Musculoskeletal disease in very elderly nursing home patients: does under-reporting exist?

To determine the extent of under-reporting of musculoskeletal disease among very elderly nursing home patients, 50 Veterans Affairs Nursing Home patients were evaluated by means of retrospective medical chart review. The primary caregivers' charted musculoskeletal examinations were scored objectively; then the patients completed an arthritis questionnaire, a short-form Geriatric Depression Scale assessment, and the Katz Activities of Daily Living Scale assessment. Finally, each patient underwent an objectively scored musculoskeletal examination by a rheumatologist. The results indicated that musculoskeletal disease in the very elderly nursing home patient is more prevalent than self-report or examination by the primary caregiver suggested. Brief but directed arthritis symptom questioning followed by a specialized examination were necessary to diagnose treatable musculoskeletal disease in this population.