim: To describe quality of life of older persons with osteoarthritis.

Methods: A descriptive study was performed and articles were retrieved from PubMed and Cinahl databases. The final 8 included studies were selected articles were

published within 10 years.

Results: Osteoarthritis is a chronic disease, which has a huge impact on the quality of life of older persons. After repeated comparison and integration of relevant research results, the quality of life of the older persons with osteoarthritis was summarized into three aspects: physical aspect, psychological aspect and social aspect.

Conclusion: Conclusion: Most studies showed that osteoarthritis has a great negative impact on the older persons daily life.The older persons experienced many problems in e.g.physical and psychological well-being, social relations, daily lives and so on.

Therefore, nurses need to support the older persons with osteoarthritis and provide them with social support and psychological comfort. Furthermore,nurses should be able to give understand advanced medical information, improve their skills and support older persons to improve their quality of life.

Key words: Older people, Osteoarthritis, Quality of life

摘要

背景：全球骨关节炎的发病率正在增加。 骨关节炎引起的关节疼痛和僵硬严重影 响老年人的日常生活。但是骨关节炎没有绝对的治疗方法，主要目标是提高生活 质量。作为护士，我们应该从老年人的角度出发，提供更多有益的策略来提高生 活质量。

目的：描述患有骨关节炎的老年人的生活质量。

方法：进行了描述性研究，并从 PubMed 和 Cinahl 数据库检索了文章。 最终的 8

项纳入研究是 10 年内发表的精选文章。

结果：骨关节炎是一种慢性疾病，对人们的生活质量产生巨大影响。 经过反复比 较和综合相关研究成果，将老年人骨关节炎的生活质量概括为三个方面：身体方 面，心理方面和社会方面。

结论：大多数研究表明，骨关节炎对老年人的日常生活有很大的负面影响。 老年 人在身体和心理健康，社会关系等方面遇到许多问题。 因此，护士需要为患有骨 关节炎的老年人提供支持，并为他们提供社会支持和心理安慰。 此外，护士应能 够提供先进医疗信息，提高其技能并支持老年人改善其生活质量。

关键词：老年人，骨关节炎，生活质量

Table of Content

1. Introduction...1

1.1 The definition of quality of life...1

1.2 The definition of osteoarthritis... 2

1.3 The definition of the older people...2

1.4 The nurses’ role...2

1.5 Nursing theory -Self-Care Deficit Theory of Nursing... 3

1.6 Previous reviews... 3

1.7 Problem statement...3

1.8 Aim and research question...4

2.Method...4

2.1 Design...4

2.2 Search strategy... 4

2.3 Selection criteria...6

2.4 Selection process and outcome of potential articles...6

2.5 Data analysis... 7

2.6 Ethical considerations... 7

3. Result... 8

3.1 Findings of the study...8

3.2Physical aspects...9

3.2.1 Pain, Fatigue, Limitation of body function...9

3.2.2 The decrease of muscle strength... 10

3.2.3 Weight impact...10

3.3 Psychological aspects...11

3.3.1 Depression, Anxiety... 11

3.3.2 Lack of confidence, Fear, Low self-efficacy... 11

3.4Social aspects... 11

3.4.2 Attitudes to social activities... 12

4.1Main result...12

4.2 Result discussion ...13

4.2.1 Physical aspects... 13

4.2.2 Psychological aspects... 14

4.2.3 Social aspects...15

4.3 Method discussion ...16

4.4 Clinical implications... 17

4.5 Suggestions for future research...18

5.Conclusions...18

6.References...19

Appendices

Table1:Search strategies for the protocol

Table2:The themes and sub-themes of the results Table3:Studies included in this review

Table4: Studies’ aim and results included in this review

1. Introduction

Osteoarthritis (OA) is one of the most common joint disorders worldwide for older peop les. Its prevalence is increasing because of the growing aging of the population in devel oped and developing countries as well as an increase in risk factors leading to OA, parti cularly obesity and a sedentary lifestyle (Palazzo et al., 2016).

In the United States, OA affects more than 26 million people, while in England and Wa les, it affects about 1.6-3.4 million(Cooper et al., 2019).It is estimated that men with sy mptomatic OA account for 9.6% and women 18%. According to the definition of radiol ogy, the prevalence rate is usually higher. The self-reported OA definition study reports that the prevalence rate is 5.1% -10.5% for men , Women are 11.9% -17.6%（French et

al,2015).

OA can cause inactivity in the older people, secondary to pain and loss of function, and ultimately damages the quality of life. The pain, swelling, or stiffness of osteoarthritis c an make it difficult for individuals to perform simple daily activities(Cooper et al., 201 9).Osteoarthritis remains a major public burden, with direct costs in 2002 in France exce eding 1.6 billion Euros, about 1.7% of the expenses of the French health system. People s made more than 13 million visits to physicians for OA. Medication costs were 570 mil lion Euros and inpatient treatment costs were 820 million Euros (Palazzo et al., 2016).

