Full text of DOI:10.1093/gerona/56.8.M471

Journal of Gerontology: MEDICAL SCIENCES
Copyright 2001 by The Gerontological Society of America
2
001, Vol. 56, No. 8, M471–M476
Chronic Rheumatologic Symptoms in a Tri-Ethnic
Sample of Men and Women Aged 75 and Older
Shiva Satish, Luis G. Postigo, Laura A. Ray, and James S. Goodwin
Department of Medicine and Center on Aging, The University of Texas Medical Branch, Galveston.
Background. The high prevalence of musculoskeletal symptoms in elderly persons tends to obscure the recognition
of specific medical conditions. The purpose of this study is to describe the prevalence of chronic rheumatologic symp-
toms and the associated measures of health status in an older population.
Methods. This is a cross-sectional study of 507 noninstitutionalized tri-ethnic men and women aged 75 and older liv-
ing in Galveston County, Texas. A home interview collected data on demographics, chronic medical conditions, cogni-
tion, depression, and functional status. Site, severity, and duration of rheumatologic symptoms such as morning
stiffness, body tenderness, and body aching in the past month were also collected.
Results. There was a high prevalence of nonspecific rheumatologic symptoms such as morning stiffness (32% in the
shoulder girdle, 31% in the hip girdle), tenderness to touch (9%), and generalized body aching (11%) in the study popu-
lation. Twenty-one percent of the subjects reported either bilateral shoulder or hip girdle stiffness or tenderness lasting
more than 30 minutes almost every day or every day or generalized body aching most of the time during the past month.
Age-, gender-, and ethnicity-adjusted multivariate analyses showed that more than three self-reported chronic medical
conditions, poor or fair self-reported health, impairment in instrumental activities of daily living (IADL), and the pres-
ence of depressive or anxiety symptoms were associated with the presence of these chronic rheumatologic symptoms.
Conclusion. Chronic rheumatologic symptoms are common in people aged 75 and older. Such symptoms are mark-
ers for underlying poor health and for anxiety and depression among older subjects.
USCULOSKELETAL disorders are the leading cause
of pain and disability among people aged 65 years
and older (1–3). Nearly two-thirds of the women and more
than half of the men in this population present to their physi-
cians with pain or limitations of function related to a muscu-
loskeletal disorder (2).
The purpose of this population-based study of men and
women aged 75 and over is to describe the prevalence of
nonspecific rheumatologic symptoms such as morning stiff-
ness, muscle tenderness, and generalized body aching
among three ethnic groups. We also examine the relation-
ship between these symptoms and chronic medical condi-
tions, functional status, and other measures of health status.
M
Diagnosing specific musculoskeletal disorders in older
adults presents a unique challenge. Radiologic findings of
osteoarthritis are highly prevalent but correlate poorly with
symptoms and physical findings (4). Commonly used sero-
logic tests, such as rheumatoid factor and antinuclear anti-
bodies, have very poor positive predictive value in elderly
persons (5). In addition, nonspecific rheumatologic symp-
toms such as morning stiffness, muscle tenderness, or total
body aching overlap with a broad range of disorders includ-
ing rheumatoid arthritis, polymyalgia rheumatica (PMR),
and fibromyalgia.
Somatic complaints in the elderly population are very com-
mon (1,2,6). Elderly patients have multiple chronic medical
conditions that may contribute to the overall somatic com-
plaints, which masks the specificity of musculoskeletal disor-
ders. Whereas the prevalence of joint pain and physician-
diagnosed arthritis has been relatively well studied, there is
very little information on the prevalence of the nonspecific
rheumatologic symptoms such as stiffness, tenderness, and
fatigue, particularly among older populations. Because there
are often no gold standards in diagnosing musculoskeletal
disorders in elderly persons, the high prevalence of muscu-
loskeletal complaints tends to obscure the recognition of
these specific diseases.
METHODS
The data for this study come from the baseline survey of
a population-based sample of noninstitutionalized men and
women aged 75 and older living in Galveston County, Texas.
