Cognitive, behavioral and psychological issues in the rheumatological care of the elderly

The ageing process is accompanied by changes in biological functions and the context of behavior. Biological changes are often thought to be the source of poor adaptation to the demands of ageing and disease; however, the data indicate environmental, psychological and social factors must be considered. Problems related to sensory-cognitive ageing, dependency, adherence, sleep disturbance, sexual functioning, psychological distress, family issues and ethics are discussed in terms of their impact on rheumatic disease management. Diagnostic measures developed for the elderly are reviewed and interventions from a behavioral approach are outlined. The chronic nature of rheumatic disease interacts with the changes associated with ageing leading to a complex situation requiring attention to biological, behavioral, environmental and psychosocial factors.