Important strategies that help delay the deterioration of the condition and maintain physi cal activity include early detection, correct diagnosis, and optimal management. Since th ere is no absolute cure for osteoarthritis, improving the quality of life of people has alwa ys been the main goal of osteoarthritis treatment, including controlling pain, reducing di sability and improving joint function(Shin et al,2014).

As nurses, we should stand in the perspective of the older people and formulate appropri ate plans based on the life needs of the older people with osteoarthritis，to provide mor e effective help to improve the quality of life of the older people.Therefore, the authors of this review sought to describe the quality of life of older people with osteoarthritis in a more comprehensive way.

1.1 The definition of quality of life

The World Health Organization (WHO) defines quality of life (QoL) as the

‘individual’s perception of their position in the life context of the culture and the value

systems in which they live and in relation to their goals, expectations, standards and concerns （WHO, 2007).

1.2 The definition of osteoarthritis

Osteoarthritis is related to joint pain, limited movement, and tenderness. It is caused by the loss of articular cartilage in synovial joints, most commonly in the knee, hip, and hand joints（French et al,2015）. There is a breakdown of the equilibrium between breakdown and repair of joint tissue, leading to the loss of articular cartilage,

remodeling of subchondral bone, osteophyte formation, ligament laxity, periarticular muscle weakening, and occasionally synovitis (Cooper et al., 2019).

1.3 The definition of the older people

Due to different historical development and regional factors, there are different definitions for the elderly. The World Health Organization (who) and some western developed countries define the elderly as people over 60 years old. In ancient China, the age of 50 was used as a division, and the government of the people's Republic of China set it as 60. Therefore, the general criteria for selecting the elderly in this study is over 60 years old（Old age, 2016).

1.4 The nurses’ role

Nurses have the responsibility of supporting persons with osteoarthritis. They should be alert to persons with joint pain and stiffness, help them maintain and improve joint mobility, and limit the progress of joint injury. In the process of nursing, nurses can set activity goals for persons to improve joint function. As a nurse, it is one’s responsibility to let the persons know how to manage their own condition, recommend them to lose weight when it is reasonable, and provide them with active support (Practice Nursing, 2019). Nurses also need to fully assess their condition and provide them with

appropriate psychological education to treat the pain and disability of osteoarthritis. The

1.5 Nursing theory -Self-Care Deficit Theory of Nursing

Dorothea Elizabeth Orem’s Self-Care deficit theory of nursing described why and explained why people can be helped through nursing. The self-care deficit theory included of the four related theories： the theory of self-care which describes how people take care of themselves,the theory of dependent-care explains how family members or friends provide care for socially dependent people,the theory of self-care deficit describes why people can get help through nursing,the theory of nursing system describes the relationship between the establishment and maintenance of generative nursing(Orem, 2001).As they are providing care for people with a chronic and incurable disease, nurses have the responsibility to help them establish self-care mode and

encourage them to carry out self-care activities according to their degree of self-care. . Therefore, the theory of self-care can be used to describe the quality of life of the older people with osteoarthritis.

1.6 Previous reviews

Osteoarthritis is a highly painful and disabling age-related disease, and there is no cure at present. Osteoarthritis, a debilitating disease, develops slowly and can last for decades, seriously impairing the ability of normal life function and causing excessive psychological pressure (Marks, 2014). Previous studies have described the risk factors for osteoarthritis, including obesity, gender, and age ( lc et al., 2010). In addition, there are some articles focus on relevant treatment and intervention. Simoens and Laekeman (2010) described the treatment of osteoarthritis with glucosamine sulfate.

Ram (2013) talked about the functional analysis of total hip replacement, which can relieve the pain.

1.7 Problem statement

According to the research, the incidence rate of osteoarthritis is the highest among the ol der people, and the incidence rate of osteoarthritis increases with age. However, osteoart hritis often begins in middle age with early and insignificant symptoms, and develops gr adually over a long period of time. Therefore, when the older people find themselves suf fering from osteoarthritis, they are often in the middle and late stages. Osteoarthritis has

affected the lives of the old people. For example, many older people walk with their he

ads slightly forward, hips and knees slightly flexed, and even give a sense of inability to walk and fall. The old people's long-term movement inconvenience and physical pain will cause bad psychology, which will also affect the old people's going out and make th em unable to live normally.

However, few articles describe the quality of life of osteoarthritis in the older people.

Therefore, the purpose of this review is to describe the quality of life of the older people with osteoarthritis, and to provide a support for future nursing researchers who might be interested in this topic.