The methods used for sampling and data collection are dis-
cussed elsewhere (7). The list of all residents of Galveston
County 75 years or older as of February 1, 1995 were identi-
fied by a master enrollment file of Medicare beneficiaries
obtained from the Health Care Financing Administration
(HCFA). Exclusion of those subjects misclassified as living in
Galveston County and those who listed a nursing home as their
permanent address resulted in a target population of 9945.
Differential sampling was performed to ensure equal num-
bers of three ethnic groups (African Americans, Hispanic
Americans, and non-Hispanic white Americans) and equal
numbers of men and women in each category. Hispanic
Americans were identified by surname, forming the first
subgroup; African Americans were separated on a second
subgroup on the basis of Medicare racial identification; the
remaining individuals formed the third subgroup of non-
Hispanic whites. The final sample consisted of 200 His-
panic Americans, 201 African Americans, and 200 non-His-
M471

M472
SATISH ET AL.
panic whites. Ethnic group membership as classified by
HCFA was confirmed in the face-to-face interviews by ask-
ing respondents how they self-identified, which determined
the final categorization by ethnicity. Correlation between
the HCFA list and self-identification was very high (99%).
Six women with Hispanic surnames were included in the
non-Hispanic white category on the basis of this self-identi-
fication. Of the Hispanic Americans, a majority (87%) iden-
tified themselves as Mexican Americans.
cific rheumatologic symptoms such as morning stiffness,
muscle tenderness, or generalized body aching in the past
month. For those who responded yes to the above question,
the duration and distribution of these symptoms were also
determined. For example, “In the past month how often did
you wake up with stiffness in your upper arms or shoulders?
Is it a few times, about half of the time, almost every day,
every day?” For those who responded yes to any of the
above options were asked, “Was this stiffness on one side
only or both sides?”, “How long did this stiffness usually
last? Is it less than 30 minutes, 30–59 minutes, 1 hour or
more, most of the day or all day?” Similar questions were
asked regarding stiffness in the hips and thighs. Information
on muscle tenderness was obtained by asking, “In the past
month were the muscles of your shoulders or arms tender to
the touch most of the time? Was this on one side or both
sides?” Similar questions were asked regarding tenderness
in the hips and thighs. Generalized body aching was as-
sessed by asking whether the statement “I ached all over my
body most of the time in the past month” was true, partly
true, or not true at all. Subjects who responded “true” were
considered to have generalized body aching most of the
time in the past month. Subjects who reported the presence
of (i) bilateral morning stiffness either in the shoulders or
the hips, lasting more than 30 minutes, every day or almost
every day during the past month; (ii) bilateral muscle ten-
derness either in shoulders or hips, most of the time during
the past month; or (iii) generalized body aching most of the
time during the past month were defined as a subgroup with
chronic rheumatologic symptoms.
Trained bilingual interviewers conducted in-home in-
terviews. Interviews were conducted in either Spanish or
English, depending on subject preference. Fifteen percent (n ꢀ
9
4) of the interviews were conducted with a knowledgeable
proxy respondent because those subjects were too ill or
were believed by family members to be cognitively im-
paired. As compared with respondents included in this study
sample, proxy subjects were more likely to be older than 80
years of age (65% vs 55%), were more likely to be Hispanic
Americans (50% vs 30%), and were more likely to have had
fewer than 8 years of education (100% vs 51%). Proxy data
were excluded from the current analyses due to a lack of in-
formation pertaining to the objectives studied. As a result,
our study sample consisted of 507 individuals including 177
African Americans, 153 Hispanic Americans, and 177 non-
Hispanic white Americans.
Data collected included age, marital status, annual in-
come, level of education, living arrangements, chronic med-
ical conditions, self-reported health status, and functional
status. Chronic medical conditions were assessed by asking
subjects if they have been told by a physician that they had
any of the following diseases: stroke, cancer, diabetes, hy-
pertension, osteoporosis, kidney disease, prostate problems,
respiratory problems, hip fracture, heart disease, and arthri-
tis. These questions were similar to questions used in the
Established Populations for Epidemiologic Studies of the
Elderly to assess health conditions (8). Depressive symp-
toms were measured with the Center for Epidemiologic
Studies–Depression Scale (CES-D) (9–10). The CES-D
contains 20 items, each corresponding to a specific symp-
tom of depression. The frequency with which each symp-
tom had been experienced in the preceding week was as-
sessed on 4-point scale. Anxiety symptoms were measured
with the Zung Self Rating Anxiety Scale (Zung SAS) (11).
