Chronic pain and fatigue conditions

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Figure 5.3 Proportion in the age group 65–79 who feel they are in good/very good health. 2002-2012. Per cent

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Men Women

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Source: Norhealth/Statistics Norway

The most frequently occurring mental disorders among the elderly are depression and anxiety. Depression increases with age. Both anxiety and depression are more widespread among women than among men. Impaired health and functioning in later years can affect opportunities for social contact and lead to loneliness. There appears to be a stronger

connection between loneliness and mental health than between loneliness and physical health.

Loneliness is more widespread among the elderly than among the young, and three of ten people over the age of 80 say that they are lonely. The Government is heightening its efforts to reduce loneliness among the elderly and create conditions for more social contact and activity. In the Revised National Budget for 2015, the Government increased by a total of NOK 10 million support for the work of voluntary organisations to prevent loneliness among the elderly.

Developments in the past decade have been positive. The prevalence of depression and anxiety has fallen in older age groups. In 2008, about five per cent of those aged 65–74

suffered from depression and anxiety, compared with around 11 per cent in 1998. Among women over the age of 75, 12 per cent suffered in 2008 compared with 14 per cent in 1998.

Physical health problems, particularly impaired function, vision or hearing, can be a cause of anxiety or depression. The Government investment in mental health will also benefit elderly women.

The aging of the population will affect society as a whole. In order to improve the quality of life and well-being of the elderly, the Government will make a concerted effort to increase their participation in working life and in the community. In autumn 2015, the Government will present a strategy for a modern senior citizens policy. The strategy is intended to help to elicit more knowledge on factors that will promote an active life for

seniors, and will have a gender perspective. A more detailed account is given in Report no. 19 to the Storting (2014–2015) Folkehelsemeldingen – Mestring og muligheter [The Public Health Report - Self-management and possibilities].

Denmark. It has also been shown that patients with chronic pain spend four to five times as many days as an inpatient in a hospital as the rest of the population. Long-term pain is more common among women than among men. The gender differences are moderate with respect to pain in general, but considerably greater for more severe pain, particularly pain that is experienced in several parts of the body. The gender differences are also apparent when experimental subjects are subjected to pain in laboratory experiments, and they have also been found in some laboratory animals. This is evidence that biological mechanisms underlie the gender differences. The prevalence of chronic pain among young people is not well mapped in Norway, but as figure 5.4 shows, pain is more prevalent in young women than in men of the same age group.

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Figure 5.4 Proportion of the population with chronic pain, by age [Column labels]

Per cent Women Men Both

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Source: Fit Futures in 2010 (15–16 year-olds) and the Tromsø Survey in 2008 (age 30 and above) There is a disturbing trend of chronic fatigue in young people. Women are in the majority when it comes to fatigue conditions such as CFS/ME.⁹ Uncertain estimates based on foreign studies indicate that there are between 10 000 and 20 000 cases in Norway. In the period 2008 to 2012, 5 809 patients were registered in the Norwegian Register of Patients with the diagnosis CFS/ME. Seventy-five per cent of them were women, and the majority were in the age groups 10–19 and 30–39. A national advisory unit on CFS/ME was established in 2012 to boost the national building up of research and expertise. The unit is intended to help to develop and raise the quality of services for CFS/ME patients through an integrated care pathway. It is also responsible for ensuring that expertise on the syndrome is built up and disseminated, and for providing guidance for the health and care service as a whole. Moreover, it is responsible for monitoring and mediating treatment results,

participating in research and teaching and establishing researcher networks. This professional community reports an increase in patients referred with chronic fatigue disorders. The reasons for this increase are not known.

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9 Chronic fatigue syndrome (CFS) / myalgic encephalopathy (ME).

Figure 5.5 The number of hospital stays with registered primary or secondary condition post-viral fatigue syndrome, 2008–2012, gender and

age.

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Number of hospital stays 2008–2012 Age (in years)

Man Woman

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Source: Norwegian Patient Register

Chronic pain may affect work capacity and physical function, mental health and quality of life, sleep and mortality. We do not know the causes of some pain conditions. The symptoms may occur individually or collectively. The usual names given to these conditions are fibromyalgia or other forms of chronic muscular pain, whiplash and tension headaches.

Sufferers of these conditions are predominantly women. Common to these groups is that we lack a generally accepted understanding of the causes of the disease, its mechanisms, and the treatment options. People are affected to varying degrees, but for a considerable number of people it is a question of severe loss of quality of life that may last for a number of years.