1.8 Aim and research question

The aim of the literature review was to describe the quality of life of older people with osteoarthritis. How about the quality of life of older people with osteoarthritis?

2.Method 2.1 Design

The study was a descriptive literature review (Polit & Beck, 2012).

2.2 Search strategy

The following search terms were used to search for articles in this study: Quality Of Lif

e (free text), Older People MeSH), and Osteoarthritis (MeSH). The relevant termswere

used MeSH (pubmed) and Headings(Cinahl).. First, search for terms individually, and t

hen combine them to search again. Our findings were limited to "and" (Polit & Beck, 20

12). In the preliminary search (see Table 1), 294 titles and abstracts were skimmed, and

articles selected were all published within 10 years and in English. After an exhaustive r

eview of these articles, we found 8 articles that are closely related to our theme. Table 1

shows the results and limitations of the database used, search date, search terms, hits an

d possible articles. Then, the next step in the process of selecting the final article is sho

wn in Figure 1.

Table 1.Search strategies for the protocol

Database Limits and search date

Search terms Number of hits Possible articles (excluding double s)

CINAHL 10 years, Englis h, aged: 60+ yea rs old

2020.5.18

“quality of life" 31753

CINAHL 10 years, Englis h, aged: 60+ yea rs old

2020.5.18

"older people" 13061

CINAHL 10 years, Englis h, aged: 60+ yea rs old

2019.7.1

“Osteoarthritis” 8745

CINAHL

10 years, Englis h, aged: 60+ yea rs old

2019.7.1

“quality of life"

and "older peo ple"

1821

CINAHL

10 years, Englis h, aged: 60+ yea rs old

2019.7.1

“quality of life"

and "older peo ple" and “Osteo arthritis”

26 ³

PubMed

10 years, Englis h

2019.7.1

“quality of life” 226851

PubMed

10 years, Englis h

2019.7.1

“older people” 162943

Medline via PubMed

10 years, Englis h

2019.7.1

“Osteoarthritis” 43009

Medline via 10 years, Englis “quality of life" 12967

PubMed h

2019.7.1

and "older peo ple"

Medline via PubMed

10 years, Englis h

2019.7.1

“quality of life"

and "older peo ple" and “Osteo arthritis”

268 ²⁴

Total 27

2.3 Selection criteria

Inclusion criteria: ① English articles that meet our research aim ② Empirical scientific papers using quantitative methods within ten years ③ Participants are people over 60 years old (including men and women).

Exclusion criteria: ①Articles that include only men or only women ②Articles under 60 years old ③Articles that only describe the current status of osteoarthritis, or how to manage or treat it.

2.4 Selection process and outcome of potential articles

First of all, the titles and abstracts of found articles were skimmed, and then screened

whether the articles were answering the aim and research question of the study. Next,

the articles were read in full-text. Both authors were involved in all stages of the

selection process. Further information of the selection process, please see Figure 1.

Figure 1: Exclusion process of articles.

2.5 Data analysis

The author analyzes the influence of osteoarthritis on the quality of life in the older peo ple through the form of tables, so that the content of each article can be expressed more clearly. In these possible articles, the author finds out the aspects of low quality of life, a nd lists them one by one. Two tables are used to show the main content of the article. Ta ble 3 lists the author's name, year of publication, country of publication, title, design (po ssible approach), participants, data collection method(s), data analysis method(s), and ta ble 4 lists the author, aim and results.

2.6 Ethical considerations

The articles selected by the authors were published and reviewed, and met the requirem ents. The reading and review of the article was objective, without any subjective feeling s of the authors. The results were presented entirety without being altered according to t he authors’ wishes. The degree project will be free from plagiarism.(Polit & Beck, 2012)

The title doesn’t contain keywords (n=257)

The article is incomplete (n=10)

Articles are not related to our aim and question (n=9) Selected general articles (n=294)

Articles after reading the title and abstracts (n=27)

Articles after reading full-text ( (n=17)

Total articles can be used in our literature

review(n=8)

3. Result

The purpose of this review was to describe the quality of life of older people with osteoarthritis. A total of eight studies were included among which seven were cross- sectional and one was a cohort study. All the studies were quantitative, without any qualitative articles. The population investigated were all over sixty years old people with osteoarthritis. The published study countries include Arabia, Thailand, Brazil, Croatia and the Netherlands. A brief description of the instruments is as follows:

SF-36: It constitutes 36 items concerning physical functioning and role, bodily pain, general health, vitality, social functioning, emotional role and mental health.

WHOQOL -OLD :It has 24 items attributed to six domains: sensorial function, autonomy,past,present and future activities,social participation,death and dying ,intimacy.