This scale is based on the presence of 20 specific anxiety
symptoms during the past week. Cognitive impairment was
assessed using the Pfeiffer Mini Mental Exam (12). Sub-
jects’ self-care abilities were measured using the Katz Ac-
tivities of Daily Living scale (ADL) (13) and the instrumen-
tal activities of daily living (IADL) (14).
Subjects were also asked a series of questions to assess
their nonspecific rheumatological symptoms in the past
month. Arthritis symptom questions used in The National
Health and Nutrition Examination Survey were modified in
this study to assess more nonspecific rheumatological
symptoms (15). Similar questions have also been used in
Hispanic Established Populations for Epidemiologic Study
of the Elderly (16). Self-reports of musculoskeletal symp-
toms in elderly subjects have been shown to be valid in
comparison to a standardized physician examination (17).
Subjects were asked whether they had experienced any spe-
Data Analysis
All analyses in this study were conducted with weighted
data to reflect the overall population of adults aged 75 and
older in Galveston County, Texas, using SUDAAN version
7.5 (Research Triangle Institute, Research Triangle Park,
NC) (18). Data were dichotomized on the basis of demo-
graphic, medical, and functional characteristics as follows:
age ꢁ80 versus ꢂ80 years, education ꢃ8 versus ꢄ8 years,
and annual income ꢁ$15,000 versus ꢂ$15,000/year. Sub-
jects were also dichotomized on the basis of the number of
chronic medical conditions (ꢃ3 or ꢄ3) and of their self-
reported health status as excellent/good versus fair/poor.
Subjects scoring 16 or more points in the CES-D scale were
considered to have high depressive symptoms, those scoring
ꢂ12 were considered to have high anxiety symptoms, and
those subjects scoring ꢂ6 in the Pfeiffer Mini Mental Exam
were considered cognitively impaired. Subjects were con-
sidered to have depressive or anxiety symptoms if they
scored either 16 or more points in the CES-D scale or 12 or
more points in the Zung SAS. Subjects were classified as
functionally impaired in ADL or IADL if they needed help
with one or more activities. The prevalence of chronic non-
specific rheumatologic symptoms was described using sim-
ple cross-tabulations. Cross-tabulations with chi square
analyses were done to describe the demographic and medi-
cal characteristics associated with chronic rheumatologic
symptoms.
The purpose of our analyses was to identify the clinically
accessible factors associated with chronic rheumatologic

RHEUMATOLOGIC SYMPTOMS AMONG 75 AND OLDER
M473
symptoms. Because we did not collect all the potential inde-
pendent factors associated with chronic rheumatologic
symptoms, we ran a series of logistic regression models ad-
justing only for age, gender, and race to assess the magni-
tude of association between clinically relevant individual
characteristics with chronic rheumatologic symptoms. The
analyses were considered significant if the p value was
ꢃ.05.
shoulder or hip girdle tenderness to touch, and 11% had ex-
perienced generalized body aching all or most of the time
in the past month. Morning stiffness was more common
among African Americans and less common among His-
panic Americans compared with non-Hispanic whites. With
the exception of morning stiffness in hips or thighs, there
were no major gender differences in these symptoms.
Overall, 105 subjects (21%) experienced bilateral morn-
ing stiffness or tenderness either in the shoulders or hips,
lasting more than 30 minutes, every day or almost every day
during the past month; or generalized body aching all or
most of the time during the past month. We call this constel-
lation of symptoms chronic rheumatologic symptoms. Table
3 shows the prevalence of chronic rheumatologic symptoms
by demographic and medical characteristics. The preva-
lence varied by ethnicity, with Hispanic Americans report-
ing the lowest prevalence and African Americans reporting
the highest. Other characteristics significantly associated
with chronic rheumatologic symptoms included comorbid-
ity, self-reported health, depressive symptoms, anxiety
symptoms, and impairment of the IADL. Age, gender, edu-
cation, income, cognitive impairment, and ADL impairment
were not associated with the presence of chronic rheumato-
logic symptoms.