When a definite cause of the problems is not known, it is also difficult to find the right treatment. Patients may be sent from one specialist to another: neurologists, rheumatologists, specialists in physical medicine or in psychology/psychiatry. Specialisation in hospitals coupled with uncertainty concerning the problems has caused many of these patients to feel that they were tossed back and forth in the system, where a difficult process often ends without a diagnosis or adequate treatment. This is a challenge for the health service.

There have long been relatively large differences between the options for assessing and treating this type of disorder, compared with those available for illnesses where men are in the majority, such as diabetes and cardiovascular disorders. The Government wanted to see a change in this situation. In 2015, NOK 20 million were therefore granted for a pilot project with the specialist health service's diagnostic centres, with the aim of offering patients a better service for assessing chronic pain and fatigue conditions and a simpler meeting with the services. A teaching network is also to be established, with relevant professional communities taking part to boost the mediation of information in this area. This will help ensure good, comprehensive care pathways for patients and equality in the treatment services offered countrywide. This is one of the Government's initiatives for evening out differences and ensuring more equal treatment options for women and men. The project is to be evaluated.

The Government will then consider making the arrangement apply nationwide.

Need for knowledge

The Government will pave the way for more and better knowledge about this type of disorder: causes, disease mechanisms and possible treatment and management techniques. In both 2014 and 2015, the letter of allocation to the Research Council of Norway included

guidelines to the effect that research on chronic pain and fatigue disorders such as CFS/ME, borreliosis and fibromyalgia must receive priority.

In 2015, the Government has extended the increased funding of 2014 to research by health authorities on high-priority diseases, and to health service research. It was stipulated that the funding should be spent on large, inter-regional projects in seven areas. Pain and fatigue conditions such as CFS/ME, fibromyalgia, borreliosis and musculoskeletal problems are included here. The four regional health authorities have established a national

collaboration on research for six of these areas, with one regional health authority responsible for coordination. This might yield knowledge that benefits these patients. In the national research effort on musculoskeletal health, work is in progress to link the primary health service more closely with the research environments at hospitals and universities. Closer cooperation between the primary health service and the research communities could be of considerable benefit to these patient groups. The national advisory units in the specialist health service play an important part in disseminating new knowledge with a view to keeping health and care personnel updated on these diseases and disorders in their encounters with patients.

Pain and musculoskeletal disorders in elderly women

More women than men over the age of 80 report musculoskeletal diseases, and the gender difference increases with age. The over-representation of women is particularly related to osteoporosis and fall and fracture injuries. The great majority with osteoporosis are elderly women. Seventy per cent of all broken hips are suffered by women. In 2008, 4 403 women aged 75 or over suffered a fractured hip for the first time, and 26 per cent of them died within a year of the fracture.

Fractures tend to occur after working age. This may be one reason why osteoporosis has not been a highly prioritised health problem in the past, or in the public eye in the same way as some other medical conditions. Since the Women's Health Assessment of 1999, this situation has improved. The Norwegian Knowledge Centre has performed a number of

systematic summaries of knowledge on topics related to osteoporosis and the consequences of osteoporosis. Various aspects have been studied, from prevention with the aid of medicines, prevention of falls, surgical techniques for fractures, to rehabilitation programmes for patients who have suffered a hip fracture.

The national research collaboration NOREPOS, (Norwegian Epidemiological Osteoporosis Studies) is a project involving four universities and the Norwegian Institute of Public Health. NOREPOS works on a variety of projects. For example, a joint project, supported by the Research Council of Norway, is investigating why there is such great variation in the risk of osteoporotic fractures within Norway. This in turn may lead to an understanding of why the incidence of fractures is so high in Norway. The same health surveys upon which the NOREPOS collaboration is based are also included in CONOR, a network of Norwegian health surveys. The collection of health data and biological material is to form the basis for research on the causes of diseases and aspects of the health of the

Norwegian people, including fractures and osteoporosis.

Although the elderly of the future will probably enjoy better health than those of today, life after the age of 85 will often be affected by illness and loss of function. There is a large preponderance of women in the oldest segment of the population. It will therefore be particularly important to implement measures for elderly single women that help to maintain their functioning and quality of life.

For the "younger elderly" women, emphasis should be placed on maintaining their physical vigour, with a particular view to preventing and postponing health problems and reduced mobility. There is also a need for greater efforts to prevent fall and fracture injuries, particularly among the "oldest elderly" women. The Government will intensify work to prevent falls, with the goal of reducing the number of hip fractures by ten per cent by the end of 2018. Fall prevention is to form part of the work of developing services and be integrated into cross-sectoral work. Better nutrition and increased physical activity are important preventive measures. These measures are described in more detail in the reports to the Storting on the primary health service and public health.¹⁰

5.2.3 Non-communicable diseases – cardiovascular disease, cancer, COPD and