EQ-5D instrument:It has 5 items are related to the mobility, self- care, usual activities, pain and discomfort, anxiety and depression.

3.1 Findings of the study

The author identified three themes for the results. Table 2 shows the themes and sub- themes of the results. Studies included in this review were presented in Table

3.Studies’ aim and results included in this review were presented in Table 4.

Table2.The themes and sub-themes of the results

physical aspects -Pain, fatigue, limitation of body function -The decrease of muscle strength

-Weight impact

psychological aspects -Depression, anxiety

-Lack of confidence,fear, low self-

efficacy

social aspects - Neighborhood problems and unable to cope with them

-Attitudes to social activities

3.2Physical aspects

People with osteoarthritis will have changes in their bodies, which are mainly

manifested in pain, fatigue, decreased body function, as well as the decrease of muscle strength and weight .

3.2.1 Pain, Fatigue, Limitation of body function

In a lot of literature, poor quality of life in osteoarthritis persons is associated with pain (Bindawas et al., 2015; Aree-Ue et al., 2018; Cavalcante et al., 2015; Alves & Bassitt., 2013; Timmermans et al., 2017; Gomes-Neto et al., 2016). The quality of life of the older people with knee pain and back pain was significantly lower than that of the older people without pain. Participants with severe pain in the joints and back had worse health condition and lower quality of life than those without pain (Bindawas et al., 2015). In addition, knee pain and back pain have a greater negative impact on quality of life than other chronic with poor physical functions and high body mass index (Bindaws et al., 2015).

Pain is also related to physical functions (Bindawas et al., 2015; Aree-Ue

et al., 2018; Cavalcante et al., 2015; Alves & Bassitt., 2013). Extensive pain in the knee joint and back impact area is beyond the scope of body function (Bindawas et al, 2015).

Lack of balance and instability due to the pain can result in limited body function (Aree- Ue et al., 2018). The functional adaptability of patients with knee arthritis decreased.

According to Alves and Bassitt （2013), lower quality of life is related to poor physical functions.

There is a relationship between pain, fatigue and body function (Aree-Ue et al., 2018).

Pain has direct and indirect effects on quality of life. As far as the direct effect is

concerned, knee joint pain is related to the decline of quality of life. Indirect influence

through the limitation of body function, such as fatigue, also has a negative impact on

the quality of life. Pain itself is an inhibitory factor, which aggravates the negative

effects of physical functions and fatigue on the quality of life. Skeletal muscle

symptoms with greater pain intensity are associated with greater physical limitations and higher fatigue (Aree-Ue et al., 2018).

Many persons with osteoarthritis show moderate degree of physical dysfunction. When going up and down stairs, getting on and off vehicles, and doing heavy housework, the pain will become very serious, which will lead to the decline of quality of life (Alves &

Bassitt, 2013). It also increases the difficulty of daily activities and affects the quality of life (Aree-Ue et al., 2018).

3.2.2 The decrease of muscle strength

The quality of life of older people with osteoarthritis is low because of muscle weakness (Vieira et al., 2015; Cavalcante et al., 2015). There is a positive correlation between abdominal muscle strength and quality of life, which indicates that the older people with lumbar osteoarthritis of greater abdominal strength have better quality of life. Because lumbar muscles play an important role in stabilizing the lumbar spine, the strength of abdominal muscles in the older people with lumbar osteoarthritis is weak, and the degree of pain will increase, and thus the quality of life will be negatively affected (Vieira et al., 2015). Compared with the people without osteoarthritis, the lower limb strength of the persons with osteoarthritis was weaker (Cavalcante et al., 2015). The decline of muscle strength relates to the decline of joint flexibility and functional damage, and limits the realization of professional activities, damages the well-being of the older person, resulting in the decline of their quality of life (Cavalcante et al., 2015).

3.2.3 Weight impact

The decline in quality of life is also associated with weight (Bindawas et al., 2015;

Vieira et al., 2015; Gomes Neto et al., 2016). The BMI of people with osteoarthritis is

significantly higher (Bindawas et al., 2015). The increase of BMI is related to the

increase of joint pain, and thus the joint load caused by weight gain will reduce the

quality of life (Gomes Neto et al., 2016). The quality of life of obese and non-obese

people with osteoarthritis will decrease. Obese people have greater difficulty and pain in

performing tasks (Gomes Neto et al., 2016). Compared with non-obese people, obese

3.3 Psychological aspects

Osteoarthritis brings psychological changes to persons, including anxiety, depression, lack of self-confidence, fear and low self-efficacy.