RESULTS
Table 1 shows the demographic and medical characteris-
tics of the weighted sample of men and women aged 75 and
older. Fifty-five percent of subjects were older than 80 years
of age, two-thirds were women, and 36% were married.
One-third of the subjects had less than 9 years of education,
and 59% had an annual income of ꢁ$15,000. Compared
with non-Hispanic whites and Hispanic Americans, Afri-
can Americans were more likely to be older, not married,
impaired in ADL and IADL, and were more likely to report
anxiety and depressive symptoms.
Table 2 shows the prevalence of nonspecific rhematologic
symptoms in the past month stratified by gender and race.
Thirty-two percent of all subjects reported morning stiffness
in the shoulder girdle, and 31% reported morning stiff-
ness in the hip girdle. Among all subjects with morning
stiffness, two two-thirds had bilateral stiffness, and approxi-
mately half had symptoms lasting more than 30 minutes
each morning. Nine percent of the subjects reported either
Table 4 presents logistic regression models showing the
magnitude of the association between each characteristic
and the presence of chronic rheumatologic symptoms, ad-
justed for age, gender, and ethnicity. Subjects with more
Table 1. Demographic and Medical Characteristics (Weighted Percentages) of Non-Hispanic White, African American, and Hispanic
American Subjects Aged 75 Years and Older in Galveston County, Texas (N ꢀ 507)
Characteristics
Age
Total†
Non-Hispanic White‡
African American‡
Hispanic American‡
7
8
5–79 y
0–100 y
45
55
47
53
38
62
47
53
Gender
Men
Women
Married
Living Alone
Education
ꢃ8 y
35
65
36
44
35
65
37
44
34
66
28
46
46
54
48
30
31
69
23
77
51
49
80
20
ꢄ8 y
Annual Income
ꢁ
$15,000
59
41
21
50
50
22
88
12
22
81
19
12
ꢂ$15,000
Self-reported Medical Conditions ꢄ3
Self-reported Health
Poor/fair
46
54
13
21
4
41
59
12
19
ꢁ1
4
61
39
17
30
15
13
53
60
40
16
21
14
9
Excellent/good
Depressive Symptoms
Anxiety Symptoms
Cognitive Impairment
Impairment in ADLs
Impairment in IADLs
6
42
40
40
Note: ADLs ꢀ activities of daily living; IADLs ꢀ instrumental activities of daily living.
†
The percentages given in the “Total” column represent the averages weighted for the ethnic and gender distribution of the 75 year and older population of
Galveston County, Texas.
‡The percentages given in the right three columns represent the averages for the three ethnicities weighted for the gender distribution of each ethnicity in Galveston
County.

M474
SATISH ET AL.
than three self-reported medical conditions, with poor or
fair self-reported health, and with impairment in IADL were
more likely to report chronic rheumatologic symptoms.
Subjects with high levels of depressive symptoms were
nearly 4 times and subjects with high anxiety symptoms
were 8 times more likely to experience these chronic rheu-
matic symptoms. In a multivariate model including all vari-
ables significant in bivariate analyses, self-reported poor or
fair health (odds ratio [OR] 3.6, 95% confidence interval
one hand and nonspecific rheumatologic symptoms on the other
may be causal, but it is unclear in what direction the causal-
ity flows. The increased prevalence of depressive and anxi-
ety symptoms could be explained as depression and anxiety
presenting with somatic symptoms or, alternatively, the
presence of chronic rheumatologic symptoms could contrib-
ute to depression and anxiety (19).
