Demographic and Clinical Profile of Nursing Facility Residents with Gout

Abstract

To develop a demographic and clinical profile of nursing facility residents with a diagnosis of gout. Descriptive, retrospective database analysis. U.S. nursing facilities. Nursing facility residents with a diagnosis of gout. Minimum Data Set and prescription claims records of residents served by Omnicare, Inc., with an International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis of gout, for the time period of October 1, 2009, to September 30, 2010, were linked and de-identified. Acute gouty attacks were defined by a proxy measure of a ? 14-day course of oral nonsteroidal anti-inflammatory drugs (NSAIDs), oral or injectable steroids, or oral colchicine. In the 138,724 residents (36.8% male: 76.8% white, 11.6% black) evaluated, the incidence of gout was 1.8% (n = 2,487). Of those with gout, males and females were represented relatively equally. There were 1,420 (57.2%) residents 80 years of age or older. Two-thirds of residents with gout required at least extensive assistance with most activities of daily living. Comorbid conditions-hypertension (82.2%), diabetes mellitus (46.6%), arthritis (43.7%), and renal failure (22.4%)-were common. Pain was reported in 68.7% of residents. Allopurinol (60.2%), colchicine (18.6%), febuxostat (2.3%), probenecid (1.1%), and probenecid/colchicine (< 1%) were prescribed in treated residents. While treatment may or may not have been indicated, 375/2,152 (17.4%) received no treatment. Diuretic therapy was received by 75.8% of residents. Acute gouty attacks were noted in 38% of residents; 53%, 25.2%, and 21.8% received short-course treatment with oral or injectable steroids, oral colchicines, or oral NSAIDs, respectively. Despite the limitations of a retrospective database analysis, this study reveals that nursing facility residents with a diagnosis of gout have significant disease burden. Clinicians should be aware of the potential impact of this disease on physical functioning, pain, and falls in this often-frail population.