3.3.1 Depression, Anxiety

Two articles mentioned that the poor quality of life in patients with osteoarthritis was related to depression (Bindawas et al., 2015; Aree-Ue et al., 2018). People with bilateral knee pain and back pain have worse mental state and are more prone to anxiety and depression than people without pain. Poor social and psychological status are also risk markers (Bindawas et al., 2015). It is found that depression is concerned with poor quality of life in people with osteoarthritis, and it is a predictor of quality of life of people with osteoarthritis (Aree-Ue et al., 2018). Depression has a direct adverse effect on the quality of life, and it is a common disease that affects the quality of life of people with knee osteoarthritis. The quality of life of people with high degree of depression is lower than that of people with low degree of depression (Aree-Ue et al., 2018).

3.3.2 Lack of confidence, Fear, Low self-efficacy

In addition to depression and anxiety, osteoarthritis people may experience fear (Lucić

&Grazio, 2018; Alves & Bassitt, 2013). Fear, lack of confidence and low self-efficacy are related. Women with osteoarthritis are fear of pain and cling to the misconception that exercise can lead to the loss of bone and cartilage, afraid of that sports will reduce their quality of life (Alves &Bassitt, 2013).

People with knee arthritis lack confidence in their ability of daily life and show poor results in balancing confidence (Lucić & Grazio, 2018). Alves & Bassitt (2013) also explained the negative psychology, loss of self-efficacy, avoidance of daily activities and lack of confidence in physical activities in people with knee osteoarthritis.

3.4Social aspects

People with osteoarthritis suffer from social problems, including neighborhood problems that cannot be solved and attitudes toward social activities

3.4.1 Neighborhood problems and unable to cope with them

Compared with the healthy older people, the older people with chronic diseases and slow walking speed have more obstacles in outdoor environment and lower quality of life (Timmermans et al., 2017). Older people with osteoarthritis are more vulnerable to the environment due to their weakness, and will encounter more difficulties in

overcoming problems or obstacles in outdoor activities (Timmermans et al., 2017).

Over time, older people with osteoarthritis perceive more neighborhood problems than those without osteoarthritis. These neighborhood problems are mainly related to safety issues, such as hilly terrain, lack of rest places and poor street conditions, which have become obstacles to their outdoor activities. It is also mentioned that people with osteoarthritis are unable to cope with perceived neighborhood problems due to their weak ability (Timmermans et al., 2017).

3.4.2 Attitudes to social activities

According to Alves & Bassitt (2013), osteoarthritis people who are willing to engage in voluntary activities can obtain good quality of life. Because they think that even if the body is limited, they can still fully retain the autonomy. In addition, the older people who participated in voluntary work had higher income and better quality of life compared with the older people who did not participate in voluntary work (Alves &

Bassitt , 2013). However, the older people with osteoarthritis might be worried about safety issues, as their needs for outdoor activities are not satisfied, they will have low quality of life (Timmermans et al., 2017). In addition, the fear of sports influences the participation of social activities, and thus increasing the social loneliness (Alves &

Bassitt, 2013). Moreover, the decline of individual confidence in balance will hinder the possibility of community reintegration (Lucić & Grazio, 2018). The quality of life may depend on personal perception, and individuals with social support and social

interaction opportunities will tend to have high quality of life (Aree Ue et al., 2018).

4.Discussion

4.1Main result

Problems related to osteoarthritis include pain, fatigue, physical limitations, anxiety, depression, perceiving more neighborhood problems which could not be solved, and the impact of people ’s attitudes towards community activities on quality of life.

4.2 Result discussion

4.2.1 Physical aspects

The result have concluded that the quality of life of older people with osteoarthritis in terms of physical function are lower than those without osteoarthritis, because

osteoarthritis has a huge negative impact on body function and activity.

Lacey (2014) described that pain in osteoarthritis is related to quality of life, and the more pain sites, the more significant quality of life decline. The report also noted that decreased lower extremity function and increased risk of disability were associated with increased pain levels(Lacey et al, 2014).Pain and fatigue caused by osteoarthritis are associated with lower body function. Fatigue escalates throughout the day and is closely related to physical activity and this has a negative impact on their quality of life,which was mentioned in Jenkins and McCoy (2015).

There is a positive correlation between abdominal muscle strength and quality of life in people with osteoarthritis. The older people with strong abdominal muscles have high quality of life. Muscle strength plays a stabilizing role (Vieira et al., 2015). As one of the static and stable structures of the knee joint, flexion and extension of the knee joint muscle force plays a very important role in maintaining the stability of the knee joint.

The lower muscle strength of the upper extremity in patients with knee osteoarthritis is related to the lower muscle mass, lack of exercise, severe degeneration of the joint and higher degree of pain(De et al ,2018).This is consistent with our results.