Depression and anxiety have been reported to be highly
prevalent but are underdiagnosed in the older population
(20–23). Depressive symptoms are particularly common in
persons older than 75 years. Even minor and subsyndromal
depressive and anxiety symptoms are associated with ex-
cess morbidity, increased functional impairment, and health
service use (24,25). For the clinician, the presence of
chronic rheumatologic symptoms in an older patient might
serve as a prompt to screen for depression or anxiety.
In bivariate analyses, African Americans had the highest
prevalence of chronic rheumatologic symptoms, whereas
Hispanic Americans had the lowest prevalence compared
with non-Hispanic whites. These differences probably re-
flect differences in the underlying prevalence of comorbid-
ity, and anxiety, and depression in these three ethnic groups
(Table 1), because there were no differences in rheumato-
logic symptoms by ethnicity in multivariate analyses that
included comorbidity, anxiety, and depression.
[
9
CI] 1.7, 7.8), and depressive or anxiety symptoms (OR 6.0,
5% CI 2.9, 12.4) remain significantly associated with
chronic rheumatologic symptoms.
DISCUSSION
The findings of this study can be summarized as follows.
There was a high prevalence of nonspecific rheumatologic
symptoms such as morning stiffness, muscle tenderness,
and body aching in the population aged 75 and over. A sub-
stantial proportion (21%) experienced morning stiffness or
tenderness in the shoulder or hip girdle, or aching all over,
lasting at least 30 minutes or more, every day or almost ev-
ery day in the previous month. This constellation of symp-
toms, which we term chronic rheumatologic symptoms, was
associated with poorer self-rated health and the presence of
high depression or high anxiety symptoms.
The association between anxiety and depression on the
The constellation of prolonged shoulder and hip girdle
Table 2. Prevalence of Nonspecific Rheumatologic Symptoms in the Past Month Among Non-Hispanic White, African American, and
Hispanic American Subjects Aged 75 Years and Older in Galveston County, Texas (Weighted Percentages)
Total
Men
Women
Non-Hispanic White
African American
Hispanic American
(N ꢀ 507)
(n ꢀ 250)
(n ꢀ 257)
(n ꢀ 177)
(n ꢀ 177)
(n ꢀ 153)
Morning stiffness in the shoulder girdle
A few times
18
2
23
3
15
1
16
2
30
4
12
3
About half the time
Almost every day
5
5
6
5
6
1
Every day
7
5
8
6
13
5
Among those with any stiffness in the shoulder girdle
Bilateral stiffness
63
61
64
65
59
61
Duration of stiffness
ꢁ
30 min
52
20
7
49
18
9
55
21
7
53
20
4
50
20
14
16
48
15
23
15
3
1
0–59 min
h or more
Most of the day/all day
Morning stiffness in hip girdle
A few times
20
24
18
22
13
1
8
12
1
5
13
1
9
11
0
8
23
5
5
9
1
3
2
About half the time
Almost every day
Every day
9
3
12
9
9
Among those with any stiffness in hip girdle
Bilateral stiffness
63
52
67
66
54
50
Duration of stiffness
ꢁ
30 min
44
19
9
48
14
13
25
44
21
8
47
18
7
40
24
15
21
34
21
21
25
3
1
0–59 min
h or more
Most of the day/all day
25
27
28
Tender to touch—muscles of shoulder girdle
Tender to touch
Percentage of those with bilateral tenderness
Tender to touch—muscles of hip girdle
Tender to touch
9
47
9
48
9
46
6
27
22
68
15
60
9
45
11
7
52
12
9
42
11
6
33
13
23
58
3
6
55
7
Percentage of those with bilateral tenderness
Ached all over the body all or most of the time

RHEUMATOLOGIC SYMPTOMS AMONG 75 AND OLDER
M475
†
Table 3. Prevalence of Chronic Rheumatologic Symptoms by
Table 4. Factors Associated With the Presence of Chronic
†
Demographic and Medical Characteristics Among Non-Hispanic
White, African American, and Hispanic American Subjects Aged
Rheumatologic Symptoms Among Non-Hispanic White, African
