Psychosocial Functioning and Osteoporosis in Late Life: Results of a Multidisciplinary Intervention

Abstract

Objective: To determine whether older women and men with osteoporosis who participated in a medical evaluation program showed improvement in psychosocial functioning when compared to a age-, gender-, and disease severity-matched group of osteoporotic patients who did not participate in this program. Design: A prospective clinical investigation of older women and men with osteoporosis. A pretest–posttest design was used with intervention patients compared to patients receiving usual care. Setting: Bone Metabolism Clinic and Duke University Preventive and Therapeutic Program for Osteoporosis (DUPATPO), at Duke University Medical Center. Participants: One hundred and three community-dwelling older adults (mean age = 67 years; 91 women and 12 men) who had registered for treatment of osteoporosis at the Duke University Bone Metabolism Clinic. All 43 patients who enrolled in DUPATPO between July 1988 and April 1989 were recruited for this study. In addition, 60 comparison patients from the Bone Clinic population who had not been offered DUPATPO participation were also enrolled. Intervention: DUPATPO, a four-day initial program with a multidisciplinary team including endocrinologists, geriatricians, physical therapists, nutritionists, and other support personnel. After the initial program of education, exercise, and nutritional counseling, patients were seen at three-month intervals for the next year. Comparison patients received usual care (a consult appointment with an endocrinologist with possible referral to physical therapy). Main Outcome Measures: Short Psychiatric Evaluation Scale (stress symptoms), the Rosenberg Self-Esteem Scale (self-esteem), and the Hopkins Symptom Checklist 90-Revised (psychiatric symptoms). Results: No significant differences on primary outcome measures at baseline were found between intervention and comparison patients. At 60-day follow-up, however, analyses of variance showed significant differences in stress symptoms (P = 0.021) and general psychiatric symptoms (P = 0.002). A multivariate analysis of variance using the SCL-90-R subscales as outcomes (e.g., depression, hostility) showed overall significance (P = 0.04). Significant differences were seen on the somatization (P = 0.026), obsessive–compulsive (P = 0.003), and anxiety (P = 0.002) dimensions. Conclusions: This study demonstrates that psychosocial functioning of older women and men can be improved with multidisciplinary intervention.