Weight is associated with quality of life in people with osteoarthritis (Bindawas et al., 2015; Vieira et al., 2015; Gomes Neto et al., 2016). BMI was significantly higher

among people with osteoarthritis (Bindawas et al., 2015). The increase of BMI is related

to the increase of joint pain, and therefore the joint burden caused by weight increase

will lead to poor quality of life (Gomes Neto et al., 2016). In addition, weight loss in

people with osteoarthritis can significantly improve disability and reduce knee load

(Vieira et al., 2015). Obesity can increase joint load and have harmful effects. The gait pattern of obese people also changed, thus increasing the cumulative load of joints and increasing the incidence rate of osteoarthritis(Thijssen et al, 2015).Besides, Thijssen (2015) also mention that excessive load will have a great impact on the joint tissue, and it is likely to be an important factor of obesity leading to arthritis.

According to Orem's self-care theory, self-care defect is the core of self-care theory.

Nurses should encourage people to complete self-care activities and functional exercises according to people' self-care defects. Nurses can increase the health education of the older persons with osteoarthritis, mobilize the enthusiasm of the people, increase the rehabilitation training of the joints, and guide them in the training of home life. During the treatment, nurses should actively communicate with people, assist people to take comfortable body position, music therapy, deep breathing and other measures to reduce the pain. In addition, nurses should encourage people to take rehabilitation exercise to promote blood circulation of the joint and enhance the function of the joint.Social learning theory should be applied in self-management plan to make participants get rid of the traditional passive role of information receiving. When interventions include self- management education based on social learning theory, pain, disability and overall health will improve( ruger-Jakins et al ,2016).

4.2.2 Psychological aspects

In our study most people with osteoarthritis will feel anxious and depressed. Depression has a direct negative impact on the quality of life. It is a comorbidity that affects the quality of life of older persons with knee osteoarthritis. Low quality of life in older people with osteoarthritis is associated with depression (Bindawas et al., 2015; Aree- Ue et al., 2018). Similar results in Jenkins and McCoy(2015) described,people with osteoarthritis may have higher depressive symptoms than people without osteoarthritis.

However, the depressive symptoms were not found by nurses, resulting in poor quality

of life.

Women with osteoarthritis cling to the wrong idea because of fear. They think exercise can lead to the loss of bone and cartilage. They expressed fear of exercise, which had a negative impact on their quality of life (Alves & Bassitt, 2013). This result is consistent with Jenkins and McCoy (2015), because of the effects of fatigue and pain, the older persons with osteoarthritis may avoid or need the help of certain activities, which may have a negative impact on their quality of life.

According to Orem's nursing theory, nurses can guide people' s self-care activities according to their negative emotions. Before psychological nursing, we need to

understand the psychological state of persons and strengthen the emotional management of persons. Through nursing intervention, we can provide psychological support for them and help them manage their emotions better. Nurses should actively communicate with them, listen to them, and especially provide care to them, comfort them during the treatment. In view of the persons' bad psychology, we use encouraging language to enhance their self-confidence, and use language persuasion to improve their self- efficacy. At the same time, nurses should also encourage persons' relatives and friends to listen to the persons, do a good job in their psychological counseling, and so that the they can feel the support of their family and friends, and thus getting psychological encouragement and support, eliminating their inner doubts, building their confidence and alleviating their negative emotions.

4.2.3 Social aspects

Our research shows that older people with osteoarthritis perceive more neighborhood problems, and they can't solve these problems. However, their attitude towards social activities can help improve their quality of life.

With the passage of time, the perceived neighborhood problems of older people with osteoarthritis are more closely related to the decline of quality of life. Due to the

growing pain, disability and functional limitations, the aged with osteoarthritis are more vulnerable to environmental impact than the older people without disease, being unable to overcome neighborhood problems. This is related to their poor handling of

neighborhood issues, which is connected with security issues (Timmermans et al., 2017).

In the related research by Pas (2016), the older people with high utilization rate of

community resources have higher quality of life. As these people get social support and

care, the more care they get, the more help they get. When they do heavy physical work, they can use community resources to get help, so the knee joint injury will be smaller, which will lead to a relatively high quality of life. At the same time, it can also show that they will get help from the community when dealing with neighborhood problems.

Research shows that the low score of old women with osteoarthritis only represents the low quality of life. Physical compromise does not necessarily affect the patient's decision-making ability. Even if the body function changes, active participation in social activities will bring about good quality of life (Alves & Bassitt, 2013). The results of Zhao (2018) are different. Many older persons with osteoarthritis are

relatively lonely in social life. Physical reasons greatly limit their social scope, and there are few expressive friends around them. They are unwilling to integrate into social activities. Quality of life depends on individual perceptions, and individuals with

opportunities for social support or interaction tend to have positive quality of life (Aree- Ue et al., 2018). Alves & Bassitt (2013) believe that volunteers play an important role in maintaining the health and quality of life of the older people, which will improve the quality of life of patients. Similar with the view of Zhao (2018), extensive life support has a positive effect on patients' health recovery and disease treatment.