American, and Hispanic American Subjects Aged 75 Years and
Older, Adjusted for Age, Gender, and Ethnicity
7
5 Years and Older (N ꢀ 507)
Characteristics
Age
Weighted %‡
p Value§
Odds
95%
‡
Characteristics
Ratio Confidence Interval
.442
7
8
5–79
0ꢅ
20
24
Age (increase of one year)
Female
African Americans (vs whites)
Hispanic Americans (vs whites)
Living alone
ꢃ8 y of education
Annual income of ꢁ$15,000
ꢄ3 self-reported medical conditions
1.02
1.55
1.37
0.66
0.95
0.67
0.67
2.74
0.96–1.09
0.87–2.79
0.81–2.31
0.37–1.20
0.51–1.77
0.34–1.31
0.31–1.47
1.37–5.47
3.35–15.32
1.69–8.01
4.23–16.7
0.42–2.15
0.33–2.62
1.03–3.74
Gender
Male
Female
Race
.136
.035
17
24
Non-Hispanic whites
African Americans
Hispanic Americans
21
27
15
Poor/fair self-reported health (vs excellent/good) 7.16
§
Education
–8 y
.302
.143
.880
.007
.001
.007
.001
.868
.997
.026
High depressive symptoms
3.68
8.41
0.96
0.93
1.97
ꢀ
0
26
20
High anxiety symptoms
Cognitive impairment
¶
ꢄ8 y
Annual Income
Impairment in one or more ADL
Impairment in one or more IADL
ꢁ
$15,000
23
15
ꢂ$15,000
Living Alone
Note: ADL ꢀ activity of daily living; IADL ꢀ instrumental activity of daily
living.
Yes
No
22
22
†Chronic nonspecific rheumatological symptoms describes those subjects
experiencing bilateral upper or lower girdle stiffness lasting more than 30 min
almost every day or every day, bilateral upper arms or thighs tenderness most of
the time, or aching all over the body most of the time during the past months.
Number of Self-reported Medical Conditions
0
ꢄ3
–3
18
38
‡
Logistic regression models showing the magnitude of association of each
Self-reported Health
Excellent/good
Poor/fair
Depressive Symptomsꢀ
individual characteristic with chronic nonspecific rheumatological symptoms,
controlling for age, gender, and race.
9
37
§Subjects scoring ꢂ16 on the CES-D depression scale are considered to
have high depressive symptoms.
Yes
No
45
18
ꢀSubjects scoring ꢂ12 on the Zung anxiety scale are considered to have high
anxiety symptoms.
Anxiety Symptoms¶
¶Subjects scoring 6 or more on the Pfeiffer cognitive function scale are con-
sidered cognitively impaired.
Yes
No
58
14
#
Cognitive Impairment
Yes
No
23
22
Impairment in One or More ADL
tic trial of low-dose corticosteroids. PMR is often unrecog-
nized in the community (26–28). This would appear to be
true particularly among ethnic groups with poor access to
medical care (27). The findings of the current study suggest
that one contributing factor to the under-recognition of
PMR is the high background of rheumatic symptoms in the
general population of older patients. With 20% of the el-
derly population experiencing symptoms reminiscent of
PMR, it may be difficult for primary care physicians to rec-
ognize the 1% who actually have PMR. Subjects with late
complications of medical conditions such as stroke, diabe-
tes, or chronic renal failure can present with similar nonspe-
cific rheumatological symptoms. In our study, subjects with
a history of arthritis (OR 5.1, 95% CI 2.5, 10.5) or diabetes
Yes
No
22
22
Impairment in One or More IADL
Yes
No
29
17
Note: ADL ꢀ activity of daily living; IADL ꢀ instrumental activity of daily
living.
†Chronic nonspecific rheumatological symptoms is defined as those subjects
experiencing bilateral shoulder or hip girdle stiffness or tenderness, lasting more
than 30 minutes almost every day or every day, or aching all over the body all or
most of the time during last month.
‡The prevalence calculations by characteristics were adjusted for sampling
design (i.e., adjusted for gender and ethnicity).
§
Chi-square.
ꢀ
Subjects scoring ꢂ16 on the CES-D depression scale are considered to have
(
OR 2.4, 95% CI 1.1, 5.4) were more likely to experience
depressive symptoms.
