Home | Clinical Focus | Gout on the rise, underdiagnosed in aged care

Gout on the rise, underdiagnosed in aged care

Gout is a condition that affects approximately 187,000 Australians yearly. The global prevalence of gout is increasing and is highest in the Australasia region.

More prevalent in older people, instances of gout peak in the age bracket 75–84 years (up to 4 per cent) and as the population ages, these numbers will continue to rise.

New research from Macquarie University shows that gout affects up to 10 per cent of residents in aged care.

“Gout is severely debilitating because it causes extreme pain. People have likened the pain to childbirth, with most gout sufferers not even able to withstand having a sheet touching their toe in bed,” says lead author Dr Amy Nguyen of Macquarie’s Australian Institute of Health Innovation.

“Even though we feel the result is likely an under-representation – 10 per cent is still a very large proportion of people with gout in the residential aged care population.”

Of those residents, the most common comorbidities were hypertension (71.3 per cent), heart disease (37.9 per cent) and diabetes (33.0 per cent) and they were more likely to have renal disease and historical myocardial infarction.

“It has been shown that of all chronic conditions, gout has the lowest adherence rates. Gout patients need to be prescribed the long-term urate-lowering medications at the right dose, and they also need to take them.

“Diagnosis of gout is very important to ensure it is being managed to avoid putting residents in unnecessary pain. A lot more awareness about gout, especially in a RACF where residents such as those with dementia are unable to express they are feeling pain, is very important.”

Polypharmacy also impacts how gout affects the body. Some medicines disrupt the kidneys abilities to clear uric acid, thus causing gout.

“This is compounded by the fact that gout patients usually also have renal impairments. Our next study involves looking at the medication profiles of these residents to see if they are being managed in concordance with gout guidelines,” Nguyen says.

In 2015–16, gout cost the Australian health system an estimated $176.5 million and Nguyen says that holistic management of gout is needed in this population, with careful consideration of chronic comorbidities and treatments.

“Gout is more common than we think … The good thing is that [there are] very effective treatments that can stop gout attacks from happening. The bad news is that many people aren’t prescribed this medication (and at the right dose).

“This means a lot of unnecessary – but preventable – pain,” she said.

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