Based on self-care theory, nurses should provide social support to older patients with osteoarthritis as soon as possible after they accept the fact that they have physical defects and disabilities. Nurses can understand the status quo of patients, provide them with better personalized care, so that patients can get maximum recovery in social participation and social activities. In addition, nurses also need to pay attention to the patients' families, whose daily behaviors also have a great impact on the patients.

Nurses can encourage patients' family members to actively answer their family members' questions, so that patients and their families can support and help nurses.

4.3 Method discussion

the article must be written in English. Its limitation lies in that English is not the author's native language, which means misunderstandings are likely to occur. In addition, these articles should have been published between July 1,2009 and July 1, 2019 to limit search results. This may cause the author to miss the researches published earlier, which is the limitation of the current literature review. However, articles that have been

excluded for more than a decade ensure more advanced and modern results, which can also be regarded as an advantage (Polit and Beck, 2012). In addition, articles must be made available free of charge to GäVLE University, which may be a limitation as the author may have missed the articles due to lack of resources. Polit and Beck (2012) suggested that the author read these eight articles carefully and repeatedly, and the two authors read them independently to avoid affecting each other’s understanding of the article and looking for more useful information.

In this literature review, the authors used a descriptive design (Polit & Beck, 2012) to describe the quality of life in older persons with osteoarthritis. According to the data collection method adopted in this literature, relevant articles are selected for research, and the results are completely consistent with the purpose of this study.

In this study, PubMed and Cinahl databases were used to collect articles related to research purposes.In addition, search different combinations with different keywords to find more articles related to the purpose of this study.

4.4 Clinical implications

In this review, three themes that describe how older persons with osteoarthritis

experience quality of life were found. Osteoarthritis has brought a great harm to the

body and mind of persons. Therefore, it is very important to understand the quality of

life of the older persons with osteoarthritis. Nurses should pay special attention to this

group and provide them with professional care. They will feel physical discomfort,

nurses should often give nursing intervention guidance, timely and effective functional

exercise. For persons' psychological care, nurses can give more humanistic care and

social support to them, encourage them to express their feelings, let family members

participate in nursing, establish trust between nurses and patients, and provide better

nursing for them. They are uncertain about their prospects, so as health professionals,

they can provide a lot of effective rehabilitation information, especially information

related to improving the quality of life.

4.5 Suggestions for future research

Through the analysis and summary of the article, we learned that the quality of life of the older persons with osteoarthritis were generally decline. Many older persons experience physiological, psychological and social changes in their daily life. At the same time, when aging, osteoarthritis is becoming more and more serious. Therefore, it is very important that nurse that meet older persons with osteoarthritis needs to improve their quality of life. During the study, result showed that exercise is very significant in improving the symptoms of osteoarthritis, but few literature have systematically described this aspect. The author also found that there are few studies on how to

improve the quality of life of persons with osteoarthritis from the perspective of nurses, which needs further study by follow-up scholars. In addition, the author suggests that future scholars should study and compare a series of physiological and psychological reactions of persons with osteoarthritis of different genders and educational

backgrounds.

5.Conclusions

According to this study, the quality of life in older people with osteoarthritis has decreased. They suffer from physical, psychological and social negative effects.

Therefore, they should not only have the ability of self-care, but also have the ability of

self-treatment, which needs more social attention. For nurses, learning advanced

medical knowledge and improve nursing skills can help improve older persons with

osteoarthritis quality of life.

6.References

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Appendices

Table3: Studies included in this review Authors

and

year/countr y of

publication

Title Design

(possible approach)

particip ants

Data collectio n

method(s )

Data analysis Method(s )

Stud y code

Alves J &

Bassitt D Year of publication : 2013 Country:Br azil

,

Quality of life and functional capacity of elderly women with knee osteoarthritis

A cross- sectional study /A qualitative approach

Number :40 participa nts

Average Age:

74.1

WHOQ OL- OLD instrume nt

Descripti ve analysis

A

Aree-Ue S et al Year of publication : 2019 Country:Th ailand

Path model of factors influencing health- related quality of life

among older people with knee

osteoarthritis

A cross- sectional study /A qualitative approach

Number :200 participa nts Age:

between 65- 89years of age.