¶Subjects scoring ꢂ12 on the Zung anxiety scale are considered to have anx-
these chronic rheumatological symptoms.
iety symptoms.
The presence of musculoskeletal pain has been shown to
be associated with physical disability in community-dwell-
ing elderly persons (29-–30). We found an association be-
tween the presence of chronic nonspecific rheumatologic
symptoms and the impairment in the performance of the
IADL but not of the ADL.
This investigation should be interpreted with recognition
of the limitations in its methodology. The degree in which
these findings in Galveston County, Texas can be extrapo-
#Subjects scoring 6 or more on the Pfeiffer cognitive function scale are con-
sidered cognitively impaired.
stiffness or tenderness, or aching all over, is similar to the
presentation of PMR (26). PMR is a disease that inflicts el-
derly persons and is typified by proximal muscle aching or
stiffness or tenderness, an elevated erythrocyte sedimenta-
tion rate, and a prompt and dramatic response to a therapeu-

M476
SATISH ET AL.
lated to other geographic areas is unclear. The majority of
the non-Hispanic whites and African Americans in our
study were born in the Galveston area, whereas half of the
older Hispanics were born in Mexico. In addition, although
this was a population-based sample, it excluded certain frail
older subjects such as those institutionalized and those for
whom a proxy interview was obtained. A small proportion
of elderly persons who were not on the HCFA rolls (i.e.,
those without Medicare coverage) were also excluded. Fi-
nally, in this cross sectional study, we cannot infer any
causal relationships between chronic rheumatologic symp-
toms and the presence of anxiety or depression symptoms.
In conclusion, nonspecific rheumatologic symptoms are
common in the population aged 75 and older. It would ap-
pear that such symptoms are particularly frequent among
older patients with symptoms of anxiety or depression. Such
symptoms should prompt the physician to screen for those
conditions.
center for epidemiologic studies of depression scale in arthritis popula-
tions. Arthritis Rheum. 1989;32:991–997.
1. Zung WWK. A rating instrument for anxiety disorders. Psychosomat-
ics. 1971;12:371–379.
2. Pfeiffer E. A short portable mental status questionnaire for the assess-
ment of organic brain deficit in elderly patients. J Am Geriatr Soc.
1
1
1
975;23:433–441.
1
3. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of
illness in the aged: the index of ADL, a standardized measure of bio-
logical and psychosocial function. JAMA. 1963;185:914–919.
14. Lawton MP, Brody EM. Assessment of older people: self-maintaining
and instrumental activities of daily living. Gerontologist. 1969;9:179–186.
5. Anderson J, Felson D. Factors associated with osteoarthritis of the
knee in the First National Health and Nutrition Examination Survey
1
(
NHANES I). Am J Epidemiol. 1988;128(1):179–189.
1
6. Markides KS, Stroup-Benham CA, Goodwin JS, Perkowski LC, Lich-
tenstein M, Ray LA. The effect of medical conditions on the functional
limitations of Mexican-American elderly. Ann Epidemiol. 1996;6:
3
86–391.
1
7. Hughes SL, Edelman P, Naughton B, et al. Estimates and determinants
of valid self-reports of musculoskeletal disease in the elderly. J Aging
Health. 1993;5(2):244–263.
1
8. Shah BV, Barnwell BG, Bieler GS. SUDAAN User’s Manual Release
7
.5. Research Triangle Park, NC: Research Triangle Institute; 1997.
Acknowledgments
1
9. Magni G, Moreschi C, Rigatti-Luchini S, Merskey H. Prospective
study on the relationship between depressive symptoms and chronic
musculoskeletal pain. Pain. 1994;56:289–297.
This study was supported by a Health of the Public grant from the PEW
Charitable Trust and The Robert Wood Johnson Foundation.
2
2
2
2
0. Conn DK, Steingart AB. Diagnosis and management of late life de-
pression: a guide for the primary care physician. Int J Psychiatry Med.
Dr. Luis Postigo, who is currently practicing medicine at Goliad, Texas,
was a fellow in Geriatric Medicine at UTMB while preparing this
manuscript.