Sex:

male 28 Female:

172

SF-36 Question naire

Calculate the score for each dimensio n

B

Bindawas S et al

Year of publication : 2015 Country:Sa udi Arabia

Health- related quality of life in older adults with bilateral knee pain and back pain:

Data from the

Osteoarthriti s Initiative

A cross- sectional study /A qualitative approach

Number :1252 participa nts Age:

over 65 years old Sex: not mention ed

SF-12 Question naire

Multiple linear regressio n

analysis C

Cavalcante P et al Year of publication : 2015 Country:Br azil

Functional Fitness and Self- Reported Quality of Life of Older

A cross- sectional study /A qualitative approach

Number :90 participa nts Age:

over 60years

SF-36 Question naire

T-test D

Women Diagnosed with nee Osteoarthrosi s:

A Cross- Sectional Case Control Study

old Sex：all female

Gomes- Neto M et al ,2016 Year of publication : 2016 Country:Br azil

Comparative study of functional capacity and quality of life among obese and non-obese elderly people with knee

osteoarthritis

A cross- sectional study /A qualitative approach

Number :35 participa nts

Age:

between 60-86 years old Male 8 Female 27

SF-36 Question naire

Shapiro- Wilk test

E

Lucić L &

Grazio S Year of publication : 2018 Country:Cr oatia.

Impact of Balance Confidence on Daily Living Activities of Older People

A cross- sectional study /A qualitative approach

Number :47 participa nts Age ： over 60 years

SF-36 T-test F

Physical Function, Pain, and Quality of Life – A Preliminary Report Timmerma

ns E et al ,

Year of publication : 2017 Country:Ne therlands

Associations Between Perceived Neighbourho od Problems and

Quality of Life in Older Adults With and Without Osteoarthriti s:

Results from the

Hertfordshire Cohort Study

A cohort study /A qualitative approach

Number :294part icipants

Average Age:71- 80 years old Sex;

female1 50 Male 144

EQ-5D instrume nt

Edwards -

Nunnally index

G

Vieira S et al

Year of publication : 2015 Country:Br azil

Abdominal muscle strength is related to the quality of life among older adults with

lumbar osteoarthritis

A cross- sectional study /A qualitative approach

Number :40 participa nts Average Age:

65.9±4.

8years old Male 8

SF-36 Question naire

Shapiro- Wilk test

H

Female

： 12 control group：

average age:67.9

±4.6 Male6 Female 14

Table4: Studies’ aim and results included in this review Authors and

year/country of publication

Aim Result

Alves J & Bassitt D

Year of publication: 2013 Country:

This study correlated functional capability and quality

of life of elderly patients with knee osteoarthritis

Even if the function is damaged due to knee osteoarthritis, it may have a good quality of life Avoid sports for fear of pain

Fear of social activities increases social loneliness, and volunteers have better quality of life

Aree-Ue S et al

Year of publication: 2019

The aims of this study were to determine the

Low quality of life is

associated with

and indirect effects on quality of life among Thai older people with knee OA.

High depression leads to low quality of life The increase of disease duration leads to the deterioration of quality of life

Bindawas S et al

Year of publication: 2015 Country: Saudi Arabia

This study’s objective was to examine the association of self-reported bilateral knee pain ( P) and back pain (BP) with health- related quality of life among older adults.

Low quality of life is associated with pain and depression

Cavalcante P et al

Year of publication: 2015 Country:

The aim of this study was to evaluate the functional fitness and self-reported quality of life differences in older people diagnosed with knee osteoarthrosis (O) who participated in health promotion groups.

Increased pain, reduced functional health, reduced quality of life

The decrease of muscle strength is related to the decrease of joint flexibility and function, which leads to the decrease of life quality.

Cavalcante P et al

Year of publication: 2015 Country:

The aim of this study was to evaluate the functional fitness and self-reported quality of life differences in older people diagnosed with knee osteoarthrosis (O) who participated in health promotion groups.

Increased pain, reduced functional health, reduced quality of life

The decrease of muscle

strength is related to the

decrease of joint flexibility

and function, which leads

to the decrease of life

quality.

Gomes-Neto M et al ,2016

Year of publication: 2016 Country:

To compare the functional capacity and QoL of obese and non-obese older adults with knee OA

Both obese and non-obese patients have a decreased quality of life

Obese patients have more severe pain, and joint load from weight gain leads to lower quality of life

Timmermans E et al ,

Year of publication: 2017 Country:

This study examined whether the association of quality of life (QoL) with perceived

neighborhood problems is stronger in older adults with osteoarthritis (OA) than in those without

OA.

The quality of life of patients with osteoarthritis decreased more

significantly over time Osteoarthritis patients perceive more

neighborhood problems, but they are unable to cope with them, and their quality of life declines more significantly over time

Vieira S et al

Year of publication: 2015 Country: Brazil

The aim of the present study was to determine the association between abdominal muscle strength and quality

of life among older adults with lumbar osteoarthritis.

Weak abdominal strength

leads to low quality of life

in the elderly with lumbar

osteoarthritis and better

quality of life in the

elderly with greater

abdominal muscle

strength.