1
997;27:269–281.
1. Hales RE, Hilty DA, Wise MG. A treatment algorithm for the manage-
ment of anxiety in primary care practice. J Clin Psychiatry. 1997;58:
This manuscript was presented as a poster at the 52nd Annual Scientific
Meeting of Gerontological Society of America at San Francisco, Califor-
nia, November 1999.
7
6–80.
2. Gurland BJ, Cross PS, Katz S. Epidemiological perspectives on oppor-
tunities for treatment of depression. Am J of Geriatr Psychiatry. 1996;
Address correspondence to Dr. Shiva Satish, Center on Aging, UTMB,
4
(suppl): S7–S13.
301 University Blvd., Galveston, TX 77555-0460. E-mail: ssatish@utmb.edu
3. Fifer SK, Mathias SD, Patrick DL. Untreated anxiety among adult pri-
mary care patients in a health maintenance organization. Arch Gen
Psychiatry. 1994;51:740–750.
References
1
2
3
4
. Arthritis prevalence and activity limitations. United States, 1990.
MMWR. 1994;43:433–438.
24. Unutzer J, Patrick DL, Simon G, et al. Depressive symptoms and the
cost of health services in HMO patients aged 65 years and older.
JAMA. 1997;277:1618–1623.
25. Johnson J, Weissman MM, Klerman GL. Service utilization and social
morbidity associated with depressive symptoms in the community.
JAMA. 1992;267:1478–1483.
26. Goodwin JS. Progress in gerontology: polymyalgia rheumatica and
temporal arteritis. J Am Geriatr Soc. 1992;40:515–525.
27. Goodwin JS. The very low prevalence of polymyalgia rheumatica in
blacks may be an artifact. J Am Geriatr Soc. 1990;38:824–826.
28. Healey LA. On the epidemiology of polymyalgia rheumatica and tem-
poral arteritis. J Rheumatol. 1993;20:1639–1640.
29. Scudds RJ, Robertson JM. Empirical evidence of the association be-
tween the presence of musculoskeletal pain and physical disability in
community-dwelling senior citizens. Pain. 1998;75:229–235.
30. Van Scaardenburg D, Van den Brande K, Ligthart G, Breedveld F,
Hazes J. Musculoskeletal disorders and disability in persons aged 85
and over: a community survey. Ann Rheum Dis. 1994;53:807–811.
. Zeidler H. Epidemiology of musculoskeletal conditions in the geriatric
population. Eur J Rheumatol Inflamm. 1994;14:3–6.
. Jette AM, Branch LG. The Framingham disability study II: physical
disability among aging. Am J Public Health. 1981;17:1211–1216.
. Reinhard JD, Calkins E. Geriatric issues in the diagnosis and manage-
ment of patients with rheumatic disorders. Clin Prim Care. 1993;20:
9
11–923.
5
6
7
. Ruffatti A, Rossi L, Calligaro A, et al. Autoantibodies of systemic rheu-
matic diseases in the healthy elderly. Gerontology. 1990;36:104–111.
. Schneider EL, Guralnik JM. The aging of America: impact on health
care costs. JAMA. 1990;263:2335–2340.
. Goodwin J, Black S, Satish S. Aging versus disease: the opinions of
older black, Hispanic, and non-Hispanic white Americans about the
causes and treatment of common medical conditions. J Am Geriatr
Soc. 1999;47:973–979.
8
. Cornoni-Huntley J, Brock DB, Ostfeld AM, Taylor JO, Wallace RB,
eds. Established Populations for Epidemiologic Studies of the Elderly.
Resource Data Book. Bethesda, MD: National Institute on Aging. NIH
publication No. 86–-2443.
9. Radloff LS. The CES-D scale, a self report depression scale for research
in the general population. Appl Psychol Measur. 1977;1:385–401.
Received November 11, 1999
Accepted April 28, 2000
1
0. Blalock SJ, DeVellis RF, Brown GK, Wallston KA. Validity of the
Decision Editor: John E. Morley, MB, BCh